Kevin Downs and Keith Jones The Royal Derby Hospital
Facts About Our Hospital The Royal Derby Hospital is the newest hospital in the East Midlands 334 million has been invested in the development Annual budget of around 475 million Officially opened in April 2010 by Her Majesty The Queen and His Royal Highness The Duke of Edinburgh. We now care for more than 180,000 people as inpatients, outpatients, emergency patients and day cases. This equates to around 1,000,000 visits from patients each year. There are 1,159 beds in our 50 wards (Inc. 4 wards from our London Road site) And 200 of them are in single rooms with en-suite facilities Over 8,000 employees We have 35 operating theatres, plus a number of suites
Available At Derby Now A quick re-cap All information tracked to individual Patient and can feed the electronic record; 1. Products Tracked to Patients across all 40 clinical rooms (Inc. store rooms) 2. Full Traceability of Trays and Instruments Infection Control 3. Full Traceability of Staff and Location Scheduling / Productivity 4. Data that enables; Consultant to Consultant discussion Clinical and Product Variance / Training /LoS/PRE-OP information SUI Resolution What actually happened in theatre? Reduced Clinical admin Ordering/Writing up/duplication of data/accuracy improved Case Carts and Product Standardisation imminent Financial - Conservative savings of 1m pa consumables Coding Improvement 1m pa
Implementation Plan and Timescales Initial Planning stages - Commenced November 2013 Roll out to General Theatres - April 2014 9 theatres multiple specialties General Day case Theatres - December 2014 3 theatres multiple specialties Radiology January 2015-2 suites Cardio Catheter Labs May 2015-2 suites Urology day case August 2015 2 theatres Ophthalmology - Sept 2015 3 theatres Hand Theatres November 2015 3 theatres Gynae and Children's January 2016 6 theatres Trauma and Orthopaedics June 2016 8 theatres WARDS /Outpatients - Ward 403 Pilot August 2016 All theatres now Live! 38 Theatres inc. suites and a trial on a ward complete. Endoscopy went live for a clinical trial 12 months ago. 97,000 theatre episodes have been recorded to date
Apply GS1 standards at Derby; Patient : GS1 wristbands to capture & identify the right patient Product: GS1 GTIN s to identifying & trace the right products Place: GS1 GLN to identify the right location Process: GS1 standards in the NHS and patient care
Our Theatre Data Capture Device: Patient: Scan Wristband (GS1 GSRN) Timers: Knife to skin, time in recovery Location: Records locations (GLN s) Staff: Who is present. (GSRN) Procedure: Operations linked to OPCS codes In Theatre: Questions Anaesthetic: Type used Devices: Products, Trays & Implants used (GTIN s) Including Lot, Batch and expiry data Inventory: Enables automatic ordering
BIG STEVE Co-Morbidities Recording
Location ID Catalogue Mgmt. Patient ID Inventory Mgmt. Purchase to Pay Product Recall Patient Identification: htrak Theatre Scanning Solution Developing the solution to force positive patient identification
Our Ward Data Capture Device: No need for multiple devices Embedded in existing eobs Location: Records locations Staff: Who is present and carrying out the task Procedure: Task Captured Ward: Additional data available Devices: Products, (GTIN s) Future scope; Workflow / efficiency notifications Training / Infection data Patient path way easily documented
A high Level Patient Pathway Patient Ref 20026307 Elective Radiology Theatre Pt admitted for Elective Gastrostomy insertion @ 10.40hrs Pt admitted for Elective Gastrostomy insertion@15.27hrs 26 / 07/16 27/07/16 12/08/16 19/08/16 22/08/16 23/08/16 15/08/16 17/08/16 04/09/16 07/09/16 Ward Replacement of Tracheostomy tube @14.56hrs Suction of Tracheostomy @11.43 Suction of Tracheostomy @12.09 Suction of Tracheostomy @18.18 Change of Urinary Catheter @12.12 Suction of Tracheostomy @05.32 Suction of Tracheostomy @10.28 Emergency Operation for revision of Tracheostomy @ 08.27 Suction of Tracheostomy @09.52 Suction of Tracheostomy @06.40 Suction of Tracheostomy @ 16.23 & 19.25 IV cannulation @16.19 Emergency theatre Diagnostic endoscopic exam of Pharynx, larynx, oesophagus and biopsy of lesion @16.39 Data from PatienTrak would have all other nursing interactions e.g. Observations, fluid balance etc.
Full traceability across our theatres and suites; Product Recall; PC: H7493926224300 LOT:18787023 Built in to BAU Derby Process
Full traceability across our theatres and suites;
Once Identified the Patient Case Study
Full Product Traceability: Additionally Costing and Income for Procedures
Location ID Tray Traceability Infection Control Pre Scanning Solution: CJD Instances Reported Patients Notes Reviewed Trays Identified Min. 50 hour review per patient Cannot be 100% confident that ALL patients who subsequently came into contact with the contaminated trays could be identified CJD Instances Reported Catalogue Mgmt. Patient ID Inventory Mgmt. htrak Reviewed Purchase to Pay Product Recall 50 hours work per patient Low confidence in results Trays Identified NOW: 30 minutes to identify ALL affected trays and patients High level of confidence in the findings as all information electronically captures Affected Patients Identified 30 mins work for all patients High confidence in results Tray Analysis: Infection Control Traceability Audit Report Affected Patients Identified
Test Case Study CJD Scare Trays and Instruments Four Patients; Identified Patient Tray and Instrument used Other Patients affected?
Providing consultants with detailed Pre-op notes, prior to carrying out surgery Knowledge of implants prior to procedure: How many plates / screws are in already Types of screw heads to expect The right equipment to hand Not going in blind!
Driving Product Recalls when faulty products are identified - BARIATRICS Patient 1 - Arrives at Darlington for removal of faulty product fitted at Derby previous day - following Additional device failure during Derby procedure Patient 2 Arrives at Derby for removal of same faulty product, operated on in London. Patient 3 Operated on in Derby and removal of faulty product in Derby. Derby: Can trace product and batch in Seconds. Can identify location of store room where other faulty products are located
Submitted Evidence: Laparoscopic Cholecystectomy Consumable Costs and Consultant Variation Consultant Description Avg Consumable Cost Avg No of Products Avg No of Staff Avg Minutes No of Procedures Lower Quartile Upper Quartile Varian ce Std Deviation Avg LoS Max LoS Min Los Cons A 285 82 5 181 1 285 285 0-3.00 3.00 3.00 Cons B 239 74 7 127 3 232 250 37 19 1.00 1.00 1.00 Cons C 231 70 6 123 6 192 255 160 59 1.83 5.00 1.00 Cons D 227 70 6 98 9 197 248 146 45 1.56 6.00 1.00 Cons E 223 70 5 100 11 216 235 120 31 1.27 4.00 1.00 Cons F 218 69 6 93 6 203 238 60 24 1.00 1.00 1.00 Cons G 209 62 6 79 8 192 231 103 38 1.63 4.00 1.00 Cons H 188 64 7 90 9 164 224 149 53 1.25 2.00 1.00
Submitted Evidence: Reporting Data System Cons A Cons B Cons C Cons D Cons E
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