Patient safety and experience: our response to Covid-19

Patient safety and experience: our response to COVID-19

Our Patient Safety and Experience, Healthy Ageing and Digital Transformation Teams have been working in partnership to support our local health and care system response to Covid-19.  Working as part of the NHS National Patient Safety Improvement Programmes, our work over the next six months will focus on the following areas to contribute to the NHS response to Covid-19.

Deterioration

Failure to recognise or act on signs of deterioration can result in missed opportunities to provide necessary care and give patients the best possible chance of survival (Patient Safety Alerts 2016, 2018). This area therefore continues to be a major patient safety priority for the NHS during the Covid-19 outbreak. A good system of managing deterioration includes processes and solutions that enable:

  • Early detection of physical deterioration. This includes a physiology assessment and early warning tools such as soft signs and the NEWS2 score. A growing number of digital solutions to support these processes are also available.
  • An understanding of what is “normal” for a resident.
  • Staff knowing what to do next if a person’s health deteriorates. Agreed escalation processes are required, including end-of-life preferences, advanced care and treatment escalation plans.
  • Staff to effectively communicate their concerns. This includes human factors and structured communication.

We already have a south London managing deterioration improvement programme as part of the national patient safety improvement work. Consequently, our team is contributing to national developments and assisting regional and local efforts aimed at optimising patient outcomes during the pandemic. We are also building connections with a growing number of digital projects aimed at enabling remote assessment and monitoring of patients within the community setting.

Our Programme Director for Patient Safety and Experience, Catherine Dale, is a national co-lead for the Patient Safety Collaboratives on deterioration and was instrumental in the delivery of a very successful national webinar for GPs working hard at the front line to tackle Covid-19.

Our Tracheostomy programme as part of the Patient Safety and Experience team’s wider response to Covid-19. Through the South London Critical Care Network and other local colleagues, we have been exploring what inpatient tracheostomy care looks like currently in trusts and how teams can be supported to improve it and make it even safer during these challenging times. The team are also starting to think about what service provision is available for tracheostomy care in the community, for those discharged from hospital. Find out more about the AHSN Safe tracheostomy care work here.
Our Patient Safety and Experience team is still working in collaboration with Revealing Reality and Hill+Knowlton Strategies, adapting our previous work on Behavioural Insights into Catheter Careto support and protect the health and wellbeing of healthcare staff during the current pandemic. Many staff in the NHS and beyond have found themselves in strange new territory or have been greatly affected by this global crisis. We are applying our experience of Behavioural Insights and Quality Improvement to a new project that aims to support south London staff and equip them to face the challenges ahead.
Care and outcomes for women and babies remains a priority during the pandemic. The team has been working with local trusts, as well as teams nationally, to support the sharing of intelligence and spread of innovations with the aim of maximising learning and improving safety.

We are supporting four units in south London to adopt a standardised assessment and triage system called The Birmingham Symptom-specific Obstetric Triage System (BSOTS). This provides a framework for women to be assessed quickly and reliably when presenting with concerns and those who need urgent care are prioritised, rather than reviewing women in order of attendance.

We have also been supporting the spread of the QUiPP app – a locally born clinical decision-support tool that helps to predict the likelihood of preterm delivery when a woman presents at hospital. The supporting toolkit for adoption has been rapidly rolled out during the pandemic as this innovation helps to decrease unnecessary admissions and transfers.

In partnership with our London colleagues, we have also begun to consider safety practices and cultures in maternity and neonatal care in the coming months as we enter the next phase of the pandemic.

There is evidence that patients who have information about their medicines when they are transferred to their usual community pharmacy are less likely to be readmitted to hospital. In the current Covid-19 response, with large numbers of patients being discharged quickly, it is imperative that medication safety is not overlooked. TCAM schemes are a structured way to pass on medicines information from hospital settings to community pharmacies. Trusts that already have TCAM schemes in place are asked to review their referral criteria to make sure patients at the highest risk and with the greatest need are prioritised.

We are are working with trusts who are yet to establish TCAM schemes by engaging with hospital pharmacists, community pharmacists and local pharmaceutical committees (LPCs) in those areas.

“High quality, safe care can be achieved through preparation, planning and education; the National Patient Safety Improvement Programme has created this important national program to rapidly develop the skills and knowledge for bedside staff to deliver safe tracheostomy care everywhere.”
Brendan McGrath – National Clinical Advisor for National Patient Safety Improvement Programme Covid-19 Response (Safe Tracheostomy Care); Intensive Care Consultant, Manchester University NHS FT

The team will be very happy to hear from you if you want to know more about any of our projects above or discuss support for your local work, contact hin.southlondon@nhs.net

You can also access nationally available resources and webinars on the AHSN Network Patient Safety COVID-19 webpage here.

