Sept 2013 KEOGH REVIEW PROGRESS The Keogh review has provided the Trust with a further opportunity to really scrutinise its performance and approaches to patient care. The report which was published in July not only confirmed areas of weakness, many of which were highlighted as part of the due diligence for acquisition process, but also highlighted areas requiring urgent attention. We must never lose sight of the fact that this review has been about patients and the care they have received and what they should expect to receive. We are continuing to work hard to address the areas recommended for improvement in the report and good progress has been made, including: REDUCING MORTALITY AND HARM-RATE Out of hours surgery led by a consultant surgeon and consultant anaesthetist Management of the Deteriorating Patient Group set up Embedding National Early Warning Scores (NEWS) on all wards Transferred high-risk pathways from West Cumberland Hospital to the Cumberland Infirmary Development of out-of-hours service for Emergency GI (gastroenterology) currently advertising for four gastroenterologists Five new surgeons been appointed to support planned moves for high risk surgery ESTATES IMPROVEMENT PLAN A comprehensive review has taken place in estates and facilities with a full compliance check on theatres across both hospitals undertaken. Other areas where a lot of work is on-going include: IN THIS ISSUE... Quality staff for quality care Specialist cancer clinic goes west Renal unit named among best in UK Urgent patient referrals The role of the Primary PCI Coordinator Top trainee feedback for ENT Discharge summary target update Focus on - Audiology Previous editions of GP Update are available at: www.ncuh.nhs.uk/for-gps/gp-newsletter.aspx Ward staffing assurance Developing Hospital@Night Reducing infection rates Improving Serious Untoward Incident Process and Embedding Learning Improved complaint handling Improving engagement and ownership with new board to ward scheme staff taking ownership in delivering their safety and quality priorities If you have any questions or would like to know more about any of the areas mentioned above, please email gp.linkgroup@ncuh.nhs.uk
QUALITY STAFF FOR QUALITY CARE As acknowledged in the Keogh report, the Trust is working with Northumbria Healthcare NHS Foundation Trust to strengthen our recruitment process. Our number one priority is improving the quality of care for patients; therefore we will not settle for anything other than the best candidate for the posts and this will guarantee our continuous focus on the quality of services we provide. In the past, the Trust has had difficulty attracting new consultants to North Cumbria, particularly to West Cumberland Hospital. Now, as we work closer with Northumbria, more senior clinicians from across the country are being attracted by the prospect of working in our Trust. Dr Varma Since September 2012, dozens of permanent consultants and nursing staff have been recruited, bringing years of skills and experience to the Trust and helping to shape the future development of specialist services across North Cumbria whilst also helping to reduce costs of locum doctors which the Trust has historically had to incur. Dr Madhusudhan Varma has recently joined as a consultant interventional cardiologist, expanding the team in the Heart Centre in the Cumberland Infirmary. Dr Varma said he was very excited to join the team just as the new Primary PCI service was launching: Looking at the volume of patients we have been getting just in the first month, the predictions were right that the volume would be extremely high, so this the place to be for someone in my specialty, he said. A sixth consultant interventional cardiologist is also set to join the team. Dr Varma has taken the lead on safety and audit, and will chair a weekly meeting which addresses any safety issues in The Heart Centre and Coronary Care Unit. One session a week has been set aside to address complaints, near misses and any safety concerns staff may have to try to address issues at an early stage. Nurses and other staff can come and talk to me and tell me anything they want, Dr Varma said. I m not here to blame anybody this is a supporting culture. If we make a mistake, we need to talk about it so we can prevent it happening again. As well as new consultants in medical specialties such as rheumatology and respiratory, new consultant surgeons are also joining in colorectal, vascular, upper GI and gynaecology. Consultants who are being recruited will work across both of our hospital sites. Our A&E departments are also benefitting from new permanent consultants. Dr James Hayton has joined West Cumberland Hospital from North Tees and Hartlepool NHS Foundation Trust. James said: It s an exciting time to join West Cumberland Hospital as there are lots of changes going on in terms of the Emergency Department. A new consultant is also set to take up post in A&E at the Cumberland Infirmary in September. Dr Clive Graham, Business Unit Director for Clinical Support & Cancer Services said: The new consultants we are recruiting are bringing a wealth of new ideas and expertise with them. Recruitment is going well and some excellent appointments are being made as we work towards securing a more stable consultant workforce for the longer term. This is an exciting time to join our organisation as the acquisition with Northumbria moves forward to create one of the biggest Trusts in the country.
