5. The Swan newsletter April 2010 - Become an NHS Foundation ...

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IN DEPTHPatient care in tTaking a fresh look at urgent careDelivering the right urgent care to our patients has never been more important. Longwaits in overcrowded A&E departments are no longer seen as acceptable, and peopleexpect to be assessed and treated with the minimum possible time in hospital. If anyfollow-up care is required they want this to be as close to home as possible.With such changes in the culture of healthcare, combined with ever growing pressures onresources, the Trust has looked afresh at its urgent care services. How can we both deliver whatpatients want whilst also operating more effectively?The patient is the driving force behind all the urgent care reforms. And more specifically the patient’s journey through the Trust. Thereforms have looked at every step, from the moment a patient arrives at our front door to the moment they return home. To succeed, anychanges have to be interdependent, creating better pathways of treatment for patients. So for example, enhanced weekend radiology andtherapy services can assist the new patient pathway facilitators and the medical teams to help patients get home even sooner.The proposed changes inmore detail:Treatment Initiation Streaming (TIS):Behind the technical language lies apotentially enormous change for patients. Itwill mean senior decision-making A&Edoctors being involved in assessing,investigating and streaming patients from themoment they arrive.Patients will be placed in a clinical decisionunit for assessment or short-term observationby doctors whilst a decision is taken onwhether to admit or treat and discharge.Pilots across both sites have proved verysuccessful in directing patients to theappropriate specialist doctor much more quickly.Progress to date: Consultation on the TIScontinues and we hope to finalise theseduring 2010.Patient Pathway Facilitators (PPFs):See page 7.Weekend radiology investigations andtherapy: Providing enhanced weekendservices - meaning patients can be assessedimmediately and go home straight away ifappropriate, without waiting until Monday oreven later for assessment.Progress to date: The weekend radiologyservice is now in place at both sites.The weekend therapies service is currentlybeing consulted on with staff.Medical on-call model: The reforms proposeto change doctors’ on-call rotas so that theywork for consecutive days on-call rather thansingle days. It will mean fewer handoversbetween teams, which can sometimes delaydecisions on treatment or discharge.Progress to date: Discussions are stillunderway with changes proposed for 2010.Alternatives to admission: Some patientsare currently being admitted when it mightbe possible to offer alternative treatment.Three approaches being introduced are:more senior specialist opinion being availablewhen patients are in A&E; providing rapidoutpatient appointments; and newguidelines for all clinicians to follow prior toadmitting a patient.Progress to date: Hot clinic appointmentsand telephone access to specialist medicalMRIs are accessible at the weekendopinion are now available. Clinical guidelinesfor conditions not normally requiringadmission are under development and will beintroduced in early 2010.Estate changes to the emergencydepartments: Making better use of thespace available in A&E has been the focus atStoke Mandeville, increasing minor treatmentspace and reducing pressure on the maindepartment. A further proposal is to create anew ‘front door’ to our A&E service, with lesspatients being seen in a GP-led urgent carecentre at Wycombe where appropriate.Progress to date: Essential work to increasecubicle capacity at Stoke Mandeville A&E isunderway. Bucks Urgent Care is developingthe ‘front door’ GP service at Wycombe.Short stay ward: The Trust is creating apurpose built short stay ward (up to 48hours) for patients who do not needadmission to a general ward. Changes to themedical on-call model once finalised willmean patients being cared for by the sameteam for their entire stay. Fast track access toinvestigations and treatment, with supportfrom the dedicated patient pathwayfacilitator, will help to ensure these patientsspend as little time as possible in hospital.Progress to date: This is closely linked tochanges to the medical on call model.Jo Hockley – helping lead changeJo Hockley, Trust programme director for change and central toall the current reforms in urgent care, has been chosen to be alearning network facilitator. Part of a hand picked national teamoperating in NHS South Central, Jo will be helping clinicians andmanagers to lead service improvements across our area throughthe clinical leaders network.Jo had to attend special training along with her fellowfacilitators looking at ways to support change in areas asvaried as mental health, acute and planned care andlong term conditions. It is a great achievement for Jo andalso puts Buckinghamshire hospitals centre stage inimproving care to patients.6 Give us your news - phone the communications team on (130) 4959 or email communications@buckshosp.nhs.uk