Helping break unwelcome news

Helping break unwelcome news COVID-19 outbreak

Health Education England has published a set of materials and films which aim to support staff through difficult conversations arising from the Covid-19 outbreak.

The AHSN Network was part of a small group of people that helped pull this resource together in less than two weeks.

The framework includes posters and films based on the evidence base from Real Talk and then filmed with willing volunteers.

You can also follow #UnwelcomeNews on Twitter.

Start here for an introduction to the framework: Discussion of Unwelcome News during the Covid-19 pandemic: a framework for health and social care professionals

You can watch the films here:

  1. The framework
  2. Community
  3. Breaking bad news
  4. Ceilings of treatment

Then access the resources here:

Follow this link for more information on patient safety during Covid-19.

Covid-19: Patient Assessment the role of physiology and oximetry

COVID-19: Patient Assessment the role of physiology and oximetry

The assessment of patients who are unwell with Covid-19 or other causes presents a significant challenge for GPs and clinicians working in Primary Care. The Royal College of General Practitioners (RCGP) and the AHSN Network are holding a joint webinar looking at the role of oximetry and other physiology in that assessment.

The webinar will be led by:

  • Dr Jonathan Leach, RCGP Honorary Secretary and Covid Lead
  • Dr Alison Tavaré, Primary Care Clinical Lead at West of England AHSN
  • Dr Simon Stockley, RCGP Lead for Acute Deterioration and Sepsis

Overview of content to be explored:

  • Clinical features of Covid-19
  • Importance of oximetry in Covid
  • Clinical judgement and physiology in Patient assessment
  • Role of NEWS2 in General Practice and Care Homes
  • Remote oximetry in the assessment and management of Covid disease in the community
  • This will be followed by a Q and A session.

The webinar will be held on Wednesday 29 April, 13.30 – 14.30pm and you can register here. The webinar will be recorded and shared afterwards.

Improving Patient and Staff Experience and Safety with Queue Management Software in the Emergency Department

Improving patient and staff experience and safety with queue management software in the emergency department

Visible queue management software in the emergency department at-a-glance

Visible electronic queues in hospital emergency departments to improve patient experience and reduce pressure on staff.
The desire to use techonology to reduce pressure on emergency department reception teams and improve patient experience and safety.
• Better patient experience in Emergency Departments.
• Improvements in staff experience in Emergency Departments.
• Fewer interruptions for busy reception staff, with knock-on efficieny benefits and a reduction in complaints about behaviour related to wait time information.
• Greater transparency and education around the complexity of wait times in Emergency Departments.

Visible queuing: a game changer in hospital emergency departments

HIN Innovation Grants will fund an innovative project to improve patient experience in the Emergency Department at St George’s University Hospitals NHS Foundation Trust.

This project will pilot a visible electronic queue management system so that patients can see where they are in the queue to be seen at any time. The team is understood to be among the first in the UK to introduce this.

The new system aims to improve patient experience and reduce the time receptionists in the Emergency Department at St George’s spend dealing with waiting time or queue position queries. Staff in Emergency Departments around the country deal with a high volume of these questions which can have a knock-on delay in booking-in new patients.

The idea for the new system came from junior doctor Dr Lindsey Bezzina who worked in the Emergency Department for a year and witnessed the problems reception teams and other staff encounter first-hand when it comes to waiting times queries. Currently, a whiteboard behind the reception desk is used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This leads to repeated queries to reception staff about the waiting time and these queries are not always easy to answer due to the complexity of queues. As well as frustration for patients, these queries can occasionally result in aggressive and abusive behaviours which put additional pressure on staff.

The new system will offer people a code when they first arrive and register their details. This code will correspond with a number shown on an electronic screen, showing where the number is in the queue. The display will be visible from all parts of the waiting room and will make clear that there are multiple queues at any one time and that if someone arrives who needs more urgent care, the queue positions will move accordingly.

This means patients will be able to monitor their own position and progress in the queue, which provides assurance that they have not been missed or forgotten, reducing anxiety as well as the likelihood of aggression directed towards other patients or staff. The transparency the system will offer has the potential to educate people waiting about the multiple queues in operation at any one time, aiding understanding about the way Emergency Departments operate and why some people are seen more quickly.

The grant awarded will be used toward developing and implementing the queue management software in the Emergency Departments department. If this innovative pilot is successful and adopted as business as ususal, the software can be spread and adopted by other NHS emergency departments. There is also an opportunity for use of this system in outpatient departments at a later stage.

