In the United Kingdom, Black Wednesday is the first Wednesday of August when newly qualified doctors enter their first postgraduate positions within the National Health Service (NHS) hospitals. It is also the day that most junior doctors rotate to different wards to begin new roles. It is thought that this sudden influx of inexperience and unfamiliarity increases the risk of medical errors. [1] A study using retrospective hospital admissions data from 2000 and 2008 found that mortality rates of patients admitted on the first Wednesday of August were 6 - 8 % higher than patients admitted on the final Wednesday of July.[2] A similar phenomenon is perceived in the United States, known as the July effect, although several studies have conflicting outcomes as to whether a knock to patient care is observed.[3] Despite a lack of conclusive data, several guidelines have been introduced in the United Kingdom to ensure optimal patient care throughout the changeover season.
Guidelinesedit
In 2012, a letter from Sir Bruce Keogh introduced a mandatory 4-day paid shadowing period for all foundation year 1 (FY1) doctors prior to their official start date.[4] The purpose of this period was for FY1 doctors to gain practical familiarity and comprehensive inductions to their working environment. The shadowing period aimed to enhance performance on the first working day and ultimately improve the safety and efficiency of patient care. The Academy of Medical Royal Colleges in conjunction with NHS Employers, later developed practical recommendations to help mitigate problems associated with patient care during the changeover period.[5] Their goal was to ensure that newly qualified doctors had access to adequate support to practise medicine safely. The four recommendations were as follows:
Consultants and senior staff must be available to provide support during the changeover period
Rotas should be designed so that new doctors have access to clinical and educational supervision
High quality clinical inductions must be conducted
Reduction of elective work so that staff are available to offer support and guidance
As outlined in their contract, junior doctors must engage fully with all necessary training.[6] To improve compliance of junior doctors to such training and ultimately improve patient care, a novel e-learning induction and training programme was implemented in a district general hospital in South-West England (August 2013). [7] The success of the programme was assessed via a summative test whereby 100 % compliance (n=370) was achieved. Analysis of a subgroup (n=141) concluded that 85.7 % had completed the mandatory training by day 1 (the mean completion time was 3 days prior to day 1 with a standard deviation of 14.2 days) thus helping to put an end to Black Wednesday.
Although various studies[which?] both within the United Kingdom and internationally have suggested a knock to patient care during the influx of junior doctors, the actual number of excess deaths during August are very small (45 deaths over nine years).[8] There is no proven link to inexperience however action to improve the performance of junior doctors should be taken regardless. Studies[which?] have also concluded[when?] that there is a systematic difference that fewer patients are admitted during the changeover period than the previous week, suggesting that only critically ill patients are admitted and therefore may skew the results.
Referencesedit
^Dunn, Lucy (2022-08-03). "What's the truth about the NHS's 'Black Wednesday'?". The Spectator. Retrieved 2023-01-24.
^Jen, Min Hua; Bottle, Alex; Majeed, Azeem; Bell, Derek; Aylin, Paul (2009-09-23). "Early In-Hospital Mortality following Trainee Doctors' First Day at Work". PLOS ONE. 4 (9): e7103. Bibcode:2009PLoSO...4.7103J. doi:10.1371/journal.pone.0007103. ISSN 1932-6203. PMC2743809. PMID 19774078.
^Zogg, Cheryl K.; Metcalfe, David; Sokas, Claire M.; Dalton, Michael K.; Hirji, Sameer A.; Davis, Kimberly A.; Haider, Adil H.; Cooper, Zara; Lichtman, Judith H. (2021). "Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes". Annals of Surgery. 277 (1): e204–e211. doi:10.1097/SLA.0000000000004805. ISSN 0003-4932. PMC8384940. PMID 33914485.
^"Shadowing for Foundation Year 1 (F1) Doctors". GOV.UK. Retrieved 2023-01-24.
^"Recommendations for safe trainee changeover" (PDF). Retrieved 2023-01-24.
^"Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016" (PDF). Retrieved 2023-01-24.
^Gaskell, Natalie; Hinton, Richard; Page, Tristan; Elvins, Tracy; Malin, Adam (2016). "Putting an end to Black Wednesday: improving patient safety by achieving comprehensive trust induction and mandatory training by day 1". Clinical Medicine. 16 (2): 124–128. doi:10.7861/clinmedicine.16-2-124. ISSN 1470-2118. PMC4952964. PMID 27037380.
^Barrie, Josh (2018-08-01). "Junior doctors join wards for the first time - do death rates rise?". inews.co.uk. Retrieved 2023-01-24.