he driving seatIN DEPTHPutting patients firstPatient Pathway Facilitators have already started work at Stoke Mandeville, ensuring that patients receive theirtreatments more quickly and more smoothly during their time in hospital. The team of three senior nurse PPFs atStoke Mandeville will be joined by a parallel team at Wycombe Hospital in April 2010.Geraldine Kirkby, PPF team leader at StokeMandeville, believes the PPF role is of benefitto both patients and staff. Whilst the PPFteams need time to settle in, “many staff canalready see the benefits and that we canactually free them up to spend more timewith patients. We are here to help anddefinitely not just to chase beds”.Geraldine believes it has been vitally importantto recruit senior nurses with a wide range ofward experience to the PPF roles: “Our clinicalexperience allows us to understand thepotential delays patients can face in their care,and to recognise the pressures which wardstaff are under.The PPF team are currently working in threekey medical areas of the hospital:• The emergency assessment unit, A&E andthe surgical assessment unit• Wards 5 and 20, acute medicine andhaematology• Wards 2 and 8, medicine for older peopleand the stroke unit.For PPFs to succeed is dependent on theother proposed changes to urgent care inmedicine. For example, by making weekendradiology and therapies available. PPFs canhelp highlight those patients needing theseservices, thus potentially speeding up theirdischarge.“It is still early days,” says Geraldine, “but wehave already seen improvements for patients,less administrative pressure on nursing staff andspace being freed up on some ward areas”.Another important part of the PPF role is aspatient advocate. For example, if a patient isanxious about when they will have a CT scanthe PPF nurse can find out. The nurses act asa vital link between the patient and othermembers of the MDT.Whilst the PPF team focus on patients withmore straight forward pathway needs, theyalso work closely with staff looking after thoseneeding more complex discharge support, thehospital discharge co-ordinator team.The PPFs are in touch with external support inthe community, such as GPs, district nurses,intermediate care teams and also social services.They ensure that preparations are fully inplace for a patient’s safe and timelydischarge, hopefully reducing the risk ofunexpected re-admission.So what is it like day-to-day for the PPFteam? “It can be a stressful role but isultimately very rewarding when you see apatient receive the care they need promptlyfollowed by safe discharge home to theirloved ones,” says Geraldine.How one patient journey would changeSo what will the reforms really mean for patients? Let’s follow one fictional patient as she progresses through thehospital. An elderly woman who we will call ‘Elizabeth’ arrives by ambulance at Stoke Mandeville’s A&E with acuterespiratory problems:1 Ambulance arrives at Stoke Mandeville A&Eon Friday evening. Following rapidassessment and investigations by a seniorA&E doctor and TIS team, Elizabeth is takento the clinical decision unit, where she isassessed by the on-call medical team.2 The doctor starts treatment and requeststhat Elizabeth be admitted to the shortstay ward to be seen by a therapist onSaturday morning.3 Elizabeth is assessed by the weekendtherapist and receives therapy. It is decidedthat Elizabeth is well enough to go home.4 Elizabeth is discharged on Saturdayevening, with an outpatients appointmentarranged for Monday morning.Julia Mee, head of therapies: Geraldine Kirby, patient pathway facilitator team leader: David Taylor, respiratory consultant and leader ofthe urgent care reform team:“Providing weekend therapiescoupled with the other urgent carechanges mean more patients can beseen immediately and eitheradmitted or allowed to go home. Forour staff it will clearly meanchanges to their working patterns butby providing therapies over sevendays the logjams therapists currentlyface on a Monday morning will bemuch reduced.”“Our role is to free up nurses onthe wards to help their patients.We take care of the paperworkand telephone calls needed toprogress a patient through thehospital onto discharge, whilst alsohaving the clinical expertise to dealwith any concerns.”“With these proposals we wanted tolook at the whole culture of urgentcare. How could we improve theexperience of the patient, whilst alsosmoothing the patient pathwaythrough the hospital? We believe thatstaff as well as patients will seethe benefits of these changes asthey work through and that thealready good reputation of ourhospitals will be further enhanced.”Spring 2010 Issue 5 The SWAN 7
Page 2 and 3: NEWSHealthchecksuccessOur most rece
Page 4 and 5: NEWSEver met a SimMan?Well neither
Page 8: STAFF SPOTLIGHTCelebrating the best
Page 12: STAFF SPOTLIGHTSwanning around…My

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