Clinical Nurse Specialist Plastic Surgery Report 2011 - Barts and the ...

Daren Edwards
Clinical Nurse Specialist
April 2011
abcd
Clinical Nurse Specialist Plastic Surgery
Annual Report 2010-2011
1
www.bartsandthelondon.nhs.uk/plasticsurgery

Contents
Executive Summary Page 3
Background of current Services Page 4
Scope of Service Page 6
Aim of Service Page 8
Referral patterns Page 10
Review of the Service Page11
Activity Analysis Page 12
Future developments and Initiatives Page 18
Conclusion Page 22
Appendices Page 23
2

Executive Summary
This is the 7th Annual Report of the Plastic Surgery Service at Barts and The London NHS
Trust.
The service is led by 1.0 WTE Band 7 Clinical Nurse Specialist facilitating best practice
using evidence based care within the Speciality.
This background is utilised with in the Trust’s objectives Excellence in Care
Nursing, Midwifery and AHP Strategy (2009).
The Service continues to provide a high quality, holistic led approach to the patient care
pathway, in both elective and trauma work with a provision of a unique role within the Trust.
The Role of the Clinical Nurse Specialist continues to focus on specific areas:
• Providing specialist nursing advice within Plastic Surgery.
• Promoting and maintaining best practice within the Specialty including the use of
evidence based practice.
• Providing and maintaining educational advice to both nursing and medical
colleagues.
• Raising the quality threshold for patients and carers
• Maintaining links with other specialities that link with Plastic Surgery
• Building links with our community partners
• Enhancing the profile of Plastic Surgery both within Barts and the London NHS Trust
and outside the Organisation, particularly in view of a possible East London NHS
merger in 2012.
• Maintaining and raising satisfaction levels for patients and reducing the length of
stay.
• Ensuring a smooth transition from the Acute to Primary care setting.
• Working with other CNS colleagues to provide a dignified end of life programme.
3

Background of current Services
The Department of Plastic Surgery sits within the Cutaneous Medicine and Surgery Clinical
Academic Unit. This CAU is the smallest in the Trust’s current organisational map, lying
within the Regional Division.
The service is led by 4.5 WTE Consultants with the appropriate support from Registrars
and SHO’s and 1.0 WTE Band 7 Clinical Nurse Specialist.
Considered to be a small service by other Plastic Surgical nursing colleagues with in the
Greater London area, the Plastic Surgery service provides both large numbers of elective
and trauma work with in the sites of St Bartholomew’s and the Royal London Hospitals with
a high turnover of patients both within and outside the Trust’s traditional catchment’s area
of North East London and Essex. Our surrounding Boroughs have some of the highest
deprivation within the UK and this is reflected in our length of stay figures
The Clinical Nurse Specialist (CNS) includes an aim to develop and strengthen links with
other disciplines in order to facilitate and improve the care pathway for patients who may
need the use of the Plastic Surgery Service.
The Service strives to:
• Implement evidence based care and advice on Plastic Surgery Issues
• To be apart of a reconstructive process that includes the main aims of plastic
surgery which is restoration, function and appearance.
• Provide a high quality educational advice to staff within BLT and outside the
Organisation as required.
This includes
• The Consultant and Junior Plastic Surgeons
• Ward staff across both sites, particularly:
• Bedford Fenwick and 3A at Bart’s
• Harrison, Charrington Treeves wards at the Royal London
• Therapists
• Tissue Viability
• Pain Team
• Neurology
• Renal
• Vascular
• Haematology
• External fixation team
• Accident and Emergency
• Outside agencies and other NHS Trusts including walk in centres and GP service
4

The Service is led and provided by Daren Edwards RGN, ENB 264
Contact telephone: 0207 377 7000 Ext 2345 (voice mail) Bleep 0970
Correspondence can be sent to:
Department of Plastic Surgery
2 nd Floor John Harrison House
The Royal London Hospital
Whitechapel
London E1 1BB
Email address: daren.edwards@bartsandthelondon.nhs.uk
The Lead Clinician is Mr Graeme Moir, Consultant Plastic and Reconstructive
Surgeon.
5

