from national guidance to local implementation
TRANSCRIPT
UNIVERSITY HOSPITAL SOUTHAMPTON SEVEN DAY SERVICES
FROM NATIONAL GUIDANCE TO LOCAL IMPLEMENTATION
DR CHRIS ROSEVEARE – CONSULTANT PHYSICIAN IN ACUTE MEDICINE: [email protected]
DR JULIANE KAUSE – CARE GROUP LEAD, EMERGENCY MEDICINE: [email protected]
UNIVERSITY HOSPITALS SOUTHAMPTON NHS FOUNDATION TRUST
‘A consultant presence should be maintained on the AMU for a minimum of 12 hours per day, 7 days per week’
HOW MANY CONSULTANTS?
Approximate
number of beds on
AMU
Number of
admissions per
24hrs
Approx. Number
of patient
contacts 8am-
8pm
No. consultant
equivalents req’d on
the AMU 8am-8pm
<30 ≤ 25 ≤55 1 - 1.5
30-50 25-44 55-89 1.5 – 2
51-70 45-60 90-135 2 – 3
>70 >60 >135 >3
Source: RCPL Acute Care Toolkit 4 October 2012
CURRENT AMU STAFFING LEVEL
%
PREVIOUS ARRANGEMENTS FOR AMU CONSULTANT STAFFING
• 1:11 ON-CALL ROTA
• SINGLE AMU CONSULTANT – APPROX. 6 HOURS PRESENCE (0.3 PA)
• MORNING AND AFTERNOON WARD ROUND (8-12, 4-6)
• REVIEW OF ALL PATIENTS ADMITTED OVER WEEKEND (75-80% IN <14HRS)
• SELECTIVE REVIEW OF EXISTING IN-PATIENTS ON AMU
WEEKEND DISCHARGE RATES 2008-2011 %
NEW ROTA FROM NOVEMBER 2014…..
• 10 CONSULTANT ROTA (8 ‘ACUTE PHYSICIANS’)
• 12 HR/DAY SPLIT WEEKEND
• 1 PA PER CONSULTANT (PREVIOUSLY 0.3PA)
• 5% INTENSITY SUPPLEMENT
EARLY RESULTS ENCOURAGING….
• 92% PATIENTS SEEN WITHIN 14 HOURS OF ARRIVAL ON AMU (88% WEEKDAYS)
• ALL PATIENTS REVIEWED ONCE DAILY
Fewer weekday consultant hours
on AMU
EARLY RESULTS ENCOURAGING….
• 92% PATIENTS SEEN WITHIN 14 HOURS OF ARRIVAL ON AMU (88% WEEKDAYS)
• ALL PATIENTS REVIEWED ONCE DAILY
Twice as many weekends
patient
Leadership
Communication
strategy
Clinical outcomes
The plan
LEADERSHIP
• ORGANISATIONAL SUPPORT FROM TRUST BOARD FOR LEADERSHIP AND
SUSTAINABLE LONG TERM PLAN
• SELF ASSESSMENT TOOL PROVIDES OPPORTUNITY TO ASSESS IMPACT
• IDENTIFY ORGANISATIONAL LEAD – WITH PROTECTED TIME TO CARRY
OUT THIS WORK – 2 DAYS PER WEEK MINIMUM
• HARNESS PERSONAL ENERGY – THERE ARE MORE ENTHUSIASTS IN YOUR
ORGANISATION THAN YOU THINK
• LOCAL LEADERS: CLINICIANS, DEPARTMENTS
HAVE A PLAN
• UHS HAS 3 YEAR PLAN, STARTED JUNE 2013
• TRIAGE APPROACH TO PLANNING YOUR SERVICE:
• TRUE EMERGENCIES VS ROUTINE WORK
• HOW FAR SHOULD WE GO?
• SERVICE NEEDS TO BE AVAILABLE TO ALL THOSE WHO NEED THE SERVICE BUT NOT
NECESSARILY IN ALL LOCATIONS, EG WEEKEND OUTPATIENT SERVICES
• LONG TERM AND SUSTAINABLE, CAREER PROSPECTS
• IT SYSTEMS TO SUPPORT SEVEN DAY WORKING
CLINICAL OUTCOMES
• CURRENT OUTCOMES
• DESIRED OUTCOMES
• DO IMPACT ASSESSMENT AND TRIAL OF PRACTICE CHANGE BEFORE LARGE INVESTMENTS
• OUT OF HOURS MULTIPROFESSIONAL SERVICE: ADVANCED NURSE PRACTIONERS, PHARMACY,
MEDICAL ASSISTANTS, IT SYSTEMS
• AMU, ASU AND PAU EXTENDED SEVEN DAYS A WEEK CONSULTANT DELIVERED SERVICE AND
RESTRUCTURE
COMMUNICATIONS STRATEGY
• SHARE THE PLAN WITH ALL STAFF AND PATIENTS
• PATIENT ENGAGEMENT
• QUESTIONNAIRES
• EDUCATION
• CELEBRATE SUCCESS
• TIP THE BALANCE TOWARDS SEVEN DAY SERVICE
• CHANGE PERCEPTIONS