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GP News: May 2012

GP News is your monthly source of information about Ashford and St. Peter's

In this month's edition:

Trust Provides Local Service for Cardiac Ablation

ENT Team Focus on Children

Update on Ambulatory Emergency Care Pathways

Improving the Patient Experience

Dates for Your Diary


Download in PDF format

Download in PDF format
Trust Provides Local Service for Cardiac Ablation

In January 2011, Dr Riyaz Kaba re-established our service to provide a highly specialised treatment, called ablation, at St Peter’s Hospital for patients with heart arrhythmias.

Heart arrhythmias afflict many people, both young and old. Ablation treatment is playing an increasingly important role in the management of these conditions and uses a radio frequency, or similar, form of energy to alter the electrical properties of the heart cells and thereby remove their participation in a short-circuit, which gives rise to many arrhythmias.





Ashford and St. Peter?s Cardiology Consultants L-R. Dr Adam Jacques, Dr David Fluck, Dr Ian Beeton, Dr Riyaz Kaba and Dr Peter Wilkinson



This can often be performed under a local anaesthetic, but we have also recently developed a General Anaesthetic service to enable even more procedures to be performed locally at St Peter?s Hospital. Following ablation therapy, most patients are cured from their SVTs and therefore do not require long-term follow-up. In 2011, out of 378 patients referred by GPs in the North West Surrey/Feltham areas for this treatment, 26% were treated at St. Peters. The success rate for this treatment for the Trust is high.


Indicators for catheter ablation are:

  • Supraventricular tachycardia (SVT) of all types, including atrioventricular nodal reentrant tachycardia (AVNRT), atrial flutter (especially common right atrial forms), Wolff-Parkinson-White syndrome and unifocal atrial tachycardia.
     
  • Atrial fibrillation with lifestyle-impairing symptoms, usually after inefficacy or intolerance of at least one antiarrhythmic agent.
     
  • Ventricular tachycardia (VT).
     
  • Symptomatic, drug-refractory idiopathic inapropraite sinus tachycardia.
     
  • Lifestyle-impairing ectopic beats.


Contra-indications are few, including:

  • Left atrial ablation should not be performed in the presence of known atrial thrombus.
     
  • Left ventricular thrombus is a contra-indication to left ventricular ablation.

Previously our consultants had to refer their patients to various different London Hospitals, including St George?s, Imperial College Healthcare or Royal Brompton and Harefield Hospitals to provide this treatment. Consequently, our local patients, and their cares, often had to travel on long and very inconvenient journeys to these centres. Now we are able to perform many of the procedures here, at St Peter?s Hospital ? and we were first and still remain the only centre in Surrey able to do this, without the need for external support. This enables patients to be treated closer to home, with the added bonus of making it easier for family and friends to visit, while also having a positive impact on expenditure for GPs through the difference in MFF (2012/13: ASPH 1.1700 compared to St. George?s 1.2125, Imperial 1.2417, and Royal Brompton 1.2532).





ENT Team Focus on Children

The ENT Department at St Peters Hospital offers a First Rate Service for children with Ear, Nose and Throat problems.

The team, headed by Consultant Paediatric ENT Surgeon Pandora Hadfield, has improved the facilities and made them more child-friendly.

Regular Paediatric ENT outpatient clinics are run by Pandora, these comply with the new Department of Health National Service Framework for Children Standard which specifies that hospital services should consider ?the whole child? not simply the illness being treated and that the overall experience for the child and family should be integrated and coordinated around their individual needs. Therefore she sees children in dedicated clinics, with trained paediatric nursing and medical staff and age appropriate facilities.

All of the ENT team are happy to accept paediatric referrals to their clinics.





The new Paediatric ENT and Ophthalmology waiting area at St. Peter’s Hospital



The ENT department has recently renovated the Outpatient Clinic and, with the help of Outpatient Matron Di Lashbrook, installed a fully equipped playroom with new children?s furniture, books and toys for the use of paediatric ENT patients as they wait for their outpatient consultations and hearing tests at St Peters.

Pandora has also co-ordinated the writing and publication of specialised departmental information leaflets for the parents of children undergoing ENT Surgery. These explain the practical details and clinical reasons for the proposed surgery, useful contact numbers and advice for care during the postoperative period at home.


Children who need to undergo surgery benefit from a relaxed atmosphere, friendly surroundings and the opportunity to play. A team of experienced staff is also crucial and this positive experience not only enables the child and family to enjoy their stay but also results in less anxiety in the anaesthetic room, reduced post-operative discomfort and a lower requirement for pain relief medication. According to Pandora the caring Paediatric Nurses on Oak Ward at St Peters, together with experienced Paediatric Anaesthetists are experts in ensuring a safe and worry-free admission for the child and their family.

A play therapist on Oak Ward is available to accompany the children and parents to theatre, following a special dinosaur trail along the hospital corridors. The majority of these Paediatric ENT patients are treated as day cases, which is ideal for children, allowing them to return to the security of their own homes the first night after surgery.