Scope of Service
Plastic Surgery Trauma
The pathway for Plastic trauma is very complex one, involving different specialities and
disciplines within the care pathway. The pre and post surgical care can be variable with
enormously different outcomes dependent upon the nature of the mechanisms of the
trauma itself. These outcomes, with some patient interventions and experience of the
service is dependent on the combination of a strong nursing input, coupled with realistic
and achievable goals for both the patient and carers.
As a designated trauma centre The Plastic Surgery Cervice is often required for advice and
specialist wound care intervention with often complex micro vascular reconstruction needed
for the patient to regain some resemblance of a quality of life. As there is no dedicated
ward for plastic surgery patients can be decanted to the following wards:
• Charrington
• Harrison
• Treves
• Mary
• Helen Raphael
• Rachel
• Cambridge
• Turner
The work that Plastic Surgery carries out in the trauma environment includes the following
• Skin grafting for: burns, degloving injuries, and wounds that fail to heal and are
deemed to be chronic in nature; examples being pressure ulcers
• Free/Pedicle Muscle and Tissue transfers for large defects following trauma
• Ballistic injuries that often require deep exploration following large muscle loss and
subsequent coverage
• Hand trauma all types of hand trauma are dealt with by the plastic surgeons
• Paediatric Surgery (both general and trauma)
• Minor Burn Injuries (major burns or those deemed to be complex according to the
British Burns Association are transferred to Burns facilities)
• Skin grafting of traumatic defects
6

Elective Plastic Surgery
The pathway for elective patients differs enormously to that of trauma and the Trust’s
patients are primarily treated at the St Bartholomew’s site.
Those elective patients vary in age and diagnosis and often require educational
intervention both pre and post operatively as inpatients and outpatients.
Those patient cohorts come under the following:
• Skin Cancer including melanoma’s and other high risk skin cancers and lesions
• Micro vascular and reconstructive work for head and neck carcinomas in conjunction
with ENT and Maxillo-facial surgeons
• Breast reconstruction following mastectomy and radiotherapy/chemotherapy
treatment
• General Plastic Surgery work such as abdominoplasty, gynaecomastia and scar
revision
• Paediatric congenital abnormalities such as syndactely and extra digits
• Breast reduction and enlargement
• Skin Cancer including melanoma’s and other high risk skin cancers and lesions
including lymph node biopsies and dissections.
• Micro vascular and reconstructive work for head and neck carcinomas in conjunction
with ENT and Maxillo-facial surgeons.
• Scar revision following excision of keloid scars and burn injuries.
• Tendon replantation to hands and feet.
• Ear Reconstruction and Pinnaplasty.
• Facial re-animation.
• Excision of hydradenitis.
• Nerve repair.
• Generalised restorative surgery following trauma or cancer
7

AIM OF SERVICE
The focus of the Plastic CNS is the facilitation of the care pathway for plastic surgery
patients, both in implementation and development. This involves being a key link between
the following:
• Plastic surgery team
• Day surgery team
• Ward staff
• Outpatients
• Outside Trusts
• Advice on best practice for nursing within the Plastic Surgery setting
• Participation in the setting, monitoring and evaluation of standards of care for
patients in the care pathway
The CNS offers support, education, and provides a strong input to patients, their relatives
and carers undergoing plastic surgery and rehabilitation following trauma. The CNS also
accepts patient referrals from the accident and emergency department and the Walk-in
Centre who may not require surgical intervention, but who nonetheless need expert support
and advice for their injury in an outpatient setting.
The CNS is also a key support for the wards within the Royal London and Bart’s’ where
plastic trauma patients are placed. This support and advice also extends to our colleagues
in the community, General Practitioners, Practice Nurses and Community Nurses, who can
refer patients for follow-up care or advice.
Part of this key support also focuses on the following elements which are continuously
under development through audit and quality initiatives such as satisfaction questionnaires
amongst users of the service.
These are:
• Providing high quality and cost effective patient care
• Teaching both inside and outside the Trust
• Attending and presenting at Conferences and Study Days
• Liaising with community staff and other multi-disciplinary teams
• Initiating and developing service improvements in conjunction with surrounding
PCT’s
• Presenting at national and international conferences
• Liaising and networking with Plastic Surgery Colleagues through out the UK
8

The East London Complex Wound Healing Clinic
The Plastic Surgery Department attends this clinic monthly at Mile End Hospital.
As part of the Tower Hamlets PCT core services, the CNS and Mr Simon Myers Consultant
Plastic Surgeon attends this clinic at the request of the Community Multi-Disciplinary Team.
At this clinic patients are seen and discussed and offered reconstructive surgery such as
skin grafts and flaps for wound coverage.
This clinic often sees tertiary referrals from outside Greater London and thus exposes BLT
as a centre for wound care excellence.
The added benefits of attending this clinic are:
• Education of patients and carers of skin grafts and wound care issues thus making
sure all aspects of post operative care are explained to the patient.
• Patients can be grafted at the bedside if the wounds are small thus alleviating bed
space at BLT and follow up is initiated within the community setting.
• Patients can be treated as day cases at Bart’s and then followed up by PCT staff
therefore freeing beds and do not require Plastic Surgery follow up.
• Additional income generation to BLT through Plastic Surgery Services attending
once monthly.
• Those requiring longer stays are automatically accepted at Mile End at the
conclusion of their treatment at BLT.
9

