KIDS INTENSIVE CARE & DECISION SUPPORT. Annual Report 2016/17

Transcription

1 KIDS INTENSIVE CARE & DECISION SUPPORT Annual Report 2016/17

2 REFERRAL HOTLINE: WEBSITE: kids.bwc.nhs.uk 2

3 TABLE OF CONTENTS Foreword Highlights of 2015/16 Mission Statement Service Standards KIDS Organisational Structure KIDS Personnel Activity Geographical Location of Referring Hospitals to KIDS 2016/17 Summary of KIDS Activity 2016/17 WM Hospital Referrals to KIDS 2016/17 Out of Region Hospital Referrals to KIDS 2016/17 Referring Department Categories 2016/17 Collection Department Categories 2016/17 WM Collection Hospitals 2016/17 Out of Region Collection Hospitals 2016/17 WM Destination Hospitals 2016/17 Out of Region Destination Hospitals 2016/17 Destination Department Categories 2016/17 PICANet Groups of Referred Patients 2016/17 Mobilisation Times 2016/17 Grade of Team Leader Patient Acuity 3

4 Clinical Governance Safety and Care Quality Monitoring Parent and Child Feedback Education and Training Simulation Training Outreach Education Management and Leadership Developments Away Days Regional and National Collaboration Events and Celebrations Plans for 2017/18 4

5 FOREWARD KIDS provide paediatric critical care decision support and transport for the West Midlands. KIDS is hosted by Birmingham Children s Hospital NHS Foundation Trust (BCH) in collaboration with University Hospital of North Staffordshire NHS Trust (UHNS). The service is based at 1 Printing House Street, Birmingham adjacent to the main BCH campus. KIDS serve the 20 District General Hospitals in Staffordshire, Shropshire, Birmingham and the West Midlands, Coventry, Warwickshire, Herefordshire and Worcestershire. Two paediatric intensive care units (PICU) operate within the West Midlands one at BCH and one at UHNS in Stoke-On-Trent. 5

6 HIGHLIGHTS OF 2016/ /17 saw lots of changes at KIDS KIDS rated outstanding by CQC KIDS and WMNTS (the West Midlands Neonatal Transport Service) merged in July to be jointly hosted by Birmingham Children s Hospital KIDS and St. John Ambulance took delivery of 4 brand new bespoke critical care ambulances and 1 rapid response vehicle. KIDS appointed new substantive consultant A second full-time ANP was appointed and seconded for training on BCH PICU. Birmingham Children s and Birmingham Women s Hospitals merged to create a new management structure. KIDS trained 8 new transport nurses and 13 new transport team leaders (doctors/anp). 6

7 KIDS Mission Statement To provide the right solution, at the right time, in the right place for babies, children and young people & their families with critical care needs throughout the region, with timely high quality decision support, PIC bed finding and critical care transport. KIDS Service Standards 1. KIDS will comply with the Paediatric Intensive Care Society Standards for Specialist Paediatric Transport Services. picsociety.uk/ 2. KIDS will maintain core infrastructure operational 24 hours per day, 365 days of the year, including: i. Operations Centre staffed with trained administrators and dedicated single ii. iii. referral telephone number; Trained Transport Team; Fully maintained transport equipment, drugs and disposables. 3. On-site dedicated bespoke critical care ambulances and trained drivers 4. The referral line will be answered within 5 rings 5. The referrer will be connected to the KIDS Consultant within 5 minutes 6. KIDS will comply with the appropriate policies and procedures of BCH 7. KIDS will participate in all care quality surveillance and improvements processes including clinical governance, mandatory training, infection control, documentation, child protection and patient experience 8. KIDS will use standard operating procedures (SOPs) for informing service delivery which are easily accessible on the trust drive. 7

8 9. The KIDS website will be maintained with service information, clinical guidelines, drug calculator and feedback mechanisms in place 10. KIDS will maintain close working relationships with PIC at BCH and UHNS through rotational posts and regular secondments. 11. KIDS will relentlessly pursue continual improvements in the delivery of best for patients and families. This will include care quality, patient experience, capacity management, medicine, nursing, administration, ambulance provision, information technology, telecommunication, research, innovation, risk management, education, leadership and customer service. 12. KIDS will collect data for all referrals and submit transport data to the PICAnet database. 8