SPECIALIST CANCER CLINIC GOES WEST A specialist cancer clinic for patients receiving Herceptin, which is currently provided at the Cumberland Infirmary by consultant cancer nurse Helen Roe and the cardiology physiologists, is now being delivered on both hospital sites. This move has been largely driven by the results of a patient satisfaction survey undertaken at the end of 2012 by Helen. The aim of this was to enable her to gain the patients perception of this treatment pathway from the information they received prior to commencing Herceptin, throughout their treatment, monitoring and follow up. Helen Roe The clinic has recently received national recognition as an example of a change in clinical practice which has a positive benefit for patients. The clinic received this recognition as it demonstrated quality, innovation, productivity and prevention, all of which are key components to providing a safe and effective service for patients. It also demonstrated two very different clinical teams working together to provide a patient-focused service. As a result of this recognition Helen has been asked to produce and publish an implementation document to share with others to assist them to replicate this service within their organisations. If you have any questions about the new clinic, please email gp.linkgroup@ncuh.nhs.uk RENAL UNIT NAMED AMONG BEST IN UK The UK Renal Registry, the national audit of all 71 renal units across the country, has named our Trust among the best for dialysis patients. URGENT PATIENT REFERRALS Can we please remind GPs to advise your patients who are being referred urgently to hospital that they are being referred for assessment, not necessarily admission. Many thanks for your co-operation. The figures for 2011, published recently, show how our renal unit compares very favourably across all measures, and has done particularly well in two areas. Our unit had one of the highest proportions of patients starting renal dialysis on home therapy. Just over 40% of patients who started dialysis in 2011 had this treatment in their own home, rather than in hospital something the Department of Health has been trying to encourage. Rates for one year survival of dialysis patients was also among the highest in the UK, at 93.3%. Dr Mark Boxall Dr Mark Boxall, clinical director for renal services, said: There is no doubt these results are very, very good and show that the whole renal team are doing an excellent job, and should be proud of themselves for all of their hard work.
THE ROLE OF THE PCI COORDINATOR A Primary PCI Coordinator role has been introduced to manage patient pathways in coronary care. Michael Kennedy, a member of the senior nursing team on the Coronary Care Unit, is one of the Primary PCI coordinators who take referrals directly from GP practices, the ambulance service, air ambulance, A&E and any other area in the hospital who may be concerned that one of their patients is having a STEMI (ST-Elevation Myocardial Infarction). Michael explains: I am an experienced coronary care nurse who specialises in ECG interpretation and rhythm analysis. This means that I can assess patients and on the basis of Cumbria s first Primary PCI service launched on 8 July with ambulances now taking patients in north Cumbria (including West Cumbria) directly to The Heart Centre at the Cumberland Infirmary for assessment and treatment. The centre is now open 24 hours a day, 7 days a week and within the first month, there have been 29 Primary PCI patients more than was anticipated. my interpretation of their ECG, I will call the Primary PCI team in if required. The team consists of a consultant cardiologist, a cardiac physiologist, a radiographer and two cath lab nurses. If the team is needed out-of-hours, they are on-call. I look after the patient until the team arrives and escort them safely to the lab for treatment. The new round-the-clock service is a huge benefit to north Cumbria as patients are receiving the emergency care they need much quicker and closer to home. PCI Coordinator Michael Kennedy If you have any questions about referrals to the Primary PCI Coordinator, email gp.linkgroup@ncuh.nhs.uk PATIENT PAYS TRIBUTE TO HEART CENTRE A patient has paid tribute to staff at the Cumberland Infirmary after having Primary PCI treatment. Michael Hall from Bardon Mill in Northumberland, was on a community archaeology group dig in Alston on Saturday 3 August when he started to get chest pains. He was taken from Alston to Carlisle in an air ambulance. He said: The air ambulance crew were excellent and when we arrived at The Heart Centre, I remember the team were all ready and waiting for me. I was taken straight to the lab for Primary PCI treatment and then up the Coronary Care Unit where I stated for four days. The staff were all absolutely fantastic. It came as a huge shock to me as I have never had anything like this before and lead a healthy lifestyle I wasn t aware I had any health problems. I didn t realise the Primary PCI service had only just started in Carlisle I m certainly glad it is there.
