It was communication and collaboration that put Alder Hey Children’s foundation trust on track for EWTD compliance

Alder Hey Children’s foundation trust faced a number of challenges in implementing the European working time directive. Trust workforce modernisation manager Nigel Howard explains: “There were paediatric challenges: this meant standard solutions were difficult to apply in this area. We were dealing with less experienced doctors under Modernising Medical Careers, not to mention the more general challenge brought about by the loss of 752 hours of junior doctor time.

“We had to reduce hours and maintain patient safety. They told us it couldn’t be done”

“We knew we had to introduce new ways of working. We had to work smarter, improve team working, communication and handover and enhance the skills of the multidisciplinary team in order to reduce junior doctors’ workload and hours, and maintain patient safety. They told us it couldn’t be done.”

The trust worked with clinical teams to develop compliant rotas and further developed the Paediatric Early Warning system and introduced a collaborative model of working with the Hospital at Night team. They also implemented new ways of issuing medications out of hours in accident and emergency and developed nurse-led discharge on the acute admission unit.

Advanced nurse practitioner Gerri Sefton says: “We aimed to have all doctors on compliant rotas by August 2008, and one of the essential factors was working with the clinical teams to develop rotas. There was also targeted support from a team of medical advisers. There were meetings with trainees and consultants to develop the rotas to satisfy the directive, service and education. We agreed with all specialties on compliant rotas and monitoring that would take place during April.”

Mr Howard continues: “We expected an improvement in the safety, experience and outcomes for children and young people. To all intents and purposes we are on the right track, we now have information that supports reductions in the length of stay in hospital and improvements in the training and working lives of our junior doctors. We also developed the skills and competences of our nursing staff.”

There is more work ongoing as the trust management team agreed that elements of the project should be mainstreamed, for example exploring mechanisms to facilitate the separation of paediatric medical emergency and elective workload to improve training opportunities.