9 KIDS ORGANISATIONAL STRUCTURE KIDS (BCH Urgent & Critical Care Directorate) KIDS Clinical Lead Nurse Consultant KIDS Lead Nurse KIDS Consultants Sessional Consultants KIDS Senior Sister Administration Team Leader KIDS Registrars & Fellows KIDS/NTS Junior Sisters/Charge Nurses Call Centre Administrators Rotational Nurses KIDS Volunteer ANP & ANNP s SJA Team Leader Trainee ANP s SJA Technicians 9

10 KIDS Personnel 2016/17 Lead Nurse KIDS Consultants Dr. Sanjay Revanna Dr. Mary Montgomery Dr. Intikhab Zafurallah Dr. Balazs Fule Dr. Andrea Cooper Dr Hari Krishnan BCH Sessional Consultants Dr. Barney Scholefield Dr. Gale Pearson Dr. Fiona Reynolds Dr. Dave Ellis Dr. Linda Edwards Dr. Reinout Mildner UHNS Sessional Consultants Dr. Mark Bebbington Emma Bull Senior Sister Sarah Taylor KIDS Junior Sisters (B6) Kelly Robinson Jackie Somerfield Joanne Webb Louise Kelly BCH PIC/KIDS Junior Sisters/Charge Nurses (B6) Rebecca Fry Kate Evans BCH PICU Rotational Staff Nurses (B6) Phil Ward BCH PICU Rotational Staff Nurses (B5) Rachael Bennet Vicki Warren Stephanie Dunbar Emma Knight Charlotte Salt 10

11 UHNS PICU Rotational Junior Sisters (B5/6) Claire Sidley Jayne Hodgkinson Candi Martin Leanne Lovett Mica Davey Rebecca Middleton Leanne Viggars Katie Rhodes Advanced Nurse Practitioner Anneke Gyles Advanced Nurse Practitioner Trainee Sarah Webb Emily Wyres Advanced Nurse Practitioner (PICU) Steve Cossey Rachael Morrison Hannah Roge Claire Fitzsimons KIDS Fellows / Registrars PICU Registrars / Fellows on rotation Dr Justin Wang Dr Gareth Lodwick Dr Nikki Kelly Dr Priya Dr Faiuna Haseeb Dr Georgina Harlow Dr Omer Aziz Dr Aarti Pandit Dr Mark Burgess Dr Ravi Nagaraj Other Fellows / Registrars Dr Kate Mackay Dr Andrew Wood Dr Suzie Stokes Dr Ravi Chauhan Dr Lorna Bagshaw Dr Jeny Macrae Dr Becki Taylor-Smith Dr Joe Tyler Dr Neil Tiwari Dr Ranvir Singh 11

12 KIDS Operations Centre Call - Centre Team Leader (B4) Hayley Osmani KIDS Governance Support Administrator (B4) Rachel Boffin Administrators (B3) Alice Mulcahy Administrators (B3) Richard Murphy Lorraine Rooker Sabina Mughal Sarah Slaughter Mathew Weir Christopher Rodgers Aimee Haynes Charmaine Kush Claire Martin Stuart Sommerville Michael Cook Debbie Kim Ruksar Khan KIDS Volunteer Pam Kumar St John Ambulance Services Operations Manager- West Midlands Region Samantha Fawcett Ambulance Technicians Anthony McLaughlin Chris Firkin Christiaan May Danny O Neil Darren Elgerton Duncan Murray Gary Thompson Ian Taylor Jayne Wilson Jenni Carrier John Chatton Kevin Haggett Margaret Herbert Paul Colton Paul Dickman Pete McArdle Phil Bone Phill Sprigg Ray White Sarah Miles Sue Cameron Tracey Handley William Byrne 12

