WHERE THIS HAPPENED: Plymouth Hospitals NHS Trust
Ultrasound scan (USS) is a common and important mode of investigation for emergency surgical admissions. Delay in investigation often leads to delayed diagnosis and treatment, and possible extended length of stay (LOS), which has clinical, cost and service provision implications. We aim to investigate the clinical impact on patient care and the cost-effectiveness of a pilot Surgical Assessment Unit (SAU) USS facility. We performed a retrospective data collection on 100 consecutive SAU inpatients who had an USS investigation on the ward since the introduction of the facility, matched by 100 consecutive SAU inpatients who had an USS in the radiology department before the pilot study. Results of the audit show SAU USS has a reduced mean LOS by 1.44 days compared to departmental USS, and led to more same day discharge than departmental USS (20 vs. 5), thus avoiding unnecessary overnight stay. It also significantly reduced mean waiting time from admission to investigation by 5.21 hours, which can be translated into improved patient and staff satisfaction. All these findings are both statistically and clinically significant. The estimated cost of each SAU USS is comparable to the average departmental USS (£29.71 vs. £30.80). Using the average cost of an excess bed day = £273, SAU USS has produced an estimated saving of £394.72/patient. This does not include saved opportunistic costs such as prevented elective operation cancellations, fines incurred from surgery waiting time/A+E breaches etc. To conclude SAU USS has a significant positive impact on patient care in surgical admissions by reducing LOS and investigation waiting time, as well as facilitating same day discharge.
FIND OUT MORE
WHERE THIS HAPPENED: Royal United Hospitals Bath
The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity.
A wound closure protocol was agreed by the consultant body. This information was disseminated by email and teaching sessions to all members of the multidisciplinary team, including surgeons, theatre staff and ortho-geriatricians. The plan-do-study-act model for improvement was used to reduce rates of returns to theatre for wound ooze. Interventions included cyclical teaching during each trainee rotation, updated inductions, posters, email reminders and scrub team involvement to open the protocol sutures unprompted.
The primary outcome measure was returns to theatre for wound complications. Baseline data showed 4 returns to theatre over a two month period (4.40% of patients). Length of stay for each patient affected by wound ooze was also compared to the departmental mean. In the 6 month intervention period there was one return to theatre (0.36% of patients). The observed reduction saved the department an estimated £13,831 in length of stay alone.
The standardisation of wound closure protocol, with continued reinforcement to all members of the multidisciplinary team, improves patient outcome in this group. Mobilising a group of clinicians across a variety of specialities, with one common goal, is highly effective for patients, improves multidisciplinary working and reduces cost.
FIND OUT MORE
WHERE THIS HAPPENED: University Hospital Bristol NHS Foundation Trust
Improving staff engagement has become a priority for NHS leaders, although efforts in this area vary between organisations. University Hospital Bristol NHS Foundation Trust (UH Bristol) is a tertiary teaching hospital where concerns about staff satisfaction and communication were reflected in the 2014 staff survey. To improve staff engagement, a real-time feedback mechanism to capture staff experience and to facilitate feedback from local leaders, was developed and piloted using the Model for Improvement. Initially piloted in two areas in January 2015, the Staff Participation Engagement and Communication application (SPEaC-app) was gradually rolled out to 23 areas within the trust by November 2016.
The 2015 staff survey revealed significant improvements in staff motivation, satisfaction with level of responsibility and involvement, and perceived support from managers. These improvements cannot be attributed to this new mechanism in their entirety, but local surveys indicated satisfaction with SPEaC-app, the majority reporting that giving feedback about their shift was valuable while fewer staff had noticed changes in their work area as a result of the comments made via SPEaC-app. Between March 2015 and November 2016, 9259 entries were recorded, with an average of 15 entries per day across all areas. Of the entries, 45.7% were positive and nearly 40% were negative, and ‘team working’ was the most frequent theme.
The project has identified the key factors associated with usability of the SPEaC-app, including, access, location, reliability and perceived privacy of the SPEaC-app. The SPEaC-app is valued and used most by staff in areas where feedback from local leaders is regular, rapid and comprehensive, and where staff comments are acted upon, leading to tangible change. This suggests that strong, consistent local management is required in order to embed it in new areas. SPEaC-app has the potential to support local engagement between managers and their service delivery teams, stimulate tangible improvements in service delivery and support the process of change. Longer term data are needed to determine whether SPEaC-app can influence other factors including staff turnover, recruitment and retention.
FIND OUT MORE
WHERE THIS HAPPENED: Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust
Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Baseline measurements were sought in the form of a questionnaire which allowed us to obtain the limitations to the current handover. After this and a focus group, a new electronic, ‘Microsoft Word’ based handover was created and a repeat surgery issued in 2 weeks. Further PDSA cycles over the course of 8 weeks helped to improve and implement the new handover. The overall rating, out of 10, of the new handover increased from 3.4 to 8. Doctors felt the new handover was safer for patients and could be used as a tool for reviewing or referring patients. This project describes the use of a simple, cost-effective intervention that helped to improve patient safety and staff satisfaction.
FIND OUT MORE
TPP’s SystmOne is being used to provide an integrated care IT solution in West Yorkshire, with Airedale NHS Foundation Trust deploying the system at its hospital.
The trust has been using SystmOne in a community setting since 2011 and in an acute setting since 2012. This has fostered greater integration and information sharing across the two services and other organisations using SystmOne across the region.
The integrated patient record across both care settings has had a dramatic impact on the trust’s performance, particularly when it comes to honouring patients’ end-of-life preferences.
Just 14% of the trust’s patient deaths are in hospital, compared to national average of 48.3%, with 41% occurring instead at home, compared to a national average of 22.4%.
Tony Bates, the trust’s Integrated Health Record & IT Clinical System Manager, said the integrated record had also helped reduce prescription errors and manage medicines stock more effectively.
“What’s unique about SystmOne is the shared record. Being able to seamlessly integrate with other providers, including palliative services, means that all the vital information is available to us as soon as the patient arrives for treatment.”
In the future, the trust plans to further enhance the links across care settings enabled by the SystmOne single-system approach, particularly through strengthening the e-Prescribing links between GPs and specialists.
FIND OUT MORE
ARCHIVES - last 2 years
Request any articles that are not available full-text (there is a charge of £3.00 for this service)
The Health Foundation is an independent charity working to improve the quality of healthcare in the UK
Your Specialty or Professional Group