REFERRAL PATTERNS
Patients can access the service from these areas: -
• Accident and Emergency Department, The Royal London Hospital
• Minor Injury Unit, St Bartholomew’s
• Telephone advice to other A&E Depts and inpatient areas
• Whitechapel Walk-in Centre and other Walk-in centres in North and East London
• Tertiary referral from district general hospitals and other plastic surgery centres both
in the UK and abroad
• General Practitioners and Practice Nurses with in the surrounding PCT’s
• District Nurses in conjunction with Tissue Viability CNS’s
• Plastic Surgeons within the Trust
• Waring Ward
• Advice to Tissue Viability Nurses within the North East London area and Essex
should Plastic Surgery be considered
Access to the service is also available to prospective patients, their carers and GPs through
the Trust’s Plastic Surgery Website.
The aim of the referral is for patients requiring Plastic Surgery input but whose wounds and
or condition does not necessarily require surgery.
The above referrals are accepted if the source of referral is discussed with a surgeon
beforehand as this sets out a clear line of clinical responsibility and accountability.
Other forms of referrals will be accepted in consultation with the Plastic Surgery
Consultants only.
10

Review of the Service 2010-2011
Plastic Dressing Clinic
As part of providing high quality outpatient care, the Plastic Dressing Clinic operates five
mornings per week. Each Plastic Surgery Consultant links into this clinic. Staffed by
registered Nurses, the clinic is timed to start at 9.00am each morning.
A Plastic SHO is rostered for this clinic at the request of the Consultant Plastic Surgeons to
enable teaching for wound care purposes and to treat Accident and Emergency referrals.
The Plastic Surgery Consultants have also requested an SHO presence in order that the
junior doctors become familiar with aspects of wound care.
A new Patient information leaflet describing the clinic and its features was printed in 2010.
Accident and Emergency Referrals
Daytime referrals for A&E patients have been sent to the Dressing Clinic. Patients referred
overnight are also asked to come to the clinic if their condition allows.
The Dressing Clinic nurses are responsible for collating data of the numbers of patients
referred and their source and if the referral is appropriate.
The Plastic Surgery CNS will also see those patients if requests are made.
Patient Group Directive
In 2009 a Patient Group Directive (PGD) was passed by the Trust for the use of
Flammazine. (Silver Sulphadiazine) for use in wound care, this PGD covers both inpatient
and outpatient population. For 2010-2011 22 patients were treated using this PGD
Current Plastic Surgery Clinics in 2010-2011
Monday
Dressing
Clinic
Tuesday
Dressing
Clinic
Miss Patel
Mr Ragoowansi
Mr Moir Skin
Clinic
Wednesday
Dressing
Clinic
Mr Myers
11
Thursday
Dressing Clinic
Mr Shibu
AM
Mile End joint
wound care
clinic
1 st Thursday
per month
Friday
Dressing Clinic

ACTIVITY ANALYSIS
Patient episodes are monitored monthly and these referrals are mostly within the Trust.
Referral sources have been from the following:
• Consultant Surgeons
• Junior Plastic Surgeons
• Other medical disciplines
• Ward Staff
• Tissue Viability
• Patient self referrals
• Walkin Centre (Whitechapel site)
• Accident and Emergency
• Patient self referral
• Overseas referrals
• Referrals from General Practitioners
Patients undergoing Overseas Treatment (cosmetic surgery)
The trend in patients going overseas for cosmetic or corrective surgery continues to
increase each year with Barts and the London being no exception. (2007)
In 2010-2011 a total of 7 patients were treated at the Trust from procedures such as breast
and buttock implants to fat reduction liposuction. The patients had either presented
themselves via their GP or the Accident Department. The main complications were:
• Infection
• Poor wound healing
• No follow up care in place
• Wound breakdown
• Lack of post operative education
• Bleeding
• Scarring Issues
In the case of implants these are removed or the patient advised to seek the treatment at
the original overseas hospital if the patient refuses to have them removed.
Most patients had been treated in Eastern Europe and Thailand.
British Association of Aesthetic Plastic Surgeons. (2007) London.
www.baaps.org.uk
12