13 Activity Geographical Location of Referring Hospitals to KIDS 2016/17 Location of referral No. West Midlands Hospitals 2559 Out Of Region Hospitals 311 Total Referrals 2870 KIDS Summary of KIDS Activity 2016/17 Outcome No. KIDS Transfers Total Non-Elective 529 KIDS Transfers HDU (Non-Commissioned) 55 KIDS Transfers Palliative (Non-Commissioned) 14 KIDS Transfers Total Elective 69 KIDS Nurse Only 64 KIDS Ambulance Only Request 46 NTS Transfer 929 CNN Transfer 28 Referring Team Transfer 92 Other Paediatric Retrieval Team Transfer 62 Other Neonatal Retrieval Team Transfer 0 Other/Unknown 13 Not requiring transfer 1038 Total Referrals

14 West Midlands Hospital Referrals to KIDS 2016/17 West Midlands Hospital Referrals to KIDS 2016/17 BWH BCH Heartlands Walsall New Cross Worcester Coventry Russells Hall Birmingham City Royal Stoke Good Hope Telford Hereford Sandwell Warwick Queens Burton Reddich George Elliot Shrewsbury Royal Orthopaedic Queen Elizabeth Stafford WMNTS West Midlands Hospital Referrals to KIDS 2016/

15 Out of Region Hospital Referrals to KIDS 2016/17 Out of Region Hospital Referrals to KIDS 2016/17 Other Leicester Royal Northampton Leicester Glenfield Kettering Liverpool Womens CATS Gloucester Southmead Manchester Musgrove Park Bristol EMBRACE Peterborough St Marys Manchester Warrington Gwent Sheffield Bath Whiston Arrowe Park Blackburn Robert Jones and Agnes Hunt Neville Hall Macclesfield Evelina Lincoln Furness Basingstoke Bangor PICCTS St Georges Southampton Newcastle Freeman Out of Region Hospital Referrals to KIDS 2016/17 15

16 Collection Department Categories 2016/17 Collection Department Categories Non - Elective KIDS Transfers 2016/17 ED Ward NICU PICU HDU Collection Areas Non- Elective KIDS Transfers 2016/17 Theatre ITU

17 West Midlands Collection Hospitals 2016/17 WM Collection Hospitals 2016/17 Coventry BCH Russells Hall Heartlands Walsall BWH New Cross Worcester Telford Reddich Good Hope Sandwell Warwick Birmingham City Hereford Queens Burton Royal Stoke George Elliot Shrewsbury Royal Orthopaedic WM Collection Hospitals 2016/ Out of Region Collection Hospitals 2016/17 Out of Region Collection Hospitals 2016/17 Northampton Other Kettering Royal Derby Stoke Mandeville St Marys Manchester QMC Nottingham Leicester Royal Gwent Kings Mill Gloucester Robert Jones Orthopaedic Out of Region Collection Hospitals 2016/

18 West Midlands Destination Hospitals 2016/17 West Midlands Destination Hospitals 2016/17 BCH Royal Stoke Other BWH Heartlands New Cross Coventry Russells Hall Birmingham City Walsall Sandwell Telford Worcester West Midlands Destination Hospitals 2016/ Out of Region Destination Hospitals 2016/17 Queens Medical Centre Leicester Royal Leicester Glenfield Sheffield Out of Region Destination Hospitals 2016/17 John Radcliffe Bristol Children's Newcastle Freeman Alder Hey Bristol St. Michaels St. Thomas's Out of Region Destination Hospitals 2016/

19 Destination Department Categories 2015/16 Destination Department Categories Non - Elective KIDS Transfers 2016/17 PICU Ward NICU Other/Unknown HDU Theatre Destination Department Categories - Non - Elective KIDS Transfers 2016/ PICANet Groups of Referred Patients 2016/17 PICANet Groups of Referred Patients 2016/17 Blood/Lymph Body Wall/Cavity Cardiovascular Endocrine/Metabolic Gastrointestinal Infection Multisystem Musculoskeletal Neurological Oncology Opthalmology Respiratory Trauma Other Unknown 19

20 Mobilisation Times 2016/17 Mobilisation time is defined as the time from when the decision to retrieve the patient is made by the KIDS consultant is made to the KIDS team departing to retrieve the patient. The KIDS target time is less than 30 minutes (non- elective transfers). This data is reported monthly with all delays recorded and reviewed at the daily KIDS morning meeting. On average this target is achieved 73% of the time. The most common reason for not achieving this target is the team already being out on retrieval. 20

