0095 Promoting the management of acute upper gastrointestinal bleeds by junior doctors: A quality improvement project

Background/context Foundation Year 1 (FY1) doctors, though knowledgeable, can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new on-call FY1 attended an acute upper gastrointestinal bleed (UGIB); a common emergency with a 10% in-hospital mortality. We aimed to improve FY1s’ ability to manage these critically unwell patients through simulation-based teaching, before and after the introduction of an algorithm summarising current guidelines. Methodology After assessing the FY1s’ self-perceived confidence in UGIB management, they individually attended simulation sessions. We evaluated and timed multiple aspects of their assessment and management plans, identifying pitfalls and areas where guidelines were not adhered to. Individualised, immediate debriefing and subsequent teaching sessions re-enforced learning points, with a streamlined algorithm designed as an aide memoir to improve efficiency. A repeat simulation session was arranged to assess improvements in subjective confidence and objective management targets in these patients. Results/outcomes The FY1s reported finding the algorithm and education programme helpful, expressing improved confidence in UGIB management. There were improvements across the board in various aspects of assessment and management, such as verbalisation of concern for hypotension increased from 60% to 100%; two points of access gained in 100% (from 53%); 76 s reduction in time to call senior. Collectively, the individual aspects all lead to improved patient management. Conclusions/recommendations Effective management of acutely unwell patients is best learnt through exposure, with inexperience the likely source of FY1s’ self-reported under confidence. Simulation-based teaching provides a safe but powerful modality to aide transition from textbook theory to ward situations. Algorithms can streamline care, reducing time to stabilise patient, potentially improving morbidity and mortality. This project reinforces generic competencies that FY1s can translate to their management of not only UGIBs but many acute presentations, providing a convincing argument for broader simulation use in future FY1 teaching. References Patterson M, Blike G, Nadkarni V. In situ simulation: challenges and results. Adv Patient Saf. 2008;2(3):1–18 Gee V, Morrisser N, Hooks S. Departmental induction and the simulated surgical ward round. Clin Teach. 2015;12(1):22–6 Bewley WL, O’Neil HF. Evaluation of medical simulations. Mil Med. 2013; 178 (10 Suppl):64–75 Sen B, Wollard M, Desira N. Does the Introduction of a COPD pro-forma improve the standard of care delivered by junior doctors in the emergency department. COPD. 2010;7(3):199–203