Care 24/7 Project ‘’Meeting Local

Challenges 7 Days A Week’’

Belinda Boulton, Head of Transformation

Tracey Hughes, Project Manager

‘Care 24/ 7’ Transformation Project • National Reviews – National Clinical Standards

• Whole System Involvement of Stakeholders

– Urgent Care Programme Board

– Oxon Clinical Commissioning Group and SSCG

– Risk Summit Open Event (including patients and other centres)

• Local reviews

– Higher than expected mortality rates at the weekend

– Junior doctors writing to the media

– Challenges related to meeting performance targets

Care 24/ 7 Whole Systems Approach

Care 24/ 7 Gap

Analysis

Workforce Reconfiguration

Reduce the Demand for Acute Sector Based Care

CQUIN £1.3m

Winter Pressures Funding

Business Cases

Better Care Funding

Care 24/ 7 Local Reviews

Care 24/ 7 Project Structure

Clinical Lead & Dedicated Project Manager

Monthly Reporting Through to TME & CGC

Workforce issues highlighted to WOSG

Ratification of new guidance and policies

Information cascade to all levels of the organisation: site Clinical Leads and intranet

site

Handover

IT

Pharmacy

Venue

Documents

Training

Rotas

Establishing Current Practice Phase 1

• Reports, observations & feedback made during focus groups, shadowing Junior Doctors & Night Nurse Practioner (NNP) across a 7 Day week Out of Hours (OOH) found

• Lack of general communication/coordination

• Gaps in medical/nursing rotas (responsible for cover)

• NNP Role not utilised • Junior doctors bleeped for tasks

• Separate doctors/NNP handovers

• IT security issues regarding online take referral lists

Handover Action needed…. 1. Improve communication/skill mix across 7 days a week

2. Establish suitable MDT and venue for handover

3. Mapping of rotas (gaps in service/handover timings)

4. Determining best use of IT to support (EPR)

a. Electronic patient referral system (prevent s-drive)

b. Record MDT attendance register/report issues or concerns

5. Developed

a. Handover Guidance Policy/SBAR Tool/Support rota

b. Presented staff awareness briefings & training sessions

c. Business Cases for Rota‘s, Referrals & Staff teams

d. Evaluation process

How We Moved Forward Medical SpR and Night Nurse Practitioners to jointly manage an MDT handover

• Medics/NNP alignment of shift working patterns

• Organisational Change (OC) Proposal

• A months consultation to challenge the proposal

• NNP Role change to Clinical Coordinator (CC) Role

• CC’s to act as clinical leads

• Staff choices (retire, re-train, re-deploy or be managed according to role adjustment)

• Recruited CC staff to cover gaps in practice

Mapping of Activity Early Days…

Need for….

Business Case approvals for

• Live management of an electronic rota system

• Live electronic patient referral to out of hours (H@N) services

• Increased staffing for therapies/CC’s

• Paper for Handover Guidance Policy

Results so far….

• 7 days a week MDT handover

• Medics and MDT feedback

• Clinical discussions regarding transfers, discharges, staffing, operational management

• Monitoring of MDT attendance register

• Demonstrates Home Before Lunch

Patient Activity Home Before Lunch November AGM Patients

Last ward # of Patients

Average of LOS

Time of admission

Time of discharge

H-WD EAU 273 0.5 14:10:50 16:02:15

H-WD Laburnum 84 9.7 14:10:36 15:35:39

H-WD Juniper 79 10.1 14:43:45 15:34:24

H-WD Oak 70 12.5 12:55:20 15:01:03

H-WD E 52 7.2 14:33:50 15:40:03

H-WD F 20 12.0 15:22:24 15:55:42

H-WD Crit Care 15 4.0 12:57:56 14:34:00

H-WD Childrens 2 1.0 19:20:30 09:32:30

H-DC DCU 1 0.0 10:30:00 20:10:00

Grand Total 596 5.5 14:09:32 15:42:21

Clinical Utilisation Review (CUR) • Steps are to be taken to evaluate the current practice within

the Trust in terms of discharge process mapping

• The CUR will include an interface that clearly represents the status of each patient in their discharge process.

• The CUR proforma shall highlight any barriers created in preventing patient discharge

• An EPR proforma is to be developed around ideas taken from successful software solutions

Time of Discharge - HGH

Positive Shift

Time of Discharge - JR

7 Days a Week Challenges….. • Medical Rostering

• Gathering rota mappings for Medics/Ward & Unit Teams

• Lack of a coordinated system

• Organisational Change process timescales

• Handover awareness/guidance mappings

• Multiple staff training and awareness notifications

• Modified handover start

• New venue and support rota

• IT access/updates & staff training for project implementation

• Engaging site team managers to complete allocated tasks

• Sense of support service planning for Switchboard, Pharmacy, Therapies, Radiology and Ward Relocations

Moving forward.... • NHS1Q – OUH innovation

• NHS1Q audits against self assessment

• Business Case approvals

• Rotas, Referrals and Staffing

• End of Life Care to increase specialist palliative care provision & improve patient quality of care

• Revision of the Patient Safety Academy role

Phase 2 Churchill Hospital challenges - Ward Relocation

• Rota mapping

• Working in silos

• Commencing Phase 3 and 4