6831 Using easily accessible guideline summaries increases FY2 doctors’ confidence when working in paediatric emergency medicine

Objectives In London paediatric emergency departments (PED) children are often treated by doctors in their second year post qualification (FY2s). FY2s report a lack of confidence assessing and managing children, which impacts patient care.¹ Specifically our objective was: To increase FY2 self-reported confidence in assessing and managing children across the Royal Free Hospital trust by 20%, by April 2023. Methods Baseline surveys of confidence were collected from 10 FY2s at the end of their 4-month emergency department rotation in March 2022. At Barnet General Hospital, a third of FY2s surveyed requested easier access to guidelines. Optimising access and readability of clinical guidelines was chosen as an intervention, as this is proven to improve patient outcomes.² ³ One-page guideline summaries for 14 common presentations to PED were selected and produced in partnership with the paediatrics department. They were then uploaded to the MicroGuideTM App and promoted to FY2s across the Royal Free Hospital Trust in April 2022. They were optimised and re-advertised in December 2022 in response to feedback as part of a second PDSA cycle. Post-intervention surveys were collected every 4 months at the end of rotations, up until April 2023. A total of 44 FY2s were surveyed, with response rates of 31–61%. Objective guideline summary usage data was collected monthly via a dashboard. Results Graph 1 shows FY2 mean self-reported confidence scores. Post-intervention, self-reported confidence scores increased overall for all three consecutive rotations of FY2s. The final overall confidence score in April 2023 was 20% above the pre-intervention levels (graph 1). Confidence gains were only consistently seen at Barnet General hospital, where self-reported guideline summary usage was higher than at the Royal Free Hospital (62.5% vs 41%). At both sites, perceived difficulty accessing guidelines and perceived difficulty understanding them fell (by 14% and 10% respectively). Graph 2 shows usage data from the MicroGuideTM dashboard. Paediatric guideline summaries were accessed a median of 107 times per month (Range: 50–310) and proved popular in qualitative feedback. Conclusion Our results suggest that the use of streamlined guideline summaries, accessible via a commonly-used medical App, provide a reproducible and sustainable way of improving FY2 confidence in the PED setting. In the face of the challenges of yearly winter pressures in PED, we have demonstrated an impactful way to help FY2s assess and manage children and thus improve patient care. References CH Andrews, et al. Archives of Disease and Childhood, 2019 Grimshaw JM, Russell IT. Lancet, 1993. Pondicherry N, et al. Journal of American College of Emergency Physicians, 2023.