Pandora explains ?ENT problems are common in children, accounting for up to half of all paediatric GP consultations and for children who are referred to hospital and those who may need surgery, our aim is not just to ensure excellent clinical care but to make this experience child-friendly, fun and positive for each child and their family?.







Update on Ambulatory Emergency Care Pathways

In the December 2011 edition of GP News, we reported on the progress made with the Ambulatory Emergency Care Pathways, reporting that we had implemented 12 Pathways with a further 5 to be completed.

Since then we have deployed the following 18 Ambulatory Emergency Care Pathways:

  • Acute Abdominal Pain
  • Community Acquired Pneumonia
  • Lower Respiratory Tract Infection
  • Pulmonary Embolism
  • DVT
  • Non-Cardiac Chest Pain
  • Renal Stones
  • Appendicular Fractures
  • Acute Bladder Outflow
  • Gastroenteritis
  • Stroke
  • Lower GI Bleed
  • Cellulitis (Lower Limb)
  • Deliberate Self Harm
  • SVT
  • Atrial Fibrillation
  • UTI
  • Painless Objective Jaundice



Following the successful development of these Ambulatory Emergency Care Pathways, the Trust is now to embark on a new phase of development and implementation of a further set of Pathways.

The long term plan for the Trust is to look to implement all of the 49 recommended AEC Pathways, but the next phase will be focussing on the development and implementation of Pathways based on a directive from the Department of Health, supported by Surrey PCT, which is to introduce a Best Practice Tariff (BPT). This is a national tariff that has been structured and priced to incentivise and adequately reimburse care that is high quality and cost effective. The DH has introduced BPTs for a number of emergency clinical scenarios. The aim is to promote management of these presentations on a same day basis in an "ambulatory emergency care" manner.


The clinical scenarios are:

  • Cellulitis
  • Pulmonary Embolism
  • Asthma
  • Acute Headache
  • Chest Pain
  • Lower Respiratory Tract
  • Infections without COPD
  • Appendicular Fractures not requiring immediate fixation
  • Renal/Ureteric Stones
  • Falls including Syncope and Collapse
  • Epileptic Seizure
  • Deliberate Self-harm
  • Deep Vein Thrombosis (DVT)

The BPT for each clinical scenario is made up of a pair of prices: the higher one is applied to emergency admissions with a zero day length of stay; the lower one to emergency admissions with a stay of 1 or more days. As previously reported, the Trust have already implemented AEC Pathways for most of these clinical scenarios and development has commenced on the outstanding ones, namely

  • Asthma,
  • Acute Headache,
  • Falls and
  • Epileptic Seizure,

which will be implemented over the next three to six months.

A review of all current Pathways? is underway in order to ensure that the Pathways meet the requirements for Best Practice Tariff and in addition, all Pathways will be subject to continual scrutiny in relation to keeping up to date with latest Best Clinical Practice as agreed nationally and via the various Clinical Networks e.g. Cardiac Network.

Further updates will be provided over the next few months, but if there is any further information you require, or any feedback you have, please contact the Clinical Lead for the Project, Dr Gulam Patel via email: gulam.patel@asph.nhs.uk




Improving the Patient Experience

It is the aim of Ashford and St. Peter?s NHS Foundation Trust to work in partnership with our local GPs to provide the most appropriate care for each individual patient at the appropriate time. In order to do this the Trust is in on-going consultation with colleagues and patients to improve referral pathways and communication.

In order to improve the patient experience, two programmes have recently been introduced:


GP Navigator

In order to assist patients in their journey though the emergency system the Trust would like to enlist the help of GPs by asking them to follow a simple referral navigation process: Always send a referral letter with the patient. Always speak to the on-call teams before sending the patient. This can be done via switchboard on 01932 872000. We appreciate that contacting the teams can take time so we are adding some alternative direct lines to the A&E medical teams. One is 01932 723073 and the other will be announced when it is available.

It may be that after informed discussion with a senior member of clinical staff it is decided jointly that the patient does not need to come into A&E to be seen, but advice on immediate treatment is offered and the patient is treated as an outpatient in an urgent clinic appointment. To support this process, emergency appointments have been reserved in a wide range of specialties.


Enhanced Recovery Programme

In order to further improve the patient journey a steering group led by Colorectal, Gynaecology Orthopaedic and anaesthetic consultants has been established. This group aims to ensure that an enhanced recovery programme is followed, whereby patients are informed of their journey at every stage, whether pre-operative, inter-operative or post-operative. This enables the patient to have a better understanding of what they can expect from us and what is expected of them. This clearly supports enhanced recovery and better understanding, and leads to a reduction in complaints and an improvement in outcomes and length of stay.



Dates for your Diary

Date Venue Topic Speaker
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 Mr Samer Humadi & Mr Shashi Irukulla, Consultant Upper GI and Bariatric Surgeons
18/05/2012 PGEC, SPH Dermatology Study Day Dermatology Department
22/05/2012 Oatlands Park Country Hotel, Weybridge Surrey AF Conference 2012 Dr RA Kaba and Prof AJ Camm
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
18/07/2012 Runnymede Hotel and Spa, Egham Tipping the Balance Diabetes and Metabolic Surgery


Please see the events section for further information




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:

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