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First Gastric Bypass Surgery for Ashford and St Peter’s

Gold Standards Framework Pilot for Fielding Ward

Ophthalmology EQUIP Event

Physiotherapy Services Update

Ambulatory Emergency Care Pathway Project

Dates for your Diary

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October 2011


First Gastric Bypass Surgery for Ashford and St Peter’s

Last Friday, consultant surgeon Mr. Samer Humadi and his team at Ashford and St Peter's hospitals, undertook the Trust's first ever gastric bypass operation.

This represents a significant development in specialist weight loss surgery offered by the Trust and means they will be attracting patients from a much wider catchment area for this specialist service.

Mr Humadi explains more: "We have a long history of successful weight loss surgery here at the Trust, but in the past this was limited to just two of the forms of surgery - gastric banding and gastric balloons.

With additional skills in our team we are now able to offer the full range of weight loss surgery including gastric bypass and gastric sleeves, both of which are much more complicated and severe operations than gastric banding.

Gastric bypass is undertaken using keyhole techniques and helps to significantly reduce health risks commonly associated with obesity such as diabetes and hypertension. It also reduces excess weight for patients by an average of 60 to 70%."



L to R; Consultant bariatric surgeons Dr Shashi Irukulla and Dr Samer Humadi, Matron Terri Hess, Sister Natasha Smith, Staff Nurse Emma Keenan, Deputy Sister Trisha Smith and Healthcare Assistant Sam Sparling


A gastric bypass involves creating a small pouch within the stomach which is then detached from the main part of the stomach and reattached to part of the small bowel. The main part of the stomach is therefore bypassed creating a restrictive effect, reducing the amount that can be eaten and also - by bypassing part of the small bowel - reducing the amount of calories, protein and minerals that can be absorbed.

Mr. Humadi's first gastric bypass patient at the Trust was Charlotte Simmons, who is from Isleworth. Charlotte underwent the complex surgery last Friday and thanks to the specialist keyhole techniques used, was up and about and ready to go home from hospital on Monday.

Said Charlotte: "The care here at St Peter's has been great, and the doctors and nurses have been absolutely amazing. This has been a long process but I've been able to get through it with the support of my family and friends.

I was quite nervous about the operation but now I'm excited about the future and about being a regular Mum to my two year old son Oliver, taking him out to the park and having fun with him."


Ashford and St Peter's Hospitals NHS Foundation Trust is the only designated provider of weight loss surgery in Surrey and is now expanding their specialist service into Hampshire and Berkshire. The Trust is also creating a new dedicated bariatric unit at St Peter's, with work due to start in October and the new unit expected to open in early November.



Gold Standards Framework Pilot for Fielding Ward

The Gold Standards Framework (GSF) has been used in primary care for quite some time, with GP practices using it as a means of supporting End of Life Care patients.

GSF is a systematic approach to formalising best practice, so that quality end of life care becomes the standard. It helps clinicians identify patients in the last months of life, assess their needs, symptoms and preferences and plan care on that basis, enabling patients to live and die where they choose. GSF embodies an approach that centres on the needs of patients and their families and encourages inter-professional teams to work together, reducing hospitalisation by reducing length of stay, improving rapid discharge and avoidance of inappropriate re-admission.

The National GSF Team has recognised that cross boundary care, personalised and responsive to the individual requires engagement with all care providers. The team identified that this includes secondary care and so has developed a new training programme for acute hospitals (GSFAH).



Dr Keefai Yeong (2nd from left) and members of the GSFAH team on Fielding Ward


Phase 1 of GSFAH began in September 2009 with training from February 2010. There were 16 sites nationally who participated in this phase. At ASPH, we are very pleased to have been accepted to participate in the second phase; beginning September 2011. The project will involve those appropriate patients under the care of Dr. Keefai Yeong and in-patients on Fielding Ward, Ashford Hospital.

We are hopeful that this project will help highlight those patients who may require inclusion on the primary care GSF registers, identifying their future needs and communicating any care plans to those responsible for their care at home. We hope that this will support End of Life Care patients and their families during the transition from secondary to primary care.


If you would like any further information, please contact Karen Cook, Macmillan Lead Nurse Palliative Care for ASPH NHS Trust on: 01932 72 2312 or go to: www.goldstandardsframework.org.uk



Ophthalmology EQUIP Event

The Ophthalmology Department at Ashford and St. Peter’s was involved in an EQUIP event from 19th - 21st September 2011.

The remit of this event was to look at capacity and demand with the aim of reducing waiting times for Outpatient appointments and making more slots available through Choose and Book, providing further support for patient choice.

