7 Day Health Services: ensuring the support services and infrastructure are in place to support a 7 day model

Transcription

1 7 Day Health Services: ensuring the support services and infrastructure are in place to support a 7 day model Dr Daniel Boxer West Hertfordshire Hospitals NHS Trust

2 Implementing 7 day Working in Imaging Departments: Good Practice Guidance A report from the National Imaging Clinical Advisory Group

3 Imaging services should not be looked at in isolation but as part of the whole system of healthcare provision and it is in this context that services should explore extended day working

4 Improving access to diagnostic imaging improves patient safety and can reduce costs and lengths of stay

5 Improving access to diagnostic imaging improves patient safety and can reduce costs and lengths of stay Moving from a 5 day imaging service to a 7 day service is not just a case of spreading what you already have a bit thinner

6 What does 7 Day working mean for radiology? Out-patient (elective) Urgent (in-patient/emergency)

7 Elective imaging Out-patient (elective) - Patient choice/responsivness - Improved care pathway - Efficient use of resources

8 Patient choice Do your patients/sub-groups of patients want an appointment outside of conventional working hours? Are other services available e.g. public transport?

9 Improved care pathways Does 7 day imaging shorten pathway (not if there are long waiting lists)? Does it increase cost (yes)? What effect does it have on demand/capacity? Are there other/better ways of improving pathways? Worked example Breast one-stop clinic

10 Efficient use of resources many NHS Trusts are not adequately utilising expensive diagnostic equipment, if NHS Trusts are to establish genuine efficiency, the management of machines must be improved. Taxpayers Alliance; NHS Machines, Utilisation of High-Value Equipment at NHS Trusts (2009)

11 Efficient use of resources Do not confuse activity with efficiency Need for redundancy in acute care Dichotomy between centralisation and access

12 Consideration by modality NM/SPECT/PET-CT, generally not practicable Plain films Ultrasound CT MRI

13 What does 7 Day working mean for radiology? Out-patient (elective) Urgent (in-patient/emergency)

14 Provision of Consultant Radiology Service for Acute Hospital Care Dedicated radiology service with separation of emergency and elective care Extended Hours on Site Service On-call Service

15 Drivers Patient safety; Increased morbidity and mortality at weekends How quickly diagnosis made and timeliness of access to diagnostic and thereputic interventions thought to influence outcome Reduced length of stay

16 NHS England; 7 Day working Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic tests and completed reporting will be available seven days a week: Within 1 hour for critical patients Within 12 hours for urgent patients Within 24 hours for non-urgent patients

17 Provision of an embedded Radiology service within a large Acute Admissions Unit

18 The AAU model of care New build standalone facility opened in 2009 Direct admissions from GPs Transfers from A&E Direct ambulance admissions

19 The AAU model of care - Patient mix All surgical emergency admissions All acute medical except stroke, cardiac, ITU, which go to specialist units. Comprise 75% of AAU admissions Some orthopaedics (non early surgical cases) Gynaecology & paediatrics not included

20 The AAU model of care Consultant delivered service Multiple consultant ward rounds Fully integrated diagnostic (Radiology) suite Maximum 48 hours stay either discharged or moved to speciality wards in main block

21 The AAU model - structure 3 levels modular built structure, linked to main hospital building 120 beds organised into 8 suites on levels 1 & 3 Radiology, cardiology (2 catheter labs with 12 recovery beds) and pharmacy (robotic) on level 2

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28 Ward Suites 8 suites of 15 beds comprising one twin six bedded unit and three side rooms

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30 Radiology Level 1; plain film room Level 2; CT (64 slice), ultrasound, radiology reporting room (2 PACS workstations and CT workstation), prep rooms, toilets, offices etc.

