Risk reduction: prioritisation, delegation and communication

Winter is always a busy time for the NHS. However, this year seems to be particularly bad and the public are bombarded with news of over-crowded A&E departments and patients waiting for hours in ambulances and corridors to be seen by a doctor.

I am reminded of my own time working as a medical registrar in a busy teaching hospital. As queues developed, I had no choice but to prioritise patients according to their medical need. For some patients, this meant they saw other patients arriving into the department and receiving treatment whilst they were left waiting. It is understandable why this can often cause patients, and their relatives, to feel frustrated and ignored. As these emotions are relayed to HCAs and nurses, doctors can find themselves interrupted whilst checking results or writing-up a patient’s medical records to be informed that “Mr A has been waiting for over four hours now and is not happy. Can you see him asap please?” At the same time the phone may be ringing with a referral from another specialty requesting an urgent review of a patient on the ward or a junior doctor may want to discuss one of their patients so that they can be transferred.

Your first (and many may argue quite reasonable) reaction may be to feel exasperated. However, doctors learn early in their clinical practice that there will always be numerous demands on their time and they must prioritise their workload according to clinical need.

Communication is the key to managing particularly busy times and reducing the risk of adverse incidents. Patients should be reassured that they are in the system and will be seen. This can be done at triage and often an initial apology for the prolonged delay and an estimated time of review is sufficient to manage a patient’s expectations. In my clinical practice I would often apologise for the delay as part of my introduction when seeing a new patient, and it was always reassuring to notice how many patients would graciously acknowledge it was just a busy time in the department.

Doctors can also help to ease the chaotic environment of an overcrowded and busy department by ensuring they communicate effectively with other colleagues. It is easy for healthcare professionals to become entrenched in their own agenda and tasks. However, by ensuring that other colleagues are aware of what you are doing and why, it should enable them to appreciate that you are prioritising your time and will deal with their requests as you are able.

Finally, a valuable skill for any busy doctor is the ability to delegate effectively. We can all feel best placed to perform certain clinical tasks or to review particular patients. However, it can be equally important to recognise the same skills in a colleague. In Good Medical Practice the GMC makes it clear to doctors that they can delegate tasks to appropriately skilled healthcare professionals. Instead of considering this as a last resort, it can be a valuable tool to help deal with particularly busy times. It may also help you avoid inadvertent errors.

The MDDUS has encountered several cases in which doctors have found themselves criticised for incidents that have occurred simply because they have tried to do too many things at the same time. Taking a step back to consider the best interests of each patient and the skills of those around you can often be the best use of your precious time.