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In December 2011, Ashford and
St. Peter’s 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 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 Peter’s
can continue to strengthen our
working relationship in striving to
achieve the best outcome for the
individual patient.
April 2012
Introducing The Acute Oncology Service
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.
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.
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. Peter’s, 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.
Contact Details
If you have any feedback on this
publication or the Trust in
general, require any further
information about the Trust or
require this document
electronically please contact:
Debbie Beesley, GP News
Editor, 01932 723511
Enhancing Quality Outcomes
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 Failure– 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 – 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.
Baseline Jan -Dec % Improvement
AMI 94.85% 97.44% 2.5%
Heart Failure 41.08% 56.37% 15.29%
Pneumonia 76.71% 89.88% 13.17%
Hip and Knees 77.52% 91.10% 13.58%
Pneumonia (No CURB)
Jul to Dec
2010
Jan to Nov
2011
Oxygenation Assessment 95.37% 98.69%
Initial Antibiotic Selection for CAP
82.08% 95.93%
Blood cultures performed prior to
28.81% 57.02%
Initial Antibiotic Received Within 6
72.85% 77.50%
Adult Smoking Cessation Advice/
24.44% 60.27%
Composite Process Score
76.71% 88.30%
Appropriate Care Score (ACS) 56.60% 75.72%
Hip and Knee Jul - Dec
2010
Jan -Nov 2011
Prophylactic antibiotics within one hour prior to surgery
78.92% 93.68%
Appropriate antibiotic regimen 71.50% 78.41%
Prophylactic antibiotics discontinued within 24 hours
92.80% 90.87%
VTE prophylaxis Ordered 73.66% 97.38%
VTE prophylaxis Timely 71.56% 96.91%
Composite Process Score (CPS) 77.52% 91.45%
Appropriate Care Score (ACS) 45.74% 72.78%
Heart Failure Jul - Dec
2010
Jan -Nov
2011
LV function evaluation 72.87% 86.00%
ACEI or ARB at discharge 81.48% 85.25%
Discharge instructions 3.25% 20.48%
Adult smoking cessation advice/
counselling 11.11% 37.50%
Composite Process Score (CPS) 41.08% 56.37%
Appropriate Care Score (ACS) 6.62% 20.54%
In the past, Ashford and St. Peter’s 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.
Revised Parking Arrangements for GPs.
Dates for Your Diary
Date Venue Topic Speaker
20/04/2012 Hazel Room, SPH GP Resuscitation Training Day*
Paul Wills, Senior Resuscitation Officer, ASPH
08/05/2011 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
15/05/2011 PGEC, SPH Obesity Management TBC
18/05/2012 PGEC, SPH Dermatology Study Day* Dermatology Department
22/05/2011 PGEC, SPH Ambulatory Care Pathways Dr Gulam Patel, Consultant Rheumatologist & Divisional Director for Ambulatory Care
29/05/2011 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 attached fliers included in this publication for further information
More useful information is available on our new PGEC GP Website at: http://www.ashfordstpeters-pgecgp.org.uk/