31 Radiology staffing Business case included 2 additional radiologist posts 3 Radiographers (2 band 6, 1 band 7) Radiographic helper & clerical support not funded

32 Radiologist provision Workload analyses suggested a need for 20 hours a day of radiologist time to cover all in-patient activity Mon-Fri; 08:00-20:00, Weekends and Bank Holidays; 09:00-18:30

33 Radiologist shifts Radiologists have multiple rotas Week in AAU every 4-5 weeks Weeks alternate between AAU1 (08:00-16:00) & AAU2 (10:00-18:00) Separate Mon-Thursday late rota (17:00-20:00) Separate week end & bank holiday rotas

34 Radiologist shifts Fillers to cover out of trust sessions & fixed sessional commitments (one stop clinics etc.)

35 AAU ON HEMEL STATIONS AAU-1 AAU-2 AAU-E CALL HUS1 HUS2 SCR1 SCR2 MON AM ARD AB JS NA NA KL JIH REPORTING PM ND* AB KMR JS VM JIH NA TUE AM JC AB DPG KL NA JIH KMR PM JC JS JS DPG ARD KL VM WED AM JC JIH EP KMR VM ARD PM AB JIH DB EP JS KMR NA THU AM JC KL JC JIH WB DPG PM JC AB AB JC ARD JIH/WB FRI AM JC AB AS KL KMR NA PM JC AB AB AS KL NA SAT AM AB AS PM AS SUN AM DB AS PM AS MON AM ND DB VM AB ARD KL JIH PM KMR DB KMR VM VM JIH AB TUE AM KMR BG AS KL AB JIH NA PM KMR DB AS AS ARD KL VM WED AM KMR JIH ARD NA VM ARD PM KMR JIH JIH ARD NA NA AB THU AM KMR DB AB JIH WB DPG PM SN DB KL AB ARD JIH/WB FRI AM VM DB ARD KL NA AB PM VM KL ARD ARD NA AB SAT AM ARD ARD PM ARD SUN AM ARD ARD PM ARD ST ALBANS STATIONS WATFORD SACH U1 SACH U2 SACH U3 MAMMO REPORTINGUS-RAD US-SON ANGIO SCR2 REPORTING DPG AS DB JS JC BG ND WB NA AS NA JC NA JS WB DPG SN JS NA BG AS DB NA BG NA AB SN DPG AS WB ND DB NA SN ND WB AS SN ND KMR JS NA VM EP AS/SN DB NA JS DPG SN AS BG ND ARD DB VM NA VM BG NA WB/ND DPG AS NA NA JC BG NA WB DPG AS NA JC ND NA WB DPG SN NA JC NA AS-S JC NA BG NA AB SN DPG AS WB ND DB JC SN ND WB AS SN ND NA NA JC NA EP AS VM JC NA DPG SN AS BG ND ARD NA NA NA NA BG JC WB/ND

36 Radiologist provision Standard emergency cover outside these hours Radiologists work normal timetable between AAU weeks with programmed workloads

37 Assigned Radiologist Workloads At same time as AAU opened we moved to a system of reporting off worklists Radiologists no longer have CT, NM, MRI lists or plain film reporting sessions Workload now assigned on a weekly basis dependent on individual radiologist s availability for generic reporting sessions Radiologist can now report in a totally flexible manner

38 Reaching agreement A number of joint and separate meetings between radiologists and clinical director to sell new model Radiologists agreed reporting workload tariff

39 Reaching agreement advantages to individuals Exciting model of care in AAU Consistent workload in non-aau weeks Flexible Equitable Payment for extra hours/premium time

40 Reaching agreement advantages to trust Delivered AAU service model of dedicated consultant level service with extended hours working Capacity clearly mapped Increased radiologist workload

41 Work load Challenges?

42 CT MRI Ultrasound

43 Challenges? Work load Generalist vs subspecialisation

44 Challenges? Work load Generalist vs subspecialisation New subspecialties in acute care?

45 Challenges? Work load Generalist vs subspecialisation New subspecialties in acute care? Outstanding issues - Major interventional services - MRI

46 Cardinal Rules Extended hours working should be part of a hospital wide modernisation project Major consultant input Everyone's solutions will be different (partly driven by breadth of skills) Big changes can be easier than small changes!

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