month
Ward Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Grand Total
3A 2 1 3 1 1 2 10
4B 1 1 1 3
5A 1 1
AW4 1 2 3 1 1 1 9
AW5 1 2 3
AW5C 1 1
BEDFORD FENWICK 1 5 1 4 2 1 14
CAMBRIDGE 1 1 1 3
CDU 1 1
CHARRINGTON 3 2 4 1 2 4 3 5 1 1 2 28
CROFT 1 1 1 3 6
DEVONSHIRE 1 2 3
FRED ANDREWS 2 2
GARROD 1 1 2
GEORGE 4 1 8 3 5 6 4 3 7 3 44
HARRISON 1 1 2 1 3 6 4 6 1 3 2 30
HDU 5 1 1 7
HDU AW4 1 1
HELEN RAPH 1 3 1 5
ITU 1 1 2 6 1 3 3 3 2 22
MARCY C 1 1
MARY B 1 1 2 1 1 6
MILWARD 2 1 3
PAULIN 1 1
PER POTTS 1 1
PHYLLIS FRIEND 1 1 1 1 1 5
RACHEL 1 2 1 1 3 8
TREVES 1 5 1 2 2 1 1 13
TURNER 1 2 3
VICARY 1 1
WELLINGTON 1 1 2
unknown 1 1 2
Grand Total 21 12 32 16 25 27 23 28 15 20 22 241
Table 1. Activity Analysis by Inpatient Wards
13

Activity Analysis Data for 2010-2011
Table 2.
Inpatients Treated at Bart’s and The London by the CNS Plastic Surgery
Number of pts
40
35
30
25
20
15
10
5
0
April
May
June
July
August
Sept
Inpatient Episodes
October
November
14
December
January
February
March
2010-2011
2009-2010
The lower amount of numbers treated reflect earlier discharge strategies and increase in VAC
therapy in the Community Setting.
Further Breakdown Analysis of Injuries and Treatments
Table 3.
Burn Injuries Episodes in Clinic
20
18
16
14
12
10
8
6
4
2
0
April
11
3
May
10
2
June
13
0
July
4
2
August
4
1
Sept
6
7
October
4
3
November
9
2
December
8
11
January
2
7
5 50 5
February
March
Patient episodes
Burn injuries 2009-
2010 and 2010-
2011
2010-2011
2009-2010

Table 4.
Breakdown of Inpatient Speciality Referrals to Plastic CNS 2010-2011
Compared to 2009-2010 there has been a increase of 16.3% of patients referred to the
Nurse Led Service.
Psychiatric, 2
Vascular, 5
Max Fax, 4
Gen Surg, 5
Neuro, 8
Medics, 18
Gynae, 3
Trauma
90
Burns 20
Gynae 3
Medics 18
Neuro 8
Gen Surg 5
Max Fax 4
Vascular 5
Renal 4
Urology 2
Pschiatric 2
Cardiac 4
Dermatology 14
TOTAL 179
Cardiac, 4
Urology, 2
Renal, 4
Burns, 20
Dermatology, 14
Trauma 85
Burns 29
Gynae 8
Medics 7
Neuro 5
Gen
Surg 13
Max
Fax 6
TOTAL 153
Figures 2010-2011 Figures 2009-2010
15
Trauma, 90

Outpatient Episodes 2010-2011
Table 5
140
120
100
80
60
40
20
0
April
68
43
May
46 70 59
45
June
21
July
33
August
TOTAL PATIENT
EPISODES
57
39
2009-
2010 462
2020-
2011 692
Sept
Increase of 49.8% over two years.
82
40
October
34
44
November
74
27
December
16
51
63
January
51
35
February
This is due to earlier discharges and follow up as outpatients.
Financial Implications are:
The 09-10 tariff for plastics surgery new and follow up attendances was:
• First: £165.94
• Follow-up: OPFUPSPCL - £88.58
"0q0
41
26
March
59
46
Outpatient Episodes
showing increase in
numbers of Patients treated
with complex wounds
2010-2011
2009-2010

East London Wound Healing Clinic 2010-2011
Table 6
Number
14
12
10
8
6
4
2
0
April
April, 13
May
May, 9
June
June, 6
July
July, 10
August
Mile End Patients
Sept, 6
August, 5
Sept
17
October
October, 10
November
November, 12
December
December, 4
January
February, 9
January, 8
March, 7
The Wound Care clinic continues to ask for our input and advice on specific wounds that would
benefit from Plastic Surgical Expertise.
This Clinic operates once per month and BLT is invoiced bringing additional Income to the Trust.
Month
February
March

Additional work carried out in 2010-2011
The Plastic Surgery Unit is also piloting the Millennium software package to gauge the hidden
amount of work carried out over the Trust.
Further collaborative work was carried out with other colleagues in surrounding Trusts to ensure
that patients received a smooth transition of care between BLT and other areas.
Other sources of referrals;
• Degloving Injuries.
• Burns (Major burns and those deemed complex burn injuries* are referred to the Burns
centres).
• Trauma and Orthopaedic where soft tissue cover is required utilising skin graft or tissue
muscle flaps.
• Pressure ulcer coverage.
• Advice on general wound care is redirected to Tissue Viability Colleagues
• Hand Trauma.
• Advice and action on complex wound tissue cover.
* British Burn Association Guidelines 2004
Barts and The London NHS Trust Plastic Surgery Website
The Plastic Surgery website continues to show reasonable levels of traffic visiting the site.
We continue to receive requests for help from across the globe for
• Keloid scarring advice and treatment with 48 email requests made for advice on keloid
scarring alone, the majority from other parts of the United Kingdom.
• Accessing plastic surgery services at BLT.
• Advice on clinical information in plastic surgery and requests for clinical visits of which 5
people requesting clinical placement information during 2009-2010.
The Website is currently being updated and it is anticipated that further information will be added
during the year.
In addition the website generated an additional 35 requests made by patients requesting
information and possible surgery
www.bartsandthelondon.nhs.uk/plasticsurgery
18