Find out more about our work in patient experience


Innovator Spotlight

Dr Lindsey Bezzina, Junior Clinical Fellow, Emergency Medicine, St George’s University Hospitals NHS Foundation Trust said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.

“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

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Support for the deployment of GP online consultation systems in south London

Support for the deployment of GP online consultation systems in south London

Since its inception, Health Innovation Network’s Technology team has been interested in how new communications technologies offer the opportunity to enhance healthcare interactions. Such interactions could include clinical consultations between a GP or specialist and a patient in general practice or hospital outpatients’ department. They could also include discussions between professionals, for instance:

  • A multi-disciplinary team (MDT) meeting in a hospital/community setting
  • A GP seeking the input of an expert specialist.

In July 2016,we undertook a review of the Hurley Group’s ‘eConsult’ (formerly ‘WebGP’) platform, in which we sought to understand the nature and extent of this particular opportunity to transform access to general practice. More recently, we have undertaken work to promote the spread and adoption, specifically, of video-based remote consultation in hospitals—often generically referred to as ‘Skype clinics’.

Given the announcement in October 2017 of NHS England’s GP Online Consultation Systems Fund, Health Innovation Network’s Technology team is now exploring how it could be of support to CCGs and GPs in south London as they progress plans to introduce or further develop provision for GP online consultation.

We are well-aware that CCGs across south London are by no means lacking in ambition where digital transformation is concerned, and many are already forging ahead with enhancements to primary care provision with online consultation solutions of one form or another at their heart. We watch these developments with great interest and excitement.

We would be interested to hear from colleagues across south London to understand your plans for offering GP online consultation, and to discuss how can best support you in this endeavour. We are in the process of engaging CCGs across the patch, but if you would like to discuss this support opportunity further now, please contact Tim Burdsey, Technology Project Manager at tim.burdsey@nhs.net We look forward to hearing from you—and to working with you, to help realise your digital ambitions for primary care and for your wider local health and care system.

Creating waves across the Pond

Creating waves across the Pond

Written by Catherine Dale, Programme Director – Patient Safety and Experience.

My friend gave the opening keynote speech at this month’s Institute for Healthcare Improvement (IHI) National Forum in Orlando, Florida. I was moved to tears in the audience watching her.

I got to know Tiffany Christensen this April when we both taught on the IHI’s inaugural Co-Design college in Boston, Massachusetts. I was teaching the Experience-Based Co-Design approach. Tiffany shared her insights both as a life-long cystic fibrosis patient and as a professional patient advocate with a working career in healthcare improvement.

Tiffany spoke of contending with a double lung transplant which was unsuccessful, meaning she was facing imminent death. When offered a second double lung transplant, Tiffany was initially completely thrown as she had accepted the fact that she was going to die. Being offered another chance of life was an enormous challenge to her, but in coming through that experience Tiffany chose to dedicate her working life to enhancing healthcare for others. She joined a Patient and Family Advisory Council – a core part of healthcare structure in the USA – and trained in improvement methods.

When we met at the Co-Design college, she was struck by the way that Experience-Based Co-Design enables patients to have a more active and influential role in improving healthcare. This reminded me that when ‘patient involvement’ became a buzz phrase in the NHS in the early 2000s I had often wondered ‘involvement in what?’ you can’t just be ‘involved’ without context or purpose. For me the most compelling area for patients to be involved in is improving and re-designing healthcare. I am biased as this is the field of work I have devoted myself to for the past decade and a half. But I find it so rewarding that I want to provide others with that same opportunity – hence training people in Experience-Based Co-Design every chance I get!

Tiffany and I delivered a workshop ‘Co-design is Caring: Experience Meets Experience’ at the IHI National Forum with Andrea Werner from Bellin Health in Wisconsin. The participants were extremely enthusiastic about the approach. One tweeted “It was amazing! It’s all about the ‘we’ not ‘me’ – value and include the voice and experience of patients!”

It was fantastic to have this opportunity to share and encourage co-design between staff and patients. So I was incredibly proud that ‘co-design’ was a core message in the keynote discussion between Tiffany, Derek Feeley and Dr Rana Awdish

When Tiffany gave her closing thought in her keynote I found myself gently weeping: we should not consider our efforts to improve healthcare to be drops in the ocean, every one of us is a ripple and we don’t know how far that ripple will have an effect.

If, like Derek Feeley, CEO of IHI, you would like to see healthcare evolve from patient-centred care to partnership with patients you can start here or contact me for further encouragement. If we add all our ripples together we will create waves.

Pictured above: Tiffany Christensen (left) and Catherine Dale (right)

Note: Many thanks to the Point of Care Foundation, IHI and the Health Innovation Network for enabling me to attend the IHI National Forum in December 2017.