Exceptional Healthcare Awards - Service Transformation Award

Friday, 13 November 2015

North Bristol NHS Trust is honouring outstanding members of staff and volunteers with its Exceptional Healthcare Awards.

The 2015 awards, supported by Southmead Hospital Charity, recognise and reward the hard work of staff and volunteers at the Trust.

The awards will take place on Friday, November 20, and in the lead up to the ceremony we are showcasing the shortlisted nominees in each category.

Today’s category is Service Transformation, which recognises teams or individuals who have introduced a new process or pathway designed to improve the patient journey.

Enhanced Recovery Team

The team has established an enhanced recovery (ERAS) programme for major colorectal resections. Closure of ileostomy, whilst not without its complications, is a gastrointestinal procedure performed through a minimally invasive incision and is ideal for applying enhanced recovery principles. In addition, other centres have started to implement 23 hour ileostomy closure. Before embarking on our service development, a baseline audit of 148 patients was performed.

Since the beginning of this year the team has introduced a protocol for closure of ileostomy with an aim of delivering 50 percent of cases as a 23-hour stay. As they had a well-established ERAS programme, they did this with less time and education than for major resections.

The difference between standard ERAS and the protocol for ileostomy closure is that there is no face to face specialist pre-assessment. Instead the team developed a written pre-operative information pack that is given to patients. This means that pre-operative assessment (POA) can be delivered by POA nurses rather than specialist enhanced recovery nurses.

Early data (23 patients) has shown an increase in 23 hour stay from 13 percent to 39 percent, 44 percent stayed two-three days and 17 percent stayed more than three days. After embedding this, the team will see if changing pain or anti-nausea medication alters length of stay or whether changing discharge criteria might further increase 23 hour discharge.

This service development was delivered soon after the move into Brunel and even though the 50 percent target has not been achieved, the team has tripled the number of people going home on day one saving a significant number of bed days.

Dawn Gane, Advanced Recovery Manager, said: “We’re really excited and honoured to be nominated in two categories this year and very much looking forward to the night. Advanced recovery really has had some fantastic benefits for patients and it’s great that the team have been recognised in this way.”

Vascular Physiotherapy and Occupational Therapy

The vascular team is now part of the Major Arterial Centre, which has seen vascular services transfer to Southmead Hospital from across the region. This has significantly increased the number of patients seen.

The team has worked hard at developing new clearer rehabilitation pathways for amputee patients, and are developing a joint transfer of care document. The rehabilitation pathway ensures patients are referred to the correct specialist therapists throughout the region, linking in with the Bristol Centre for Enablement for assessment for prosthetic limb fitting where appropriate.

In conjunction with the amputee rehabilitation pathways the therapists have been actively involved in the implementation of Enhanced Recovery Programme (ERP) for vascular patients. The introduction of the ERP has decreased the length of stay of patients from 5.5 days to 4.1 days for elective surgery and non-elective from 17.8 days to 12.6 days using the ERP principles.

Therapists now assess patients and give them therapy information pre-operatively, even carrying out home access visits where appropriate before surgery. If indicated the specialist vascular therapists will assess and commence early rehabilitation with patients post operatively in ICU, ensuring that the patients are beginning their rehabilitation as soon as possible in line with NICE guidance, and receiving continuity of care and specialist knowledge from the vascular therapy team.

On the ward the therapists have worked hard to ensure best practice and have set up a daily gym class where amputee patients can begin their rehabilitation in a group setting. This group not only builds physical ability but enables patients to encourage and support each other following life changing surgery.

The therapy team also empower patients with 'off the ward' groups, supporting patients to visit the shop and re-gain independence in activities of daily living. Patient feedback has been positive with patients enjoying being able to leave the ward and meet others who are going through similar life changing events.

The development of joint Physio/OT Technicians has supported the growth of these initiatives. The technicians are able to assess patient’s functional ability whilst also having the knowledge and skills to progress and maintain mobility and balance, they also gather history and information from a patient which is useful to both disciplines and ensures that the patient only has to tell their story once.

Claire Worgan, Clinical Specialist Physiotherapist in Vascular Surgery, said: “It’s been a really busy year for the team as we saw all vascular services centralised here at NBT so it’s great to be recognised in this way. We’re really proud of how we’ve developed the service and it’s so encouraging to see our patients benefit from the changes.”

Stone Unit (Urology)

Over the last three years, the Stone Unit, part of the Urology team, has worked hard to streamline and accelerate the evaluation and care for patients with painful kidney stones who attend the Emergency Department as well as oversee their after-care.

They have set up a 'hot' shock wave lithotripsy (shock wave treatment for kidney and ureter stones) service with identified patients being treated on the day of admission.

The review of this service at the end of a year in the new hospital shows high success rate and significantly reduced inpatient stays. Patients have had a quicker initiation of treatment and shorter duration of symptoms.

This service has been recognised regionally with patients now being referred from other centres such as Bath, Cheltenham, Weston, Taunton, Swindon and even Exeter.

Subsequently, this has been expanded to a five day service readily available to all patients. With referrals being made electronically through a bespoke referral system and subsequently triaged by a sub-specialist stone consultant within 24 hours, waiting times have been reduced significantly.

Joe Philip, Urology Consultant Surgeon, heads up the service. He said: “We are extremely delighted to be shortlisted for this award. We were able to adapt and expand this service in the new hospital to provide what we believe to be as good as any of the best stone centres. The award nomination is validation and recognition for the team.”