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Introducing The Acute Oncology Service

Enhancing Quality Outcomes

Physiotherapy Departments Enforce Trust DNA Policy

Revised Parking Arrangements for GPs

Dates for Your Diary

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April 2012


Introducing The Acute Oncology Service

In December 2011, Ashford and St. Peterís NHS Foundation Trust established an Acute Oncology Service in line with a nationally led directive.

The service is nurse-led by Dr Barry Quinn, Macmillan Consultant Lead Nurse for Cancer and Palliative Care, in collaboration with Consultant Oncologist Dr Maria Drzymala and a team of cancer nurses. The service consists of a senior cancer nurse who is available between 8.00am and 4.00pm Monday to Friday, and a Consultant Oncologist who is available each weekday morning. Outside of these hours the Trust can get advice from an on-call registrar and consultant at Royal Surrey County Hospital. The benefit of the service is that patients with cancer related problems admitted to A&E and to the wards can be seen more quickly and feel more reassured that their care and correct treatment is being planned and delivered.



The Acute Oncology Team L-R Registered Nurse Emma Bond, Registered Nurse Claire Johnson, Dr Barry Quinn, Dr Maria Drzymala and Registered Nurse Fiona Power.


The service is aimed at patients who may have treatment related toxicities or who may have symptoms relating to disease progression needing unplanned and sometimes emergency treatment. It also aims to ensure that those admitted with a suspected cancer undergo the correct investigations in a timely manner. The service is not designed to replace the 2WW referral procedure and this should be followed for the majority of new referrals where the GP is suspicious of a cancer diagnosis.


Currently between 5 and 9 cancer patients requiring unplanned/emergency treatment are benefitting from this service.

For patients in the above categories the service is designed to compliment and enrich the existing A&E services by:
  • allowing the patients to be seen much more quickly,
     
  • providing targeted care and treatment in a timely manner,
     
  • reducing unnecessary investigations by providing advice and support to non-specialist doctors or doctors in training,
     
  • providing education and training to A&E and ward based nursing and medical staff
     
  • improving care and facilitating a better use of services.

On leaving hospital patients are given the pager number for the on-call senior cancer nurse. Patients already undergoing treatment will already have access to their key worker, and the Acute Oncology Service aims to provide an additional level of support.

This team aim to provide additional advice and support in patient management to help ensure that the patient gets the correct treatment in the most appropriate environment. Working together the GP, community teams and Ashford and St Peterís can continue to strengthen our working relationship in striving to achieve the best outcome for the individual patient.



Enhancing Quality Outcomes

Overview

The Trust has undertaken an Enhancing Quality programme in four areas which has demonstrated increased clinical quality and potential to improve outcomes for patients, according to the first year of official data. This is summarised in SEC Annual Report. The Programme is closely linked to NICE Quality Standards, the Commissioning Outcome Framework and NHS Outcomes Framework. It supports both commissioners and providers to deliver their Duty of Quality.

The programme also supports the consistency of care through the collection and consistent use of clinical process data and analysis of outcomes. This focus on process and outcomes delivers reduced variation in care, better outcomes and improved costs. It is an evidence-based improvement programme that delivers rapid spread and adaptation of existing knowledge to multiple settings through clinical sharing and collaborative learning.

Clinical engagement in quality improvement and collaborative learning has been a major success of the Programme. Events have been well supported by clinical teams and they have attracted national speakers and experts in their field. There has been a positive response to the sharing of comparative quality data and clinical teams have been keen to take the opportunity to describe in detail how improvements have been made. This has been a key component in the rapid pace of performance improvement. This year ASPH FT was one of three Trusts in SEC to be recognised with an award for their contribution to collaborative events.


Programme design and implementation

The Enhancing Quality (EQ) Programme began data analysis with patients discharged from hospital in July 2010. Year One of the Programme is defined as July 2010 to June 2011 patient discharges. ASPH was one of 10 South East Trusts who took part in focused work in four areas. The four clinical conditions for which quality measures exist are:
  • Acute Myocardial Infarction (AMI)
  • Heart Failure (HF)
  • Hip and Knee replacement surgery (H&K)
  • Pneumonia (PN)



Quality Measures

Doctors, nurses and clinical staff across Kent, Surrey and Sussex agreed a number of key things should happen for every patient, which are referred to as clinical process and outcome measures. There are 21 measures described in Figure 1 (enclosed) for four conditions - hip and knee surgery, heart attack, heart failure and pneumonia and their associated outcomes are described overleaf.

During the first year of EQ, the data on individual quality measures within each clinical area was used to create an aggregate score representing overall quality. This score is referred to as the Composite Quality Score (CQS). Another score called the Appropriate Care Score indicates at a patient level those that have received all the measures they were eligible to receive, additionally, outcomes for the same populations are tracked to monitor change over time.


KEY FINDINGS FROM EQ

Looking at the results for Ashford and St Peters over the last 18 months we can report improvements in all pathways:



Significant improvements are reflected in:

Heart Failure
  • Following a Rapid Improvement Event in July 2011, improved integration of services with Community Heart Failure Nurse Services
  • Using a change to our electronic discharge process systems, a prompt alerts and reminds clinical staff to give tailored patient information relating to Heart FailureĖ improvement from 18% in Jan 2011 to 37% of patients receiving discharge information in Dec 2011



Pneumonia
  • Education programme strengthened to improve understanding of local antibiotic guidance and process for taking blood culture prior to administering antibiotics
  • Improved advice and counselling to smokers Ė from 20% in Jan 2011 to 75% in Dec 2011.



