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Meningitis in children: Are junior doctors prepared?

Authors

Sheena Sheth
Rahul Chodhari

Theme

8JJ Patient safety

INSTITUTION

Royal Free Hospital NHS Trust

Background

Every year nearly 2000 people get meningitis or meningococcal septicaemia in the UK, majority of them children. Currently, 1 in 10 children affected will die or have a life time cost of 6 million US$, if seriously disabled by it. The British Medical Journal identified high mortality rates when trainee doctors were unsupervised while reviewing patients with potential septicaemia or meningitis¹

Summary of Results

Out of the 60 trainees:

1 in 3 felt they had 'very little' competency in diagnosing, investigating, treating and recognizing a deteriorating child, illustrated in Graph 1

Half of the trainees were unaware of the local protocol
7 in 10 had no real life simulation exposure to cases in their training.

95% felt additional teaching would be beneficial (Graph 2)
62% recommended a compulsory presentation (Graph 3)

Suggestions included:

‘examples by clinical cases’
‘early teaching for paediatric trainees in particular’
‘easy to access’ resources

Summary of Work

An online tool was created to understand preparedness of Foundation Year 1 and 2 doctors at the Royal Free Teaching Hospital, London.

7 questions related to competency on the management pathway of Meningitis
3 questions were centered on education and training.
Questionnaire available on request

Watch our brief video on responses from doctors in our study and our follow-up intervention (link or QR scan):

https://www.youtube.com/watch?v=_igxY2C1Jqs

more detail

Conclusion

There is a lack of confidence amongst Junior Doctors in competency for managing meningitis.

This gives an opportunity to enhance patient safety and reduce mortality by improving further education and awareness of such a common, severe condition.

This can be done using a range of resources to improve training including wide-access electronic medium and simulation in the curriculum.

Take-home Messages

What next?
Two resources were put in place to increase learning opportunities:

An interactive slide-show, for group or self learning, was created based on the handbook by Meningitis Research Foundation’s ‘Lessons from research for doctors in training’, using real cases with unwanted outcomes as learning tools².
Posters around the hospital highlighting trust guidelines.

A follow-up study is currently being done to explore the usefulness of posters as a tool for education around clinical areas - click on ‘more details‘ for latest results.

more detail

References

1. Ninis et al. The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases , The British Medical Journal 2005; 330:1475, doi: http://dx.doi.org/10.1136/bmj.330.7506.1475

2. Nini N, Nadel S, Glennie L. Lessons from research or doctors in training: Recognition and early management of meningococcal disease in children and young people. 3A ed. Bristol: Meningitis Research Foundation; 2013. http://www.meningitis.org/assets/x/50156 [Accessed 15 March 2014]

Acknowledgement

With thanks to:

Royal Free Hospital NHS Trust, Paediatric Department

UCL Partners

Take-home Messages

Meningitis ‘1 minute‘ posters to raise awareness of meningitis in clinical practice

In response to our conclusions, one intervention was to use posters as an education tool aimed at giving basic information ‘in 1 minute’ and raising awareness of meningitis as an important differential around Royal Free Hospital.

At 4 weeks we surveyed 24 Foundation Year 1 & 2 doctors on the usefulness of the posters. See our video for responses from trainees on its effectiveness. The full study is yet to be complete, however here are some interesting statistics found already:

80% of the doctors noticed the posters around the hospital and found them relevant to clinical practice.

Graph 1 below shows over half the trainees found at least one learning point, and these included reminders about protocols, drugs (in particular aciclovir) and contact numbers in the hospital.

Graph 1

However, 7 in 10 doctors did not feel more confident in managing meningitis after reading the posters, as highlighted below.

Graph 2

This shows that although posters were noticeable by the majority of Junior Doctors and there were useful learning points, more needs to be done to educate Doctors. The graph below highlights that Junior Doctors are willing to self-educate if easily accessible.

Graph 3.

There will be further analysis on teaching methods to improve awareness and education of meningitis - contact us for more information in due course (sheena.sheth@nhs.net)