January 01, 1970
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This article has multiple issues Please help improve it or discuss these issues on the talk page Learn how and when to remove these template messages This article may require cleanup to meet Wikipedia s quality standards The specific problem is Cluttery article in both lead sections and guidelines Please help improve this article if you can April 2023 Learn how and when to remove this message The topic of this article may not meet Wikipedia s general notability guideline Please help to demonstrate the notability of the topic by citing reliable secondary sources that are independent of the topic and provide significant coverage of it beyond a mere trivial mention If notability cannot be shown the article is likely to be merged redirected or deleted Find sources Black Wednesday NHS news newspapers books scholar JSTOR April 2023 Learn how and when to remove this message Learn how and when to remove this message In the United Kingdom Black Wednesday is the first Wednesday of August when newly qualified doctors enter their first postgraduate positions within the National Health Service NHS hospitals It is also the day that most junior doctors rotate to different wards to begin new roles It is thought that this sudden influx of inexperience and unfamiliarity increases the risk of medical errors 1 A study using retrospective hospital admissions data from 2000 and 2008 found that mortality rates of patients admitted on the first Wednesday of August were 6 8 higher than patients admitted on the final Wednesday of July 2 A similar phenomenon is perceived in the United States known as the July effect although several studies have conflicting outcomes as to whether a knock to patient care is observed 3 Despite a lack of conclusive data several guidelines have been introduced in the United Kingdom to ensure optimal patient care throughout the changeover season Guidelines editIn 2012 a letter from Sir Bruce Keogh introduced a mandatory 4 day paid shadowing period for all foundation year 1 FY1 doctors prior to their official start date 4 The purpose of this period was for FY1 doctors to gain practical familiarity and comprehensive inductions to their working environment The shadowing period aimed to enhance performance on the first working day and ultimately improve the safety and efficiency of patient care The Academy of Medical Royal Colleges in conjunction with NHS Employers later developed practical recommendations to help mitigate problems associated with patient care during the changeover period 5 Their goal was to ensure that newly qualified doctors had access to adequate support to practise medicine safely The four recommendations were as follows Consultants and senior staff must be available to provide support during the changeover period Rotas should be designed so that new doctors have access to clinical and educational supervision High quality clinical inductions must be conducted Reduction of elective work so that staff are available to offer support and guidance As outlined in their contract junior doctors must engage fully with all necessary training 6 To improve compliance of junior doctors to such training and ultimately improve patient care a novel e learning induction and training programme was implemented in a district general hospital in South West England August 2013 7 The success of the programme was assessed via a summative test whereby 100 compliance n 370 was achieved Analysis of a subgroup n 141 concluded that 85 7 had completed the mandatory training by day 1 the mean completion time was 3 days prior to day 1 with a standard deviation of 14 2 days thus helping to put an end to Black Wednesday Although various studies which both within the United Kingdom and internationally have suggested a knock to patient care during the influx of junior doctors the actual number of excess deaths during August are very small 45 deaths over nine years 8 There is no proven link to inexperience however action to improve the performance of junior doctors should be taken regardless Studies which have also concluded when that there is a systematic difference that fewer patients are admitted during the changeover period than the previous week suggesting that only critically ill patients are admitted and therefore may skew the results References edit Dunn Lucy 2022 08 03 What s the truth about the NHS s Black Wednesday The Spectator Retrieved 2023 01 24 Jen Min Hua Bottle Alex Majeed Azeem Bell Derek Aylin Paul 2009 09 23 Early In Hospital Mortality following Trainee Doctors First Day at Work PLOS ONE 4 9 e7103 Bibcode 2009PLoSO 4 7103J doi 10 1371 journal pone 0007103 ISSN 1932 6203 PMC 2743809 PMID 19774078 Zogg Cheryl K Metcalfe David Sokas Claire M Dalton Michael K Hirji Sameer A Davis Kimberly A Haider Adil H Cooper Zara Lichtman Judith H 2021 Reassessing the July Effect 30 Years of Evidence Show No Difference in Outcomes Annals of Surgery 277 1 e204 e211 doi 10 1097 SLA 0000000000004805 ISSN 0003 4932 PMC 8384940 PMID 33914485 Shadowing for Foundation Year 1 F1 Doctors GOV UK Retrieved 2023 01 24 Recommendations for safe trainee changeover PDF Retrieved 2023 01 24 Terms and Conditions of Service for NHS Doctors and Dentists in Training England 2016 PDF Retrieved 2023 01 24 Gaskell Natalie Hinton Richard Page Tristan Elvins Tracy Malin Adam 2016 Putting an end to Black Wednesday improving patient safety by achieving comprehensive trust induction and mandatory training by day 1 Clinical Medicine 16 2 124 128 doi 10 7861 clinmedicine 16 2 124 ISSN 1470 2118 PMC 4952964 PMID 27037380 Barrie Josh 2018 08 01 Junior doctors join wards for the first time do death rates rise inews co uk Retrieved 2023 01 24 Retrieved from https en wikipedia org w index php title Black Wednesday NHS amp oldid 1189531513, wikipedia, wiki, book, books, library,