In addition to this a number of ways of improving the experience of the service for patients on the day of their appointment were suggested and many of these will be trialled over the next few months.

These changes will be introduced at every site where consultant-led ophthalmology services are provided: Ashford Heart of Hounslow St. Peter’s Teddington Memorial Hospital Woking Community Hospital

The event was positive and successful and a number of suggestions raised during the three days are currently being implemented, with others to follow.

Please do not hesitate to contact us if you have any queries regarding the service.




Physiotherapy Services Update

A recent assessment clinic day at Ashford Physiotherapy Department resulted in 135 patients being removed from the waiting list, with 83 seen on the day. This has led to a reduction in waiting times for physiotherapy patients. 5 8% of patients seen were offered another appointment, 16% were transferred to classes or hydrotherapy, 19% were discharged and 7% discharged with the option of an SOS review within 6 weeks.

The routine waiting list for out-patient physiotherapy is currently 9 weeks at St Peters and 5 weeks at Ashford.

Choose and Book appointments are available at both sites by searching under specialty : Physiotherapy and clinic type : Musculoskeletal.

Alternatively, referrals can be sent electronically to: asp-tr.physioreferral@nhs.net



Ambulatory Emergency Care Pathway Project

As part of the Unscheduled Care Programme, the Ambulatory Emergency Care Pathway Project has been developing a number of pathways, designed to reduce unnecessary hospital admissions.

With the increasing demands for its emergency care services, it has become necessary to review the models used within the Trust to ensure that they are able to provide services that maintain/improve high-levels of patient quality outcomes and patient safety.

A high volume of emergency conditions within the NHS have traditionally been managed on an inpatient basis, however there has been increasing evidence that Trusts can manage many conditions safely and appropriately as „emergency day cases. without the need for admission to a hospital inpatient bed and without negatively impacting on their healthcare outcomes.


In 2010, the NHS Institute for Innovation & Improvement published a revised Directory of Ambulatory Emergency Care Pathways for Adults which outlined 49 conditions where patients presenting with those clinical conditions (in A&E or via direct GP referrals) may be suitable for treatment on an „Ambulatory Emergency Care Pathway. (AECP).

Ambulatory Emergency Care is clinical care which may include diagnosis, observation and treatment not provided within the traditional hospital bed base or within traditional out-patient and it can be broadly split into four main clinical categories.
  • Diagnostic exclusion group (e.g. chest pain rule outs)

  • Low risk stratification group (e.g. Low Rockall score GI bleed)

  • Specific Procedural group (e.g. effusion drainage)

  • Intra structural group (e.g. care home admissions)

The introduction of AECPs is aimed at offering patients the timely management of their presenting condition so as to enhance the quality and outcomes of the care they receive (e.g. safe and efficient clinical decisions via care that may be delivered in more appropriate settings including those that are in, or are closer to home). The initial conditions involved are Community Acquired Pneumonia and Lower respiratory Tract infection, Pulmonary Embolisms, Acute Abdo Pain, DVT, Chest Pain and Cellulitis, with further revised pathways being implemented throughout the remainder of the year.

AECPs will also enable the Trust to better manage unacceptable Length of Stay variation, reduce demands for acute bed capacity and enhance patient flow within the Trust.


Further communications are planned for future issues where more details will be provided. However, if you wish to find out more information, please contact Claire Braithwaite, Associate Director -Performance Improvement, or Gulam Patel, Clinical Director, Ambulatory Care



Dates for your Diary

GP Lunchtime Meetings

ASHFORD

Thursday 10th November
1pm - 2.45pm
SPOTTING THE SICK CHILD - MANAGING ACUTE RESPIRATORY INFECTIONS
Dr Bhatti Department of Paediatrics ASPH

USING ANTIPYRETICS
PCT Pharmacists

SAFEGUARDING CHILDREN
Dr Tara Jones PCT lead GP for Safeguarding Children
Wednesday 7th December
1pm - 2.45pm
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

Tuesday 1st November GENITOURINARY UPDATE
Dr Jill Pritchard / Dr Paul Brennan-Benson
Tuesday 6th December TBC

“The Contemporary Approach to AF Management” presented by Dr Riyaz Kaba
Thursday 17th November 2011
6.30-8.30pm.

The Lightbox, Chobham Road, Woking, Surrey, GU21 4AA

Cold buffet will be served from 6.30pm with the presentation beginning at 7.15pm.

Limited places available, to reserve your place,

Please contact Sue Robertson on 01932 723716 or email sue.robertson@asph.nhs.uk

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

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