SENIOR ORTHOPAEDIC TRAINEES WORSE AT CLERKING PATIENTS THAN JUNIORS

Abstract

All neck of femur fractures are registered on a national hip database. Here a standardised proforma is used to ensure all relevant information is recorded. It is also essential all trauma admissions are thoroughly clerked and essential clinical information is recorded. Almost all trauma and orthopaedic units in the UK do not have any such proformas and admissions are written on standard headed paper.

We describe a prospective study of all trauma admissions excluding neck of femur fractures. We analysed the comprehensiveness of orthopaedic patient clerking being admitted to a teaching hospital over 2 weeks. We aim to continue with data collection to a total of 100 patients. Here we describe our initial results. We further analysed the differences between levels of postgraduate experience of doctors against the completeness of clerkings.

All orthopaedic trauma admissions were scrutinised for presence of demographic details including, name, number, consultant, date, time. We also considered patient details including presenting complaint, mechanism of injury, past medical history, social history, pulse, blood pressure (BP), respiratory rate (RR), temperature amongst others. Clerking doctor details included name, signature, bleep number. They were classified as either being present and documented or absent.

We analysed 36 case notes in total. Of these 3 (8%) were clerked by a doctor of less than 12 months experience, 18 (50%) were clerked by a doctor with 12– 18 months experience, 8 (22%) were clerked by a doctor with 24– 30 months experience, 7 (20%) were clerked by a doctor with 30– 36 months experience.

We found doctors 100% of the time included name, date, time, mechanism of injury and a plan. All doctors had very poor recording of mental score, allergies, oxygen saturations, temperature being recorded in 0%, 31%, 31% and 28% of cases respectively.

Our results also revealed that doctors with less experience had more complete clerkings than more experienced trainees. In particular doctors with less than 18 months experience were better at recording patient details 30 % of the time. Less experienced doctors were also better at recording basic observations such as pulse, BP and temperature.

These results are surprising as this would not be expected. More experience doctors may be taking ‘short cuts’ and thereby failing to document certain details.

All doctors should ensure accurate and thorough clerkings including essential criteria such as allergies and basic observations, regardless of grade and experience. A standardised trauma proforma has been used by other hospitals with some success and should be considered to be implemented regionally and nationally. This would ensure essential clinical criteria would be included in all admissions.