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This Month's News

One Year, No Hospital Acquired MRSA Infections

Pain Management Service

Osteoporosis assessment – bridging the gap

Rheumatology Services at Ashford Hospitals

Welcome To Dr Ali

Pain Clinic Welcomes Dr Anis

Dates for your Diary

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August 2011


The Trust celebrates one year with no hospital acquired MRSA infections!

Ashford and St Peter’s Trust has now gone a record 357 days (as of 20th July 2011) without a hospital acquired MRSA bacteraemia, as defined by a positive blood culture taken more than 48 hours after admission into the Trust. Between April and July 2010 we had 5 such cases. However, 3 were likely to be false positives as the patients responded to antibiotics that would not treat MRSA.

We introduced drastic measures to reduce the risk of further contaminated samples. At the end of August 2010 we introduced a phlebotomy-led blood culture taking system. There was training and competency testing for other staff, as a result of which the numbers of likely skin contaminants in blood cultures has fallen by 80%.

We have also maintained our focus on other potential sources of MRSA bacteraemias such as good insertion and care of intravenous lines and urinary catheters. All of which means we have had no further infections since July 2010. We have had the longest period without a post-48 hour case of all our neighbouring hospitals.

For further information on our infections control services please contact: Dr Angela Shaw, Consultant Microbiologist, 01932 723423 or Linda Fairhead, Consultant Nurse infection control, 01932 722128



Pain Management Service

You may have heard that Dr Kadiwal is taking well deserved retirement after many years work in the Pain Clinic at Ashford Hospital. We wish him a long and happy retirement. We also want to assure you that we continue to offer a multidisciplinary pain management service acknowledging the biopsychosocial nature of pain. We know that single dimensional treatment rarely brings about long term benefits to patients.

Our aim is to transfer patient care from Dr Kadiwal to Dr Anis (For further details, see page 3) with minimal delay, disruption and confusion to your patients. It may be that in order to achieve this some care may be transferred to Dr King, Dr Block, or myself. Please let me know if there are any particular difficulties with this process, and I'll do my utmost to resolve them.


Pain management clinics are currently run at St Peter's Hospital, Staines and Woking leisure centres. In order to improve patient access we plan to run Pain Management Programme courses in Ashford Hospital in the near future, details will follow. We are also looking to expand our range of satellite clinics to include Hounslow.

Surrey PCT guidelines for interventional pain procedures have recently come into force. The impact of these should be minimal to your patients as our clinicians are already working to the highest standards based on the best available clinical evidence.


We would be delighted to visit your practice to meet with you. We can also offer discussions or lectures on Pain Management at your practice or locality meeting. If you would like us to do so, please contact our secretary on 01932 722579.

Dr Ian Hart FRCA FFPMRCA
Pain Specialty Lead
Ian.Hart@asph.nhs.uk
01932 722579



Osteoporosis assessment – bridging the gap

Fragility fractures are defined by a fracture of any site following a fall from standing height. The NHS treats 300,000 fragility fractures annually, including 76,000 hip fractures at a cost to the NHS of £2.3 billion per year. Once a patient has experienced one fragility fracture they are twice as likely to experience further fragility fractures if not treated appropriately.

NICE issued updated guidelines for the secondary prevention of osteoporotic fractures in post-menopausal women (TA161) in Jan 2011. Comprehensive implementation of these guidelines will help to prevent half of all future hip fractures.

There is currently no established local system whereby patients presenting with non hip fractures are assessed for osteoporosis. A small number of elderly patients who are discharged from fracture clinic or A&E will be assessed by the GP providing it is clear from the clinic letter that a fragility fracture had occurred.


To address the issue, a trial was undertaken April – July 2010 to improve the assessment rate for patients over the age of 50 presenting to A&E or fracture clinic with a fragility fracture. For these patients a letter was sent to their GP requesting osteoporosis assessment (with guidance for that assessment). The patient also received a letter requesting they make a non-urgent appointment with their GP for this assessment.

At the end of the trial 45% of patients had been assessed as per the guidelines. This represents an improvement in the percentage of patients assessed compared with the “National Audit of Falls and Bone Health in Older People” (May 2011). Empowering patients appears to improve the chance of a patient being assessed or treated for osteoporosis but the majority of patients remain at risk.


One of the key messages from the National Audit is that a Fracture Liaison Service (FLS) is essential to close the management gap for secondary prevention of osteoporosis.

The FLS was first introduced in Glasgow in 1999 and is a nurse led osteoporosis clinic which offers a comprehensive mechanism for the treatment and assessment of patients who have had a osteoporotic fracture. They can now demonstrate a 97 – 99 % assessment rate for their patients. This has lead to a 7.3% reduction in hip fractures compared to a 2% year on year increase elsewhere in England and Wales.

ASPH is currently exploring the option of establishing a FLS. This service would ensure that all fracture patients over the age of 50 would receive the appropriate investigations and assessments at the point of contact. Until this becomes operational it is essential we remain vigilant in identifying patients with fragility fractures and offering them assessments and/or treatments as required.


