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This Month's News

Improving Colorectal Services with EQUIP

Guidelines for the use of the Oral Bowel Cleansing Agent Checklist

Nursing Home Project

How To Get involved With EQUIP

Introducing the One Stop Paediatric Allergy Clinic St Peter’s Hospital

Accessing Physiotherapy at Ashford and St Peter's Hospitals

Dates for your Diary April / May

Pathology News

Farewell to Mr Martin Thomas

GP News Feedback Form



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April 2011


Improving Colorectal Services with EQUIP

The entire colorectal team spent four days with EQUIP to reduce the two week rule and 18 week referral patient pathway waiting times.



We will achieve this by enabling patients to be referred directly to endoscopy and those with negative reports will be discharged on the same day . This reduces patient visits as only those with a positive report will need to come back to see the consultant surgeon unless there is a specific request from the GP. We are now piloting an electronic referral tracking system meaning we are able to view and vet referrals on a daily basis allowing us to offer appointments to patients sooner

Mr Jonathan Trickett and Mr Humphrey Scott would welcome the opportunity to meet with GP’s to discuss this. Please contact Mr Trickett’s secretary on 01932 722233 or Mr Scott’s secretary on 01932 722318.



Guidelines for the use of the Oral Bowel Cleansing Agent Checklist (OBCA list)

OBCAs are used before colonic surgery, endoscopy and radiological procedures in order to minimise faecal contamination and optimise views.

In general these preparations are safe and well tolerated. However in February 2009 the National Patient Safety Organisation (NPSA) issued a Rapid Response Report, alerting healthcare providers to the potential risk of harm associated with the use of these agents. These risks included harm to patients where there was a definite contraindication.

Examples of associated harm were; renal failure as a result of phosphate nephropathy; complications of hypovolaemia; and electrolyte disturbances.

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Although there are no reliable estimates of these complications, it is deemed reasonable to put systems into place to reduce risk.

The NPSA Report instructed that safeguards should be implemented at a local level to reduce risk and specifically that all Trusts ensure clinical assessment of each patient for contraindications.


To this end, the ASPH Colorectal team are asking all our GP colleagues to complete the OBCA list for EVERY colorectal referral, not just for those patients where Imaging or Colonoscopy is requested. This will include your clinical review of recent blood tests and some medications including ACE and Metformin. In this way, a safe and timely pathway can be ensured if ASPH staff need to organise an Imaging or Endoscopy investigation for our patients, after an out- patient consultation.

If you would like to discuss this further, contact either Anna Burrows, colorectal nurse practitioner, 01932 723415 or Mr Philip Bearn, consultant surgeon, 01932 723672. Forms are available from Anna or http://nww.asph.nhs.uk/docs/OBCA.pdf.



Nursing Home Project

Nursing home residents tend to be very frail older people with complex pathology who are very dependent, needing complex care needs. These residents will benefit from effective partnerships between primary and secondary care

We looked at 1151 residents admitted from nursing homes at our Trust from April 2006 to March 2009 inclusive. We noted that 3 nursing homes had the highest number of multiple admissions (=4). Four interventions were carried out for a period of 3 months to reduce hospital admissions from April 2010.

Our main processes included, monthly medical advisory meetings with GPs by a Consultant Geriatrician, and availablity for telephone advice on a daily basis.


The results show that geriatrician input into nursing homes reduced emergency admissions by 52%. The inclusion of 3 further nursing homes in Oct 2010 lead to a further 43% reduction in admissions following extension for project. This project has now been extended to 20 nursing homes for an initial period of 2 weeks from 7th March 2011.

For more information contact Consultant Geriatricians: Radcliffe Lisk, Keefai Yeong, Bhaskar Mandal, Zahid Dhakam, Raad Nari or Mike Baxter Medical Director


GP comments:

“Expedited access to both outpatient appointments and inpatient procedures”

"Inside information not necessarily possessed by GPs or the nursing staff”

“Ease of access to consultant advice by mobile phone”

“Education for both GPs and the nursing home staff"

”I found the service very useful and it is helping our staff to look after residents properly”




How To Get involved With EQUIP

We would like to get more primary care clinicians involved with EQUIP. In the coming months, planned pathways include:
  • How to improve Junior Doctor Induction: 4 -6 May
  • Emergency admission avoidance;
  • Outpatient Physiotherapy
  • Endoscopy
  • Medical Records
The last event was enhanced by having a local GP present for part of the time. If you would like to get involved, or have any questions please contact the EQUIP team;

equipadministration@asph.nhs.uk
01932 722893



Introducing the One Stop Paediatric Allergy Clinic St Peter’s Hospital

The aim of the One Stop Clinic is to have skin prick tests done on the day of the clinic.

The child will be seen by one of the doctors to have the skin prick test interpreted. The child will have a written management plan, epipens prescribed and epipen training given during their clinic attendance. Helen Peachy is available for advising children with asthma on inhaler technique, and Melanie Challis is available for dietary advice.

    


We accept referrals from GPs via choose and book: Ashford and St Peter's Hospital Trust (ST PETER'S)-RTK listed under Children’s and Adolescent Services – clinic type: Allergy or paper referral to Dr Haddad or Dr Dawson, St Peters Hospital.

All referrals are seen by Dr Haddad prior to appointments and he may request skin prick testing based on the details of the referral letter. Otherwise the skin prick testing will be requested by the doctor after assessment in the clinic.

We look forward to seeing your patients in the clinic, and hope that you will find this service valuable.


