February 2015 . Issue 12
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Pride Taking
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For staff, members, patients, visitors & volunteers
Connecting our care
Healthcare in Derby - as in the country as a whole - is changing faster and more completely than ever before. Rapid breakthroughs in medical technology and treatments are opening up bigger opportunities to improve the quality of our care to a growing population. In order to take advantage of every one of these new opportunities we are thinking differently about how we work. We are adopting big changes in the way we offer healthcare. This will only expand in the next few years. In this issue of Taking Pride we will look at how we are building “Hospitals Without Walls� and expanding our services across the community. We will look at how our staff are changing the way they work, working in new ways and at new places, often bringing care out to where patients are. And we will see what this means to our patients, how they will get the best healthcare they can in the way which most benefits them.
In this issue
Helen Scott-South, Chief Operating Officer at Derby Hospitals
Our vision for the future
Caring for our older patients
The future of surgery
We want your ideas
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Our vision for the future The number of people coming to our hospitals is rising. In December 2014 we saw 11,500 people come to A&E alone - that’s more than 20% higher than the previous year. Add to this the number of people being referred to the hospitals by their GPs and the number of people admitted for long-term conditions and you have a lot of people in need of our help. There are several reasons for this increase in patients, including: Higher numbers of older patients, with medical advances helping more people live longer A reduction in local services giving support to older and more vulnerable people in the community A national shortage of GPs prompting people to head straight for the hospital
Across our hospitals we have only a certain number of staff and a certain amount of space. This means that it will only get harder to treat people as the number of people coming to us goes up. So to make sure we can give the best possible care to our patients, we are changing the way we provide that care. We are looking at the way we, and all the other health and social care organisations across Derbyshire, are caring for people and making sure we are all working effectively and all working together.
We are, in short, transforming and this transformation involves everyone, both patients and staff. In this issue we will show you how we are transforming, how the changes are being carried out and what changes have already been made throughout the Trust. We will also show how you can help make this transformation happen.
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Hospitals Without Walls - our five-year vision So how will our hospitals and community services transform? And what will they look like in five years time? Andrew Hall, Deputy Chief Operating Officer for Derby Hospitals, outlined this vision. He said: “The idea is to make sure that people coming to hospital genuinely need to come to hospital. We will continue to provide the highest quality specialist surgical and medical services here, services which can only be performed at the hospital. “But we are looking to provide more and more of our services out in the community, where it is more convenient for patients. We want to be more flexible in where we work and to connect what we do with what other healthcare providers around the region are doing to create a consistent, convenient network of care for patients.”
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Some of the hospital services which will begin to take place more in the community, in patients’ homes and at local GP surgeries, include n Blood tests n X-rays and scans n Intravenous antibiotics n Ongoing diabetes care n Blood dialysis for kidney patients n Dermatology services n Simple procedures like ear-syringing
Andrew explained that these changes would give staff fresh opportunities and more variety in their roles. He said: “Work within the NHS is changing. We will have staff who have been based primarily in the hospital moving out into the community, spending time out in GP surgeries and also going to patients’ homes.
“But this means greater variety in the job. And it also means being able to give continuous care to a patient, to follow them through their journey rather than passing them off to a different department. “I think that over the next five years we will see an ever greater need for more staff in the NHS across this region and that means a lot of new opportunities for people looking for a career in healthcare.”
Derby Hospitals NHS Foundation Trust
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The Transformation team In Derby, we have realised that the best ideas about how we can work better and more efficiently come from those people actually doing the jobs each and every day: doctors, porters, nurses, therapists and midwives to name a few. Over the next few pages we will look at some of the transformation projects which are already having a positive impact on the quality of care we provide. They involve different areas of care but have one thing in Enhanced Dis common: they are all ideas which originated from charge our frontline staff and clinicians. Giving patie To help facilitate and implement the ideas you have about our healthcare, we have created a team of specialists. Led by Chief Operating Officer Helen Scott-South, the Transformation team es Elective Procedur are here to listen to ideas Unit from staff or patients about ys after treatment Shorter hospital sta how our services could be changed for the better. Their role is then to help develop these into the basis of real, long-lasting high quality services that are better for staff and patients.
nts confidenc e to look after themselves wh en they go ho me
“No one had ever explained my med before and I now ication the things I need know to focus on. This time it has been completely diffe rent, and I feel so reassure d.”