Vac Therapy
The usage of VAC Therapy has been closely monitored throughout the year with those patients
whose wounds have been assessed as manageable in the community being discharged early with
PCT funding for ambulatory VAC Therapy commenced in the community.
This has allowed the Plastic Surgery Dept to reduce the length of patient stay and initiate cost
savings by transferring the Patient to direct community management. The last year 15 patients
were discharged early into the Community with Vac therapy. The main areas continue to be:
• Tower Hamlets
• City and Hackney
• Redbridge
• Waltham Forest
• Newham
• Barking and Dagenham
19

Other Commitments throughout 2010-2011
Teaching
Teaching commitments at City University for both pre registration students.
Post registration students for the Trauma and HDU courses City University.
Pre registration students are shared with Tissue Viability and Vascular CNS’s this included 4 pre
registration nurses from Spain on exchange visits with City University.
Other educational aspects within BLT include:
• Flaps and their uses
• Skin grafts
• Leeches
• Vac Therapy
• Minor Burn Injuries
• Maggot Therapy
• Traumatic Wound Management
Continuing Education and and Conferences Support in 2009-2010
Wound Care Conference Barbican April 2010
Mandatory Updates 2010
Burns and Micro vascular Day at Queen Mary University 2010
Regional Division Quality Day 2010
Student Nurse Seminars City University
.
Infection Control meetings London
Published Material 2010
Lemonas, P., Hussain, M. A. and Edwards, D. (2011) Leeches as a cost-effective measure in
plastic and reconstructive surgery. International Wound Journal, 8: 212–213.
Bart and the London NHS Trust
Winner Outstanding Individual Award 2010
20

Future Plans, Objectives & Initiatives
• Continue to “market” the Plastic Surgery Department both inside BLT and through the
Trust’s Internet web pages
• Increase teaching input to City University as required
• A joint paper on Lower Limb Trauma with External fixator CNS in being prepared
• Present to the American Plastic Surgery Nurses Association Conference in 2011
• Continue with patient satisfaction surveys in 2011
• Revamp the Plastic Surgery Web Site
• Increase the presence of specialist nursing advice to the Trust on Plastic Surgical
Matters both locally and strategically
• Continue Pan London Cooperation with Nursing colleagues in Plastic Surgery and
through the British Association of Plastic Surgery Nurses
• Continue to increase early discharge for those patients deemed safe
• Continue and nurture working relationships with colleagues with BLT
• Increase collaborative work with Tissue Viability Colleagues in BLT
• Increase the amount of delayed skin grafting at BLT within the confines of the Human
Tissue Act (2004)
21

Conclusion
The past year has shown a significant increase in patient episodes in both inpatient
increasing by 20% and outpatient work by 50%.
This has been partly offset by the number of patients that have had complex wounds and
needed fascio-cutaneous flap repairs and other microvascular surgical procedures.
The alarming number of patients seeking treatment after cosmetic surgery has continued to
increase over the year with abdominplasty being the main cause of concern with quite
complex procedures being carried out with little or no regard for subsequent follow up in the
UK.
Aim to reduce the length of stay for with Plastic Surgery inpatients with the number of
patients being sent home with VAC therapy up by 20% on the previous year.
Our main trauma work continues to be with our orthopaedic colleagues although other
Specialities have asked for advice for wound care issues that require Surgical dedbridement
and cover.
Continue to redesign patient pathways during 2011-2012 to:
• Reduce Length of stay in Plastic Surgery
• Increase collaborative approaches with Community Colleagues
• Redesign databases to produce accurate audit data
• Identify potential areas of income generation such as out reach work
22