21 Grade of Team Leader for all Non-Elective Transports 2016/17 KIDS teams comprise of a clinical team leader, a retrieval trained PIC nurse and an ambulance technician. The team was led by an Advanced Nurse Practitioner on 18% of transfers and a Consultant either led or accompanied the team either due to patient acuity or to supervise new trainees on 26% of transfers. Grade of Transport Team Leader 2016/17 Consultant Advanced Nurse Practitioner ST 1-3 ST 4-8 Patient Acuity 2016/17 Intervention % of transfers Invasive Ventilation 69 Vasoactive Agent 15 Inhaled Nitric Oxide

22 Clinical Governance Safety and Care Quality Monitoring: KIDS maintains an open and honest governance structure, with a high level of reporting of incidents independent of clinical outcome. The high level vigilance of KIDS ensures physical resources are in a state of readiness and that minor deviations of standard practice are recognised and addressed swiftly. All referrals to KIDS are reviewed at the daily morning meetings where they are given a management score to reflect the whole of the patient journey. KIDS framework for ensuring safety and care quality are maintained includes; Strong, stable management team focussed on effective and progressive clinical leadership. Thorough recruitment process building a skilled, professional, motivated and stable team. Comprehensive training and annual reaccreditation. KIDS Standard Operating Procedures available on BCH KIDS Intranet Site Well-resourced and effectively managed equipment store, with on-line manuals, teaching packages, repair and maintenance plans empowering all staff to address problems. Equipment checks, vehicle checks, operations centre checks monitored. Audit of Critical Incidents, KIDS risk register and serious incidents. Audit of Mobilisation, stabilisation, transport duration times and blue light usage. Proactive Incident reporting

23 Implementation of all BCH care quality surveillance monitoring; Infection Control, Child Protection, Documentation, Patient Experience and Referrer Experience. Adverse Incident Reporting: KIDS reports using the incident reporting system at BCH. Threshold for incident reporting is low resulting in high volume of incidents reported (One of the highest in the Trust, despite small size of KIDS). This reflects healthy reporting culture, and is encouraged. Incidents are reported as relating to KIDS team (equipment/communication/clinical and other) or relating to referrer activities. Management of the non-kids incidents i.e. those relating to referrer activities can be difficult to classify due to the nature of the reporting system and field designation. KIDS works closely with the BCH Governance department to assist in clarifying designation as KIDS or other hospital incidents, and continue to work towards developing a system for managing non-kids incidents. Daily review of all cases referred (whether transferred or not) is performed by the MDT in the morning meeting. Any issues are raised at this meeting. Issues relating to KIDS are managed in a timely fashion through the existing channels (depending on nature of issue: equipment, clinical, team working, communication). Issues relating to non-kids activities are fed back directly to the referring centre. Monthly incident reporting is to the Directorate Management Team, with scrutiny of patterns or significant incidents. KIDS attends and reports to SIRI/RCA at BCH for any patients with KIDS involvement. 23

24 KIDS hold monthly M&M meetings as well as attending and contributing to BCH PIC monthly M&M. Any cases requiring higher level scrutiny are discussed with the BCH Governance department and BCH Leads for governance for guidance and scrutiny. Parent and Child Feedback - Child and Family Steering Group KIDS continues to gain all types of feedback received from patients and parents, in order to gain a more critical insight of the issues they face when their family experiences a critical care transport. Some examples of feedback received from parents; My wife and I would like to place on record how wonderful the team at KIDS are. We say this mainly because they saved our daughters life but also because that while she remains critically ill on intensive care, they continue to ask about her and even come over to see her personally when they get time in their busy schedules. KIDS were amazing, I ve tried really hard to think of something which you could improve on but honestly there is nothing. Fantastic and very re-assuring Made the transfer feel less anxious and stress free. Also looked after our boy very well. Nothing more to add! Making us feel relaxed and very informed at such a traumatic time! Everything was done to perfection including the cuddly bear! Themes within feedback received during the year 2016/17 were by far the most frequent, about the professional manner of the KIDS team and their calm and caring natures. 24