For further information on the trial or the osteoporosis assessment guidelines please contact:

Dr Keefai Yeong
Consultant Geriatrician
Keefai.yeong@asph.nhs.uk
01784 884246




Rheumatology Services at Ashford Hospitals
  • Arthritis and musculoskeletal conditions affect 1 in 5 of the UK population
     
  • At Ashford Hospital the average waiting time from GP referral is 40 days (less than 6 weeks), well below the 18 week target.
     
  • To support the consultant led clinics there are also 5 specialist nurse led outpatient clinics.
     
  • Both the consultant and specialist nurse led clinics run at Ashford Hospital on Tues – Fri am, with 2 clinics running simultaneously on Thursday mornings.
     
  • In addition, the rheumatology service supports two helpline numbers. The advice line number for patients who are experiencing a disease flare up is 01932 722703.
     
  • The GP enquiry line for general enquires and results is 01932 722396.



Welcome To Dr Ali

Mr Tahir Ali, MBChB MS (Lon) MRCS (Eng) FRCS (Gen). Mr Ali is a substantive General and Vascular Consultant Surgeon at both Ashford and St Peter’s Hospitals NHS Foundation Trust and Epsom General Hospital.

Mr Tahir Ali

Tahir graduated from Leicester University Medical School and completed his postgraduate general surgical training in London.

He is a fellow of the Royal College of Surgeons of England and has been awarded a Master of Surgery degree from the University of London for his research into improving outcomes following venous thrombosis. Following completion of his training, Mr Ali was awarded a national fellowship at Guys and St Thomas’ Hospital to undertake further specialisation in interventional radiology and endovascular surgery.

Mr Ali has published and presented both nationally and internationally. His main clinical interests include endovascular surgery, lower limb revascularisation, diabetic limb salvage, abdominal and thoracic aneurysmal disease, venous ulceration, minimally invasive laser therapy of varicose veins, varicose vein surgery, sclerotherapy for venous anomalies, lymphoedema, key hole surgery for hyperhidrosis, thoracic outlet syndrome and carotid artery surgery for prevention of stroke. In addition, Mr Ali also undertakes a range of general surgical procedures including open and laparoscopic hernia surgery, day case surgery and laparoscopic cholecystectomy.


How to Contact Dr Ali

tahir.ali@asph.nhs.uk
sec: 01932 722232 or mobile 07779271851.


How to Refer

For Choose and Book Mr Ali’s clinics can be found under general surgery and vascular surgery. Mr Ali is also available as a named consultant.



Pain Clinic Welcomes Dr Anis

Saad Anis is the new consultant in pain management. He is a graduate of the University of Liverpool and completed his post graduate education in London.

Dr Anis

Dr Anis trained in anaesthesia at Barts and the Royal London Hospital before choosing to specialise in chronic pain management. Saad’s pain management training was undertaken at Basildon University Hospital, and his Advanced Pain Training at the Heart of England Trust. He is a Fellow of the College of Anaesthetists of Ireland and has a BSc (Hons) in Human Biology.

Dr Anis is an extremely dynamic consultant with a keen interest in the biopsychosocial model of pain management. He has been published in peer review journals and presented at both national and international meetings.

He has a keen interest in medical education and is completing a post graduate certificate in medical education from Staffordshire University.


How to Contact Dr Anis

Saad.Anis@asph.nhs.uk


How to Refer to Pain Management

Paper or fax referral to named consultant Dr S. Anis or his colleagues Dr R. Block, Dr A. King or Dr I. Hart. Fax: 01784 884291

For Choose and Book clinics can be found under : Service: General Pain Management and Clinic: Pain Management



Dates for your Diary

ASHFORD HOSPITAL GENERAL PRACTITIONER LUNCHEON CLUB AUTUMN TERM 2011

Ashford Education Centre 1pm to 2:45pm,
Sandwich lunch from 12:30

To register please contact Gladys Essien gladys.essien@asph.nhs.uk 01932 723987
Thursday 8th September Investigating Bowel Problems –direct to test colonoscopy; barium enema, CT colonoscopy Speaker TBC
Coeliac Disease Dr Sohail Butt
GP Ashford
Prescribing Update PCT Pharmacists
Wednesday 5th October Programme TBC
Thursday 10th NovemberSpotting the sick child - managing acute respiratory infections. Dr Bhatti
Paediatric Consultant ASPH
Using Antipyretics PCT Phamacists
Safeguarding Children Dr Tara Jones
PCT lead GP for Safeguarding Children
Wednesday 7th December Dementia - Legal Issues, Consent and Capacity Dr Rejin Dayandanan
Consultant Psychogeriatrician
Prescribing in Dementia PCT Pharmacists and Dr Dayandanan
End of Life care in the community Dr Fiona Bailey
Consultant in Palliative Care ASPH

ST PETER’S GENERAL PRACTITIONER LUNCHEON CLUB AUTUMN TERM 2011

TUESDAYS 12:15pm – Lunch, 1-2 pm – Meeting
Post Graduate Education Centre, St Peter’s Hospital.

Details will be circulated when available.

“The Contemporary Approach to AF Management” presented by Dr Riyaz Kaba
This event will now take place on Thursday 17th November at 6.30pm in The Lightbox, Woking

Not 21st September 2011 as previously advertised.

To reserve a place please contact at caroline.simpson@asph.nhs.uk or 01932 723716

This seminar is kindly sponsored by AGA Medical Ltd



Contacts

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

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

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