Appendices
23

Daren Edwards CNS PLASTIC SURGERY JOB PLAN 2010
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
07.15 AM
ADMIN CHECKING EMAILS
AND VOICE MAIL
08.00
PLASTIC SURGERY
HANDOVER
WARD ROUNDS
09.30 PLASTIC DRESSING
WITH DR BULL AND
TISSUE VIABILITY TO
IDENTIFY IF ANY
PATIENTS REQUIRE
PLASTIC SURGICAL INPUT
PLASTIC DRESSING
CLINIC TO TREAT
COMPLEX WOUNDS POST
OP PATIENTS
A&E REFERRALS AND
MINOR BURNS
REVIEW WARD PATIENTS
AT WHITECHAPEL SITE
WARD REFERRALS OR
PROBLEMS
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
07.15 AM
ADMIN CHECKING EMAILS
AND VOICE MAIL
08.00
PLASTIC SURGERY
HANDOVER
WARD ROUNDS
09.30 PLASTIC DRESSING
CLINIC WOUND CARE
ISSUES
GM/SKIN CLINIC COVER
FOR WOUND CARE AND
PT FOLLOW UP
RR CLINIC COVER FOR
WOUND CARE AND PT
FOLLOW UP
WARD ROUND WITH GM
AND OR RR AT
WHITECHAPEL DEAL
WITH WOUND CARE
ISSUES OR DISCHARGES
WITH OTHER MDT COVER.
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
07.15 AM
ADMIN CHECKING EMAILS
AND VOICE MAIL
08.00
PLASTIC SURGERY
HANDOVER
WARD ROUNDS
09.30 PLASTIC DRESSING
CLINIC
SM CLINIC COVER FOR
COMPLEX WOUNDS AND
POST OP DISCARGES
AND FOLLOW UP REVIEW
NEW PTS FOR SURGERY
WOUND CARE ISSUES IN
PDC
WARD ROUND WITH SM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
24
07.15 AM
ADMIN CHECKING EMAILS
AND VOICE MAIL
08.00
PLASTIC SURGERY
HANDOVER
WARD ROUNDS
09.30 PLASTIC DRESSING
CLINIC
HP CLINIC OR MS ADULT
CLINIC
REVIEW NEW PTS POST
OP PATIENTS AND
COMPLEX WOUND CARE
ISSUES WITH PATIENTS
1 ST THURSDSAY OF
MONTH MILE END
HOSPITAL EAST LONDON
WOUND HEALING CENTRE
WITH SM FOR PLASTIC
SURGERY AND DR BULL
WOUND CARE ISSUES IN
PDC
WARD ROUNDS WITH MS
OR HP
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
07.15AM
ADMIN CHECKING EMAILS
AND VOICE MAIL
08.00
PLASTIC SURGERY
HANDOVER
WARD ROUNDS
09.30 PLASTIC DRESSING
CLINIC
ALTERNATE HP CLINIC
WOUND CARE ISSUES
AND REVIEW NEW
PLASTIC SURGERY
PATIENTS FOLLOW UP
PATIENTS
WOUND CARE ISSUES IN
PDC
WARD ROUND WITH HP
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS

PM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
ADMIN DATABASE
PERPARING TEACHING
MATERIALS
DISCUSSIONS WITH TEAM
ON PATIENT ISSUES
ALSO CAN BE IN
THEATRE
WITH SURGEONS
BARTS HOSPITAL
REVIEWING PATIENTS
16.00 ONWARDS FINISH
PM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
ADMIN DATABASE
PERPARING TEACHING
MATERIALS
DISCUSSIONS WITH TEAM
ON PATIENT ISSUES
ALSO CAN BE IN
THEATRE
WITH SURGEONS
BARTS HOSPITAL
REVIEWING PATIENTS
16.00 ONWARDS FINISH
PM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
ADMIN DATABASE
PERPARING TEACHING
MATERIALS
DISCUSSIONS WITH TEAM
ON PATIENT ISSUES
ALSO CAN BE IN
THEATRE
WITH SURGEONS
BARTS HOSPITAL
REVIEWING PATIENTS
16.00 ONWARDS FINISH
25
PM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
ADMIN DATABASE
PERPARING TEACHING
MATERIALS
DISCUSSIONS WITH TEAM
ON PATIENT ISSUES
ALSO CAN BE IN
THEATRE
WITH SURGEONS
BARTS HOSPITAL
REVIEWING PATIENTS
16.00 ONWARDS FINISH
GM: GRAEME MOIR. SM: SIMON MYERS. HP: HASU PATEL. MS: MOHAMMED SHIBU. RR: RAJ RAGOOWANSI.
OTHER CONSIDERATIONS:
PM
OTHER ACTIONS
PHONE CALLS BLEEP
CALLS
ADMIN DATABASE
PERPARING TEACHING
MATERIALS
DISCUSSIONS WITH TEAM
ON PATIENT ISSUES
ALSO CAN BE IN
THEATRE
WITH SURGEONS
BARTS HOSPITAL
REVIEWING PATIENTS
16.00 ONWARDS FINISH
EACH DAY CAN CHANGE ACCORDING TO THE PATIENT WORK LOAD AND THE SEVERITY OF POST OPERATIONS SUCH AS MAJOR TISSUE
TRANSFERS, REPLANTATION OF DIGITS FAILURE OF GRAFTS AND FLAPS AND COMPLEX DRESSING CHANGES IN THEATRE
OUT REACH VISITS TO MILE END, NEWHAM, LONDON CHEST TO FOLLOW UP PTS AND ADVICE TO NURSING STAFF
NETWORK INCLUDES CNS IN TISSUE VIABILITY TO GREATER LONDON PCT’S AND OTHER PLASTIC SURGERY UNITS WHEN DISCHARGING OR
ADMITTING PATIENTS FROM OUT OF AREA
INITIATING EARLY DISCHARGE TO COMMUNITY WITH VAC THERAPY AND RAPID FOLLOW UP IF REQUIRED
TEACHING COMMITMENTS TO CITY UNIVERSITY AND OUTLYING TRUSTS AND PRESENTATIONS.
PRESENTATIONS NATIONALLY AND INTERNATIONALLY ON PLASTIC SURGICAL ISSUES
LIAISING AND WORKING ALONGSIDE OTHER CNS’S WHERE MDT APPROACH IS REQUIRED
TEACHING AND WORKING WITH STUDENT NURSES ON PLACEMENT WHERE PLASTIC SURGERY PATIENTS ARE LOCATED
Daren Edwards CNS Plastic Surgery January 2011