More than 50% of patients supported with our enhanced disch arge care do not return to hospital for emergency trea tment.
“ The team were and friendly and kind looked after me very well whilst in their care.”
nts a year 5,000 more patie hours go home within 24 of their procedure.
The team also offer opportunities for staff to work with the team in a secondment position, working on a transformation project for an extended period of time, making sure each project has input from all levels of the workforce. The projects overseen by the team cover planned care (planned surgery, day cases, GP referrals); unplanned care (emergency, urgent and unexpected treatment); and integrated care (community care, rehabilitation, therapy, district nursing etc).
If you have any comments or suggestions on how we can improve Taking Pride please email dhft.communications@nhs.net or call 01332 785778.
Frail Elde Personalise
rly Assess ment Team
d care and support fo r frail elderly pa tients
70% of eld erly patien ts go home on day after see the same dedicated ing our team of specialist doc tor s, nurses, the rap social worke ists and rs.
“I didn’t hav e to stay in hospital. I saw everyo ne I needed to on and they hel the same day ped me to back hom get e again.”
Turning ideas into reality While the Transformation team actually co-ordinates these projects of change, it is working as closely as possible with staff across our hospitals to generate new ideas about how we can work better. One of the ways they have done this is by holding Rapid Improvement Events (RIE). Organised by the Transformation team, these weeklong events mix our staff with people from health organisations across the county to consider how to improve certain areas of care. Last year we held an RIE looking at integrated therapy. Therapists from across the Trust worked with their peers and with staff from other local organisations to discuss and progress their own thoughts and ideas to bring about improvements, as well as those of patients and colleagues. We also held an RIE about Integrated Locality Care, inviting the local ambulance service, mental health providers and social care workers. We found that some dementia patients can see up to 42 different carers in one month - far too many for the patient to feel consistently well looked-after. As a result we have looked at how these handovers can be reduced and improved communication technology between different care providers.
More Rapid Improvement Events will be held this year, so get involved and share your ideas. www.twitter.com/DerbyHospitals
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Connecting care:
Frail and elderly patient assessment We have seen a big rise in the number of older people we treat. Older patients often require the most care and the more we improve our ability to treat illness, the more this group of patients will expand. It is vital, therefore, that we as a hospital work closely with health care organisations across the community to not only treat older patients quickly and effectively if they come to the hospital but to work to help them avoid having to visit the hospital in the first place. To help achieve this, we have developed two services:
1 The Rapid Assessment Service At London Road Community Hospital, we have a specialist clinic to treat older patients with falls. We have redesigned the service with the local health community, focusing on detecting and preventing falls from happening in the community. We have increased the size of the team and enabled telephone consultation between the LRCH service and Department of Elderly Medicine (DME) consultants at the Royal Derby Hospital. As a result, the Rapid Assessment Service is seeing nearly twice as many patients as before and has cut the waiting time for an older person’s fall assessment from six weeks to 48 hours.
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2 The Frail Elderly Assessment Team If we know that a patient is frail and at risk of readmission, we need to give them specialist care to help make sure that when they leave the hospital, the right care is in place back in the community. To help make this happen on a wider, better scale than ever before, we have developed a Frail Elderly Assessment Team, based at the Royal Derby Hospital’s Medical Assessment Unit. The team is made up of different specialists, including nurses, physiotherapists, occupational therapists, with access to staff in mental health, social care, pharmacy. This means that once a patient comes into hospital and is identified as frail, they will be looked after there and then by experts who will also ensure best arrangements for the patient after discharge.
View from the floor I am a therapist working as part of the FEAT team and previously patients would have to see so many different people; it is really rewarding to be able to be a single point of contact and get to know a patient that way. “Also, far more people who need therapy are being spotted much earlier so we can help stop problems becoming more serious. “I think the extra services we now have available outside the hospital are much wider than before. There is now a sense that we are all parts of a larger jigsaw, specialist pieces which go together to make a wellconnected whole.” Ellen Wright, Occupational Therapist
The creation of the team has led to many more patients being identified as frail and more than 70% of those patients being able to go home on the same day after being seen by the FEAT team, with appropriate treatment and community support in place.