25 Education and Training KIDS trained and signed-off 13 new clinical team leaders (registrars/clinical fellows) and 8 nurses in transport during 2016/17. This was achieved through in-house study days and 1:1 training from KIDS consultants, ANP s and senior nurses. KIDS continue to provide placements for other healthcare students and other healthcare professionals (doctors, nurses, pre-hospital practitioners and work experience students) to observe the KIDS team at work. Feedback remains positive about KIDS as a learning environment for paediatric transport, service coordination and team-working. Demand for places continues to rise. Simulation Training Dr Zafurallah continues to lead the simulation programme with assistance from Junior Sister Louise Kelly, KIDS Consultants and other members of the KIDS band 6 nursing team. The high fidelity SimBaby owned by KIDS is used for training of staff at KIDS and throughout the region. It is an effective tool for delivery of real time scenarios. 25

26 The KIDS team trained in simulation use SIM frequently to delivery training around human factors and crew resource management, improving team working in complex and stressful environments. This training is not only provided for KIDS team members but also for the region through the Stabilisation of the Sick Child study days and the RAPT days, providing in-situ simulation for the district general hospitals. Outreach Education KIDS delivers, within its available resources, outreach education to many of the district general hospitals (DGH) across the region. Dr. Andrea Cooper is the lead for Education and Training. Any requests for outreach education are regularly received and are commonly cited on the feedback questionnaires received from hospitals after each transport. In the period from , all DGHs except 2 have had outreach visits (Russell s Hall and City and Sandwell), however, teaching has been delivered to them and across the region in various other forms. 26

27 The Stabilisation of the Sick Child study day was run on 3 occasions during 2016/17 to a multidisciplinary audience of doctors and nurses from around the West Midlands region. The RAPT course was taken to the region s DGH s on 7 occasions during 2016/17 and provided high fidelity in-situ simulation, allowing the hospital s to test their own processes/resources under the safety of the simulation umbrella. Education and Training days at the Critical Care Network Forum in Walsall. Management and Leadership Development 2016/17 saw quite a change in the management structure of KIDS following the merger with WMNTS. It saw the management of all advanced practitioners (KIDS and NTS) to fall with the NTS Nurse Consultant and all nurses (KIDS and NTS) to fall with the KIDS Senior Sister and KIDS Lead Nurse. Away Days There were 2 successful away days held in 2016/17 for the KIDS and NTS teams where practicalities of the merger were worked through along with exploration of how team dynamics might change, fostering strategies to reduce any negative effects of the change. 27

28 Research and Audit Poster Publications April saw 3 KIDS team members present 4 posters and deliver 1 oral presentation at the Retrieval 2016 conference, in Glasgow. Anneke Gyles and Joanne Webb attend the 8th World Congress on Paediatric Intensive and Critical Care in Toronto and presented 2 abstracts. 28

29 Regional and National Collaboration WM Newborn Transport Service The merger of KIDS and the WMNTS finally happened on 1 st July 2016 with both teams operating out of one call centre with a single referral telephone number and a single ambulance provider. Both teams were hosted by Birmingham Children s Hospital 1st hybrid NTS/KIDS transfer completed In September

30 Continuing Professional Development and External Work KIDS ANP Anneke Gyles continues to sit on the working group for the ALSG transport course NAPSTaR. Service Developments KIDS and NTS continue to work on further integrating both teams with training for all nurses to be able to work on either the paediatric or neonatal teams. Delivery was taken of 4 new bespoke critical care ambulances and a rapid response vehicle in November This ensures that there is always a reliable, fit for purpose vehicle available for all teams 24 hours a day, 7 days a week. Events and Celebrations We received 3 nominations at the BCH Star Awards St John Technician Christiaan May was named as BCH Star of the Year 2016, The KIDS Admin Team were nominated as Unsung Heroes and the KIDS Team were nominated for outstanding Clinical Service. Catherine and Emma were nominated for perfect partnership in the star of the month awards for their commitment to the merger of KIDS and WMNTS. 30

31 Plans for 2017/18 Continue to develop outreach teaching to involve in-situ simulation. Further development of the KIDS ANP team. Further integration of the KIDS and NTS teams to create a more flexible clinical workforce. Upgrading of transport trolleys and incubators. 31