Barts and The London NHS Trust
Plastic surgery attendance in 2010-11
first
Apr- May- Jun-
Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- first
Consultant_Desc
10 10 10 Jul-10 10 10 10 10 10 11 11 11 Total
MYERS 41 52 80 67 54 42 73 54 44 34 52 40 633
RAGOOWANSI 39 35 33 36 44 67 68 86 83 86 70 84 731
SHIBU 29 23 22 39 33 49 30 25 14 15 23 36 338
PATEL 24 15 21 23 23 18 13 41 5 13 11 24 231
MOIR 13 4 3 3 3 2 2 1 4 2 1 1 39
Nurse 3 4 3 2 4 2 12 21 11 3 7 10 82
SOMMERLAD 2 4 4 3 2 2 4 5 4 30
OWEN-JOHNSTONE 7 1 8
HARDEE 1 1
Grand Total 151 133 166 181 161 183 200 230 166 158 169 195 2093
follow_up
Apr- May- Jun-
Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- follow_up Grand
10 10 10 Jul-10 10 10 10 10 10 11 11 11 Total Total
299 276 324 286 253 279 259 269 199 221 232 263 3160 3793
200 188 217 236 236 258 239 256 268 279 259 252 2888 3619
107 105 125 134 113 124 102 109 72 66 73 101 1231 1569
117 92 89 73 64 99 72 105 45 73 73 65 967 1198
70 66 67 69 67 54 31 28 17 24 22 36 551 590
1 6 11 7 7 11 18 35 39 30 27 22 214 296
5 4 4 6 5 3 2 2 3 34 64
3 4 2 1 2 12 20
4 4 5
799 733 837 812 744 833 727 805 642 697 689 743 9061 11154
26

Barts and The London NHS Trust
Plastic surgery attendance in 2010-11
PCT_Desc Total %
TOWER HAMLETS PCT 2757 24.6%
NEWHAM PCT 2338 20.9%
CITY AND HACKNEY TEACHING PCT 1554 13.9%
REDBRIDGE PCT 598 5.3%
WALTHAM FOREST PCT 540 4.8%
BARKING AND DAGENHAM PCT 344 3.1%
ISLINGTON PCT 306 2.7%
HAVERING PCT 187 1.7%
HARINGEY TEACHING PCT 168 1.5%
SOUTH EAST ESSEX PCT 166 1.5%
SOUTHWARK PCT 145 1.3%
SOUTH WEST ESSEX PCT 128 1.1%
(blank) 124 1.1%
OVERSEAS VISITOR EXEMPT FROM CHARGES 112 1.0%
ENFIELD PCT 110 1.0%
LEWISHAM PCT 107 1.0%
WEST ESSEX PCT 106 0.9%
GREENWICH TEACHING PCT 97 0.9%
BARNET PCT 91 0.8%
CAMDEN PCT 88 0.8%
BRENT TEACHING PCT 77 0.7%
BEXLEY CARE TRUST 59 0.5%
WEST KENT PCT 59 0.5%
EALING PCT 51 0.5%
HARROW PCT 50 0.4%
WANDSWORTH PCT 49 0.4%
LAMBETH PCT 48 0.4%
KENSINGTON AND CHELSEA PCT 42 0.4%
WEST HERTFORDSHIRE PCT 41 0.4%
SURREY PCT 40 0.4%
WESTMINSTER PCT 40 0.4%
EAST AND NORTH HERTFORDSHIRE PCT 39 0.3%
SUTTON AND MERTON PCT 36 0.3%
BROMLEY PCT 35 0.3%
MEDWAY PCT 32 0.3%
HILLINGDON PCT 31 0.3%
CROYDON PCT 30 0.3%
MID ESSEX PCT 28 0.3%
NORTH EAST ESSEX PCT 25 0.2%
HAMPSHIRE PCT 19 0.2%
NORTH YORKSHIRE AND YORK PCT 19 0.2%
BRIGHTON AND HOVE CITY PCT 14 0.1%
KINGSTON PCT 14 0.1%
BEDFORDSHIRE PCT 13 0.1%
HAMMERSMITH AND FULHAM PCT 13 0.1%
MIDDLESBROUGH PCT 13 0.1%
BUCKINGHAMSHIRE PCT 12 0.1%
HOUNSLOW PCT 12 0.1%
NOTTINGHAM CITY PCT 12 0.1%
EASTERN AND COASTAL KENT PCT 10 0.1%
RICHMOND AND TWICKENHAM PCT 10 0.1%
SUFFOLK PCT 9 0.1%
CAMBRIDGESHIRE PCT 7 0.1%
27