Derby Hospitals NHS Foundation Trust
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Connecting care:
Home IV Service For years, patients who needed antibiotics via an IV drip had to be admitted in hospital for around two weeks to get their treatment. But there is no real reason why many of these patients need to do this: it would be far simpler, more convenient and comfortable to be given the treatment at home. As such, we have worked with our community teams to deliver a home IV service. Backed by a team of microbiologists, therapists and pharmacists at the hospital, the service sees district nurses making regular visits to patient’s homes and overseeing the administration of antibiotics. At the moment, an average of 30 people are being discharged from the hospital each month to receive the home IV service. If they had been admitted to hospital, they would have stayed an average of 14 days each, which means that the service saves about 420 days in a hospital bed. Each day a patient spends in a hospital bed costs an average of £250 - including things like food, linen, cleaning and electricity, among other things - which means the home IV service is roughly saving us about £105,000 a month, or about £1.26 million a year.
Technology Transformation Another innovation which is helping to improve patients’ experience of care in their own homes is the use of Skype technology. Skype is a free phone service which allows two people to chat via a video-link across the internet. It is being used here in Derby by our renal team, allowing patients who have regular dialysis to do so using machines in their own homes, all the time having easily-accessible contact with specialist teams at the hospital.
But the saving isn’t a cash one in this way - it simply means that those beds are free for patients with more urgent and complex care needs, which means a more efficient system with smaller waiting lists and fewer delays. It means, in short, that we can provide a higher quality of service to a larger number of people - and it is precisely these kinds of changes we will be making across our Trust in the coming months and years.
It is a strong example of how technology is enabling high quality care outside the hospital, within the community, improving patient experience.
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View From The Floor Adele Morrison, Intermediate Care Sister
I have worked in the community for ten years and I’ve always felt the care we can provide in patients’ homes is much more personalised. “I enjoy the variety of working in different places each day. More and more staff are now going out to patients’ homes and the feedback has been really positive. Being at home gives patients a huge benefit both physically and mentally.”
www.twitter.com/DerbyHospitals
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Connecting care:
The Children’s Observation Unit Every patient who arrives at adult or children’s A&E should be seen, treated and either admitted to a hospital ward or sent home within four hours. That is the target time set by the government for NHS trusts across the country. But what if the patient has a condition which could be treated in eight hours? Or six? With younger patients especially, it is common that they need longer than four hours to be sure they are well enough to go home, or for their parents to be able to come and collect them. Previously, a child staying more than four hours would have had to be admitted to a ward, triggering paperwork, a handover of staff and a transfer, no matter how long or short a period of time they eventually stayed. The use of a ward bed would also reduce the available space for further admissions, leading to delays for other patients.
The unit can also be used to conduct quick reviews with children who have previously been in A&E and who doctors feel need a follow-up check by an emergency consultant, once again avoiding an unnecessary admission. In 2013, between March and December we saw 22,365 patients in children’s A&E. Of those, we admitted
3,035. But for the same period in 2014, with the opening of the observation unit, although we saw more patients - nearly 24,000 - we only needed to admit 2,483. That’s a 20% reduction in admissions overall and with one average children’s ward admission costing about £1,141, the creation of the unit has led to substantial savings.
In order to alleviate this issue, we created the Paediatric Observation Unit in April last year. It is a five-bed unit for children whose treatment will take only eight hours or less. Children who use the unit are cared for by the same doctor from beginning to end, which can reduce the stress of a hospital visit. The unit is sited right next to the children’s A&E department, which means easy access and use of the unit avoids an overnight stay. n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
View From The Floor Emma Underwood, Registered Nurse
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What’s really nice for me is that by working on the Paediatric Observation Unit, I get more variety. It feels a lot more like working on a ward, which I miss when in children’s ED. You get to see patients right through their stay and build their trust. “A lot of times in ED, when you are up against the four hour target, you can end up admitting people you know won’t need a bed for very long. That’s frustrating because you know the effect it will have for the hospital. But now we can bring those young patients into the observation unit, it’s better for them and for us.”
