brindha dhandapani ros swift lewisham healthcare nhs trust

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Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

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Page 1: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Brindha DhandapaniRos Swift

Lewisham Healthcare NHS Trust

Page 2: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Innovative proposals for service redesign across community and acute services following integration of University Hospital Lewisham and Community Health Services in April 2010

To deliver excellent service building on the strengths in both organisations

Lack of coordination of hospital and community services, duplication of services and lack of continuity of care  

Page 3: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Gastro clinic (Gastro/dietician)

Referral received

Review

AssessmentInvestigationManagement

Joint Gastro clinic(Paed/surg/diet)

Referral/LiaisonHEN

Community Paediatrics

S&LT

Discharge

Page 4: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Referral

S&LT Assessment

Comm PaedAssessment

Hosp Paed Dietician HEN Tertiary

Page 5: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

8year old with Cerebral palsy, gastrostomy fed, vomiting, poor weight gain,

Multiple hospital & community appointments

Multiple DNAs Community staff not able to attend

appointments in the hospital No response to change in treatment plan Unable to co-ordinate services to implement

plan

Page 6: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

To provide a co-ordinated approach, through collaborative working between community and hospital services

Improved parent/carer satisfaction Reduce referrals to tertiary feeding service Reduce number of hospital appointments Providing detailed care plans with clarity of

input

Page 7: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

A multi-disciplinary feeding service for children with neuro-disability, ASD, learning difficulties with complex feeding difficulties

  To complement existing hospital based Joint Gastro-

enterology clinic and improve collaborative working

Core team - Dietician, Speech and Language Therapist, Paediatrician (Community /Acute)

Extended team - Specialist Nurse, Occupational Therapist, Physiotherapist, Care- coordinator, (Clinical Psychologist)

 

Page 8: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Children resident in Lewisham requiring;

Multidisciplinary input Poor response to initial advice Extreme parental stress Complex ethical issues 

Page 9: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

3 all day clinics Feb, April and June 2011 12 children 6 children with Cerebral palsy 3 children with Autism 1 child with Chromosomal disorder 1 with Learning difficulties 1 child with congenital infection

 

Page 10: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

All the children had detailed care plans

Six (50%) children had fewer appointments in the hospital

Six (50%) children were discharged from the

hospital clinic to avoid duplication of services

Reduced referral to tertiary feeding services by(7/12) 60%

Page 11: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Ten parents/carers (83%) completed satisfaction questionnaires

Administration of clinic was thought to be Excellent-Good by majority of the parents

  70% thought the appointment length was just right, 30% thought

it was too long  All 10 (100%) said their questions and concerns were addressed

90% said it was useful having health professionals together for the appointment

  60% thought the advice given was useful and practical but 40%

said it was not

Page 12: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

“So nice to have all professionals in one room, bringing information together and leaving as a parent with a plan”

“great having the discussion and plan written and given to me to take away”

“Would welcome more multi team appts” “Good to review matters and to be able to

monitor changes”

Page 13: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

“Wanted more practical advice”

“More advice and information instead of going over things we already knew”

“no new information or advice”

Page 14: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Seven professionals completed questionnaires

All 7 felt the length of appointment was just right

“Co-ordinated approach – most useful” “Saved time liaising with other

professionals” “Works best when the right people are

present- i.e. child’s therapist”

Page 15: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Triage referrals

Referrals received

Multidisciplinary feeding clinicS&LTHosp dietician/Home Enteral NutritionistHosp Paediatrician/Comm Paediatrician

Pre-clinic food diary/information gathering

Discharge Review Support wider team

Care Plan

Page 16: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Improved understanding of roles and services offered

Improved links with hospital and community services

Page 17: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Specialist investigations not available in the

trust e.g. videofluoroscopy

Lack of Psychology input

Different processes across hospital and community services

Page 18: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

To develop the knowledge base and expertise of the feeding team

To improve the overall management of feeding issues in the community/hospital

Potential to expand the service

Page 19: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

◦ Increased referrals might result in increased waiting times and less efficient service

◦ Extra funding and resources

◦ Duplication of assessments if services are not sufficiently well co-ordinated- Admin support

Page 20: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

8year old with Cerebral palsy, gastrostomy fed, vomiting, poor weight gain

Care plan with clear responsibilities Medication administered at school, new feed

regime, equipment sorted Reduced hospital appointments Key worker to liaise with parents and

professionals with guidance from the service Parents and professionals satisfied with

outcome

Page 21: Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

Negotiate Psychology input for the service

Resources for parents and professionals

Training of wider teams

Video-fluoroscopy service