CORNWALL AND ISLES OF SCILLY PCT 7 0.1%
SHEFFIELD PCT 7 0.1%
WEST SUSSEX PCT 7 0.1%
WARWICKSHIRE PCT 6 0.1%
ASHTON, LEIGH AND WIGAN PCT 5 0.0%
BERKSHIRE EAST PCT 5 0.0%
Data Validation Error 5 0.0%
DONCASTER PCT 5 0.0%
EAST SUSSEX DOWNS AND WEALD PCT 5 0.0%
LEEDS PCT 5 0.0%
LINCOLNSHIRE TEACHING PCT 5 0.0%
NEWCASTLE PCT 5 0.0%
NORFOLK PCT 5 0.0%
NORTHAMPTONSHIRE TEACHING PCT 5 0.0%
MILTON KEYNES PCT 4 0.0%
STOKE ON TRENT PCT 4 0.0%
BOURNEMOUTH AND POOLE PCT 3 0.0%
HASTINGS AND ROTHER PCT 3 0.0%
LUTON PCT 3 0.0%
OXFORDSHIRE PCT 3 0.0%
WIRRAL PCT 3 0.0%
BERKSHIRE WEST PCT 2 0.0%
BOLTON PCT 2 0.0%
DORSET PCT 2 0.0%
NORTHUMBERLAND CARE TRUST 2 0.0%
PORTSMOUTH CITY TEACHING PCT 2 0.0%
TRAFFORD PCT 2 0.0%
ABERTAWE BRO MORGANNWG UNIVERSITY
LHB 1 0.0%
BIRMINGHAM EAST AND NORTH PCT 1 0.0%
BLACKBURN WITH DARWEN PCT 1 0.0%
BRISTOL PCT 1 0.0%
CARDIFF & VALE UNIVERSITY LHB 1 0.0%
CENTRAL AND EASTERN CHESHIRE PCT 1 0.0%
CENTRAL LANCASHIRE PCT 1 0.0%
COUNTY DURHAM PCT 1 0.0%
COVENTRY TEACHING PCT 1 0.0%
DEVON PCT 1 0.0%
EAST LANCASHIRE TEACHING PCT 1 0.0%
EAST RIDING OF YORKSHIRE PCT 1 0.0%
HEART OF BIRMINGHAM TEACHING PCT 1 0.0%
NHS GRAMPIAN 1 0.0%
SHROPSHIRE COUNTY PCT 1 0.0%
SOUTH STAFFORDSHIRE PCT 1 0.0%
WESTERN CHESHIRE PCT 1 0.0%
WOLVERHAMPTON CITY PCT 1 0.0%
Grand Total 11185 100.0%
28

Barts and The London NHS Trust
Plastic surgery LOS for 2010-11
pat_type adm_type avg_los total_adms
DC Elective 0 455
IP Elective 2.1 437
IP Non elective 2.7 818
Number of individual patients treated in 2010-11
OP 3570
IP 1519
Both 4048
Inpatients by age in 2010-11 (Average age is 43)
age total
0 2
1 4
2 5
3 3
4 1
5 5
6 4
7 4
8 1
9 2
11 2
12 1
13 3
14 1
15 2
16 7
17 11
18 24
19 20
20 25
21 31
22 50
23 37
24 40
25 54
26 44
27 41
28 44
29 41
30 47
31 43
32 41
33 43
34 34
35 17
90 8
91 3
92 2
93 1
29

94 2
95 2
96 1
30