Journal Article

1387 The breaks board – an initiative to empower staff to coordinate and take their breaks in a busy children’s emergency department

Reunis, Elke, Kanani, Anand, Edgworth, Kate

2021

Overview

BackgroundTired doctors make mistakes and excessive workload is a key driver to burnout, creating exhausted, cynical and ineffective individuals. The RCPCH, RCEM and BMA recognised this, having designed a framework for managing fatigue and stipulated rest break entitlements according to hours worked.But how does this translate to the realities of a busy emergency department (ED)? Despite written and verbal encouragement about break entitlements, doctors reported challenges to the timely access to all entitled breaks. With additional pressures of a global pandemic, we recognized the importance of having a well-rested workforce. We therefore set out to identify and address challenges our ED staff were facing in taking breaks.ObjectivesTo introduce a break-system that ensures doctors have a 30-minute break for every 4 hours worked in a Children’s Hospital ED.MethodsWe undertook a 36-week project using plan-do-study-act (PDSA) cycles. Each intervention was evaluated to assess reported percentage of time breaks were taken and time required to coordinate breaks. Qualitative data was collected to inform interventions and subsequent cycles. PDSA Cycles P Survey designed: quantitative questions to identify baseline; qualitative questions to identify barriers, ideal time to take breaks, and staff suggestionsD Staff surveyedS Results analysedA Intervention 1: Introduction of the ‘breaks board,’ which facilitated allocation of break slot(s) at start of shift. Launch accompanied by creation of guideline for use and staff education. Details incorporated into induction program to make it the usual practice for new starters.P Design of resurvey to evaluate interventionD Staff surveyedS Results analysedA Intervention 2: printing of permanent boards for both COVID and non-COVID sides of ED; staff education; incorporating breaks allocation into template of daily board round/huddle.ResultsIntroducing a formalised breaks system via a break(s) allocation board resulted in a greater percentage of time staff reported taking both their first and second break, and reduced the time required to coordinate each break (see table 2). It did however demonstrate that the taking of a 2nd break in a 10-hour shift is still a challenge, requiring further attention.Abstract 1387 Table 1 Reported average: Percent of time 1st break taken Percentage of time 2nd break taken Time taken to coordinate each break Pre-Initiative 90% 32% 4.5 min Post-Initiative 97% 51% 2.2 min Improvement 7% 19% 2.3min 88% of people reported the breaks board helped them coordinate and take breaks. Staff reported that it ‘has been an excellent initiative’ ensuring ‘the team are proactive about everyone having their break.’ Our future work will focus on ensuring the longevity of the change, by creating a culture change in order to get the ‘whole team to fully adopt it.’ For the next cycle we plan to do this by introducing break champions or seniors who encourage ‘everyone to put their times at huddles/handovers. ConclusionsThe Breaks Board initiative reduces time required for staff to coordinate their breaks, increases people taking their breaks, and is felt by the majority to be a helpful breaks system.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Abstracts / Burnout / Children / Departments / Education / Emergency medical care / Hospitals / Intervention / Medical personnel / National Surveys / Nurses / Occupational health / Pandemics / Pediatrics / Physicians / Psychological Evaluation / Psychological Services / Rest / State Surveys / Time / Work environment / Working conditions / Workloads