Hip and Knees
  • Improved process for assessment and monitoring of VTE prophylactic antibiotics received



EQ is prepared to innovate where there is appetite and support from clinicians and others for intervention to facilitate quality improvement. The strength of clinical support has seen it expand into new clinical areas where there is no existing model of systematic quality measurement. Two new whole system pathways were initiated in 2011; Dementia and community Heart Failure, with Acute Kidney Injury planned for implementation in 2012, results for these will be released at a later date. These new work streams have required measure development as well as development of new methods for data collection.


CLINICAL AREAS QUALITY MEASURES
Acute Myocardial Infarction
  1. (AMI)Aspirin at arrival
  2. Aspirin prescribed at discharge
  3. Angiotensin converting enzyme inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) for Left Ventricular Systolic Dysfunction (LVSD)
  4. Adult smoking cessation advice/counselling
  5. Beta blocker prescribed at discharge
  6. Fibrinolytic therapy received within 30 minutes of hospital arrival
  7. Primary Percutaneous Coronary Intervention (PCI) received within 90 minutes of hospital arrival
Heart Failure (HF)
  1. Left Ventricular Function (LVF) assessment
  2. Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) for Left Ventricular Systolic Dysfunction (LVSD)
  3. Discharge instructions
  4. Adult smoking cessation advice/counselling
Pneumonia
  1. (PN)Oxygenation assessment
  2. Initial antibiotic selection for PN in immunocompetent patients.
  3. Blood culture performed in the A&E prior to the initial antibiotic received in hospital
  4. Initial antibiotic received within 6 hours of hospital arrival
  5. Adult smoking cessation advice/counselling
Hip and Knee Replacement
  1. Prophylactic antibiotic received within one hour prior to surgical incision
  2. Prophylactic antibiotic selection for surgical patients
  3. Prophylactic antibiotics discontinued within 24 hours after surgery end time
  4. Recommended venous thromboembolism (VTE) prophylaxis ordered
  5. Received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to surgery to 24 hours after surgery Outcomes tracked.

  1. Length of stay;
  2. Admission rates;
  3. In-hospital crude mortality;
  4. Readmissions within 30 days.
  5. Complications
  6. Readmissions for Pulmonary Embolus and Deep Vein Thrombosis







Physiotherapy Departments Enforce Trust DNA Policy

Whilst the telephone reminder service introduced in August 2011 has gone some way to reducing DNAs in the Physiotherapy Departments at Ashford and St. Peterís, the DNA rate is regrettably still high in that area.

Part of the reminder service is a function which allows patients to change or cancel appointments which they are unable to attend or which are no longer required.

We would be grateful if you could encourage your patients to make use of this service and allow another patient to take the unwanted slots, which will help us to reduce waiting times and improve the service.

Please also make sure that patients are aware that if they do not attend their physiotherapy appointment they will be discharged and will require a new referral should they wish to be seen at a later date.



Revised Parking Arrangements for GPs

In the past, Ashford and St. Peterís NHS Foundation Trust has issued parking permits for GPs to park in staff parking areas when visiting the Trust for patient visits, lectures or meetings.

The revision of parking areas and the introduction of barrier-controlled patient parking has led to a great improvement in provision of patient parking, which has proved very popular with the patients who no longer have to arrive early for their appointments in order to find a space to park.

In addition, from 1st April 2012 staff will be asked to pay to park, either via an annual permit or by purchasing scratch cards alongside a supporting permit.

As staff parking areas are now at a premium and are generally full, new arrangements have been made to allow us to continue to provide free parking for GPs.


The process will be as follows:
  • GPs should now take a ticket and park in the public car parks (which now have spaces available).
  • The ticket can be exchanged for a free release ticket from Security between 9.00am and 5.00pm, or from the Post Graduate Education Centre.
  • They will be required to show their ID, and numbers will be logged in order to allow the Trust to keep track of the demand.
  • GPs attending out of hours meetings should go to the barrier and buzz.
  • The car parking managers are on site until 8.00pm and the security team is available 24 hours a day.
  • Another alternative would be to collect a release ticket during office hours or at a previous visit if possible.




Dates for your Diary

Date Venue Topic Speaker
20/04/2012 Hazel Room, SPH GP Resuscitation Training Day Paul Wills, Senior Resuscitation Officer, ASPH
08/05/2012 PGEC, SPH Diabetes Management Dr Safdar Naqvi, Consultant Endocrinologist
09/05/2012 Education Centre, ASHFORD Osteoporosis & Vitamin D Mr Chris Schofield, Dr Gulam Patel and Dr David Cartwright
15/05/2012 PGEC, SPH Obesity Management TBC
18/05/2012 PGEC, SPH Dermatology Study Day Dermatology Department
22/05/2012 PGEC, SPH Ambulatory Care Pathways Dr Gulam Patel, Consultant Rheumatologist & Divisional Director for Ambulatory Care
29/05/2012 PGEC, SPH Safeguarding Children Dr Tara Jones, PTC lead GP for Safeguarding Children
30/05/2012 Education Centre, ASHFORD Family Planning & Women's Health Update Dr Tina Peers, Consultant in Contraception and Sexual Health and Dr Louise Carvalho, Specialty Doctor in GU Medicine, ASPH


Please see the events section for further information



Contacts

You have any feedback or require any further information about the Ashford and St Peterís NHS Hospitals Foundation Trust or require this document electronically please contact:

Sue Robertson,
Marketing Manager
01932 722420
Sue.Robertson@asph.nhs.uk

Debbie Beesley,
CAB Manager
01932 723511
Debbie.beesley@asph.nhs.uk