TOP TRAINEE FEEDBACK FOR ENT The GMC s National Training Survey has rated the Cumberland Infirmary s ENT department the top place to train in ENT in Northern England (Cumbria and North East). The department was compared to other hospital trusts in the Northern Deanery including City Hospitals Sunderland, County Durham and Darlington, South Tees and Newcastle. The survey is completed by foundation doctors, surgical trainees and GP trainees. This is the fourth year in a row that the department has scored high in the survey. Mr Andrew Robson with his trainees Mr Andrew Robson, Consultant ENT Surgeon, said: We are, once again, very pleased with the results of the survey. It takes commitment from the Trust and from all of the consultants in the ENT department here to provide a good learning environment. Alex Stearn who is currently a GP trainee in the ENT department at the Cumberland Infirmary, said he has gained valuable experience during this placement: ENT is common for general practice therefore is important for my training. I have found everyone here to be very helpful and they always have time for me. Kamaal Khan is a Registrar in ENT. Over the past 11 years of his training, he has completed placements in every ENT department in the Northern Deanery and in Edinburgh. He said: When I look back, I realise that I chose to specialise in ENT because I worked in Carlisle from 2004-2008. It is the best place to be for ENT training, all of registrar colleagues have no hesitations about coming to work in CIC s ENT department. Mr Robson is the best trainer you could hope for, any registrar who has worked in this department will tell you that. DISCHARGE SUMMARY TARGET UPDATE Since the start of the year, the Trust has had a big push on improving our discharge processes in order to improve patient safety, and in particular ensuring that every patient has a discharge summary report on the day of discharge. As reported in the last edition, the Trust has gone from only 33% of patients and their GPs receiving the correct discharge documentation to over 80%. The figure is now at 89.5% with some specialties achieving 100%. We are very close to achieving our initial target of 90%, but we will not stop until every single patient has a discharge summary report on the day of discharge.
FOCUS ON: AUDIOLOGY The Audiology department employs nine qualified audiologists and is a combined service dealing with patients of all ages, from newborn babies to the elderly. Referrals for assessment are mainly via ENT but the department welcomes direct referrals from GPs of routine patients over 60 years of age requiring hearing aid/s who do not present the following contra indications: Wax obstructing the ear Sudden or fluctuating deafness Asymmetrical deafness Conductive deafness, e.g. recent discharging ears, perforation Unilateral tinnitus Vertigo Appropriate referrals can be made via the choose and book system or a letter to our main office. Based at the Cumberland Infirmary, the Audiology service also operates additional satellite clinics in Workington, Whitehaven, Penrith and Keswick. It provides open access sessions to patients for repairs and modifications five days a week with appointments available on request for more complex issues. The service also works closely with Bridging the Gap and Sound Advice in providing a further 20 community sites for battery issue and minor repairs. The department provides a range of 100% digital hearing aids and has worked closely with Siemens to introduce their range of Impact Pro aids as the standard instruments in adult provision. The hearing aids are available as in-the-ear, behind-the-ear and open fit models and include many of the features associated with top of the range products. The progressive nature of age-related deafness means that an individual may require a number of assessments and adjustments in his/her lifetime. Patients issued with hearing aids are issued with batteries free of charge and can self-refer if they require a review appointment. Our audiology team at the Cumberland Infirmary The department waiting lists are well within the NHS targets with the vast majority of patients requiring hearing aids issued within two months from date of referral and re-assessments are seen within six weeks. Adult hearing aid provision is just one aspect of the service which also provides a range of investigative procedures to assist in the assessment and diagnosis of hearing related disorders including tympanometry, behavioural assessment in paediatric cases, electrophysiological assessment for threshold measurement and differential diagnosis, balance assessment, speech audiometry and auditory processing assessment. These are complemented by a comprehensive rehabilitation service for cases identified with deafness and related symptoms including tinnitus counselling and provision of Bone Anchored Hearing Aids. If you have a question for the Audiology department, please email gp.linkgroup@ncuh.nhs.uk