Derby Hospitals NHS Foundation Trust
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Connecting care:
Surgical theatres The changes we are making are not only about working more in the community. We are looking to make those services we offer within our hospitals as high quality and efficient as possible. Some of our highest-profile work takes place in our surgeries. Our highly-skilled surgeons perform complex work which can transform lives. To make sure we can treat as many people as possible, we have assembled a team of specialists to improve the way we carry out surgery. The first improvement we made was to create a Theatre Dashboard - a piece of software which tracks how efficiently we are using our operating theatres by looking at start and finish times and the number of patients we are operating on. This data is inputted live from theatres during operations and can then be accessed by all our surgeons. This lets us see where improvements can be made and how best to schedule operations. With surgery time costing ÂŁ35 every minute, it is vital we are as efficient as we can possibly be in each of our 35 operating theatres.
Combined with this is the creation of our Elective Procedures Unit. This 24bed area has been created especially for medical and surgical patients who will only need to stay in hospital for one night. Rather than be admitted to a full ward, they come here, where consultants and nurses ensure they have an early discharge the following morning, making sure there is always bed-space available for patients coming out of surgery. In addition, we are offering patients the opportunity to fill in their preoperation paperwork online either in the hospital or at home. This will help us make quick decisions on when - or even if - a patient needs a pre-operation appointment.
Barcode Scanners One innovation developed by the Trust which has already attracted national acclaim is a barcode scanner system for use in surgical theatres. The devices are used to track the medical equipment used, time taken and staff needed for each operation undertaken at the Royal Derby Hospital. The technology to scan stock barcodes is available in many hospitals across the country. But Derby is the first Trust to combine the system with the barcodes which appear on wristbands worn by patients during their hospital stay. These barcodes identify the patient and allow the software to create a record of each patient’s operation. This record shows which staff were in theatre during the procedure, how long the operation took, precisely what equipment was used and how much it all cost. The software then automatically re-orders the used equipment, according to preset stock limits. This has led to stock-taking procedure time being reduced from two days to half a day. The scanner also flags up if any equipment is out of date, improving patient safety. Since its introduction in March, the technology - developed by a team of consultants, finance, procurement and theatre staff - has saved the Trust at least £10,000 a month. The innovation has also been recognised at a national level, winning the Costing award at the 2014 Healthcare Financial Management Association awards.
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Derby Hospitals NHS Foundation Trust
A lightbulb moment More than anything, the most important thing we have to help transform our services for the future is you. Both staff and patients, at all levels and in all areas, are in the best position to see how we can improve the way we work. Patients can give us valuable feedback on the care they received and describe to us the care they would like to receive.
A Breath of Fresh Air It was a simple idea, had in the middle of the night, at home, which led respiratory consultant Dr Gillan Lowrey and her team to win a regional award and potentially change patient care across the country. Excessive amounts of oxygen can be dangerous for some patients and Dr Lowrey felt that it was not always clear how much oxygen should be given to each patient - a potentially harmful confusion.
They instantly made it obvious, for every staff member involved in a patient’s treatment, how much oxygen they should be providing.
So, in bed one night, she hit on the idea of using colour-coded rubber wrist bands to make it clear how much oxygen should be given.
The bands were developed and trialled by Dr Lowrey and her team and last year the innovation helped them win the Team Award at the East Midlands Innovation in Healthcare Awards.
These were cheap to make, easy to identify and could be given to any patient.
They are now in use across the hospital, with other trusts interested in employing the idea.
And staff will be fully alive to the pressures of providing modern healthcare and able to spot ways we can work more effectively and provide higher quality. To submit an idea you have had about any aspect of the healthcare we provide, drop an email to
dhft.lightbulbideas@nhs.net or visit the Lightbulb pages on flo. n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
NHS CHANGE DAY
NHS Change Day will be held nationally on March 11 this year. The campaign encourages people working in the NHS to submit ideas for better practice, share any tips or experiences and come up with actions they will promise to carry out in the coming year. There will be Change Day information sites across Derby Hospitals on March 11. Visit www.changeday.nhs.uk/
Do you want t challenge the status quo? Don’t be afraid to rock the boat a little
Your chance to make a difference Do that thing you see needs doing and turn your lightbulb moment into an idea.
Get your idea heard on for staff/lightbulbideas G16370/0115