Any feedback about the clinics can be sent to:

Erin.dawson@asph.nhs.uk
01932 723627



Accessing Physiotherapy at Ashford and St Peter's Hospitals

The physiotherapy teams at Ashford and St Peter's Hospitals offer a general musculoskeletal service. There are specialist women’s health and paediatric teams, based at St Peter's Hospital, but both run clinics at Ashford every week. There is also an outpatient amputee walking-school at Ashford.



The general musculoskeletal services at both sites can now be accessed via Choose and Book (see table) or by paper referral, (available on GP extranet). There is also the facility to email referrals to asp-tr.physioreferral@nhs.net

Service Name Clinic Types Hospital Site
General Musculoskeletal
Physiotherapy Service
Musculoskeletal
Not Otherwise Specified
ASHFORD
Musculoskeletal Physiotherapy Service  Musculoskeletal ST PETER’S




 As part of our service objectives for the year, we are working on developing our communication links with local GPs. If you have any suggestions or comments that could help us improve these links, then please email to sally.greensmith@asph.nhs.net we would be pleased to hear from you. 



There is a hydrotherapy pool on both sites which can be used to assist in re-gaining range of movement or early strengthening after orthopaedic surgery or accidents. All patients are assessed on dry-land initially to check their suitability for hydrotherapy. We usually offer a single course of 6 sessions and then recommend patients attend the pool at Teddington Hospital if they wish to continue with their hydrotherapy exercises.

The contact number for the Teddington pool is 020 8977 9911.



Dates for your Diary April / May

We have restarted GP lunchtime meetings at Ashford Hospital. The next event will be 11th May with lunch from 12 30 and teaching from 1pm to 3pm

The meetings will have a varied content including clinical updates, pathways for patient care and a focus on revalidation. 

Dr Coward (GP tutor) is always keen to receive suggestions for further meetings and meet GPs willing to present case histories.

For more details contact beth.coward@nhs.net

DocMan Workshop and Practice Managers Lunch

April 19th 2011 12—2pm

Lecture Theatre on the Ramp, St Peters Hospital,

EVENING SPOTLIGHT SEMINAR: Cardiology

Thursday 7th April 2011, 6.30-9.30pm. The Clubhouse, Foxhills Country Club, Ottershaw, KT16 OEL

A hot buffet will be served from 6.30pm with the presentations beginning at 7.30pm.

Topics include: Current guidelines in Lipid Therapy, Simplifying the complexities of Lipidology, Managing patients with Dyslipidaemia in Primary Care, The Challenging Patient




Pathology News

How are we doing? The pathology department will be sending a user survey to all GPs in March/April.

The Pathology department at Ashford and St Peter's Hospitals NHS Foundation Trust strives to provide our clinical users with a high quality service that is accurate, appropriate, timely, efficient and suited to the needs of the user.

This questionnaire is to enable us to be sure we are achieving these objectives and to highlight any areas we need to look into in more depth. It also forms part of the requirement for laboratory accreditation by CPA (UK) Ltd. A few moments of your time to complete this questionnaire would be very much appreciated.

If you do not receive this survey please contact Elaine Moore and you will be sent one. Elaine.moore@asph.nhs.uk or phone 01932 723424


The ICE roll-out:

Over the past few months the number of ICE generated requests has risen, from fewer than 2,000 in July to over 7,000 in February. The latest analysis of test requests shows that by the end of March, about 40% of them will be ICE generated. The benefits of ICE include:
  •  the ability to see results for patients whose requests have come from the hospital,
  •  the ability to see the status of samples from ICE,
  •  the decreased likelihood of illegible handwritten information on labels or forms
  •  guidance on collection printed on the requesting form which reduces the chance for inappropriate containers to be used
  •  guidance on sample collection printed on the requesting form which reduces the chance for inappropriate containers to be used
For Further information contact: Michael.Buxton@asph.nhs.uk



Farewell to Mr Martin Thomas

Mr Martin Thomas Consultant Vascular and General Surgeon is retiring at the beginning of April 2011 after 27 years in consultant practice.



First at St Peter’s Hospital and latterly in the combined Ashford and St Peter’s Hospital Trust (ASPH). Martin was appointed as 1 of 3 General Surgeons following senior training at St Thomas’ in London. Although he was appointed to take responsibility for vascular surgery, given the small number of surgeons at the time, Martin undertook the full range of general surgery including colororectal work, upper gastric intestinal surgery, breast surgery, as well as thyroid and parathyroid surgery. His on call commitment for emergencies was very heavy in the early days

Martin always foresaw the future and prepared for what was coming. He began multidisciplinary ward rounds which continue to this day. He developed the Julie Andrews Unit for vascular imaging with a huge amount of fund raising to pay for the equipment and salary of a technologist. He pushed for the department to expand and sub-specialise. With the appointment of specialist upper gastric intestinal, breast and colorectal surgeons Martin was generous in giving up this work to the new consultants in order to concentrate on vascular work and in latter years on endocrine surgery.

Martin was a founder member and first chairman of the Surrey Vascular Group (SVG) which began in 1997 and which to this day is the basis of a solid vascular unit at ASPH. . He published and presented papers throughout his consultant career. He taught undergraduate and post graduate courses at St Peter’s and then at St Thomas’ medical school .

Martin combined his professional career with a busy sporting and social life often involving fast cars and ocean going yachts. He also carries with him the kind thoughts and best wishes of many friends and colleagues at ASPH who have enjoyed working alongside him and under him over the years. We wish him all the best for the future.

There will be more information in a future GP news introducing Mr Thomas’s replacement to the successful vascular surgery team of Mr Neil Browning (01784 884688) and Mr Kieran Dawson (01932 723576).