evening handover to the Hospital at Night team Introduce Sat/Sun Consultant led medicine emergency ward rounds for high care and MAU: responsible for their ongoing care, rather than a single consultant on call, conducting a ‘safari’ type round of many wards. Example 4 level Example 5 level Introduction of Registrar-led telemedicine within medicine; virtual Sat/Sun ward rounds with SHO to enable all patients to be directly reviewed cf post take only. 2 Secure additional operating time within existing job plans by implementing a three session rota over extended working day from 8am to -10pm, Mon-Thurs and 8am to 5pm, Friday. 1 Example 6 level Example 7 Example 8 level Introduction of hybrid ED staffing model: additional registrar and Trust Grade Consultants into ED. This could potentially include telemedicine links to paramedics/nursing homes and GPs to deliver 24/7 consultant cover in ED and appropriate staffing to ensure rapid review of patient directly or remotely to support admission avoidance. Supported by ENPs treating minor illness in addition to minor injury Interim arrangements – additional medical registrar into ED afternoons on pilot basis 2/3 1 Introduction of model ward Friday focus for the weekend (Weekend planning): continue roll out of model ward to all wards. Friday focus on clear personal plans for all patients including eg. Resus status, ceilings of care decisions, parameters enabling discharge etc. Supported by introduction of discharge. Will also enhance multidisciplinary handover arrangements/integrity. 1 Introduce short MAU and high care Consultant/nurse/physio board rounds on Saturdays and Sundays: ensures multidisciplinary involvement in rounding in acute areas without detracting from other weekend physio requirements. 1/2 Example 9 level Example 10 level Trauma and Orthopaedics The on-call team for the new day completes a new patient clinic - 365 days a year. This is a consultant-led 3 Further expansion of Orthopaedic Nurse Specialists and Specialist Practitioners 2
defining routine work as opposed to emergency duty work although additional staffing required) Example 17 level Support Services: Pharmacy Extend opening to ensure cover up to 7pm weekdays. Amend and extend current weekend opening to support discharge 11 – 3 Saturday, Sunday and bank holidays. Outside of these hours pharmacists to provide a 24 hours service seven days per week on-call from home overnight; maximum response time of 30 minutes. Extended support to enable medicine reconciliation on admission, one stop dispensing and TTOs ready day prior to discharge. 1/2 Example 18 level Phlebotomy Extend hours to cover full day mon – fri and continue current hours sat/sun 2 Example 19 level Example 20 Cancer services – including chemotherapy and acute oncology Extend working week to include Saturdays. Reduced service on Saturday managed by two trained chemotherapy nurses 8am to 4pm and a band two ward clerk 8am to 2pm. Prescriptions to pharmacy by lunchtime on Thursday and chemotherapy delivered to the unit 2 Establish ambulatory pathways for patients waiting for MDT results rather than in-pt stay. Establish post MDT clinic on a Saturday for results. Extend availability to seven days per week and extended hours of specialist nurse to 1
each Friday in preparation for the following day. Involvement of medical staff with the booked Saturday patients is minimal. support the management of acute oncology emergency presentations 4. Headline approach & next steps to progressing towards Keogh seven day working compliance 4.1 The introduction of any of the examples described necessitates adoption of a whole health and social care system approach without which the value of introducing service change will fail. Action By when By who Undertake 3x weekend audit and range of wards/patients to determine what would make the difference to treatment and/or ability to discharge if available over the weekend August 2014 Clinical Leads Establish baseline position LOS, discharge rates, admissions etc August 2014 Dir Ops Commence reporting on KPIs by weekend and by week – ensure this information displayed outside each ward September 2014 Dir Ops multidisciplinary ward rounds Sundays - all wards to receive single ward round (acute areas to receive 2 rounds) to focus on discharge and help to ease Monday pressures. Use to determine what services (internal/external) required to ensure benefit from Sunday rounding. November 2014 Clinical Leads Review existing job contract for all clinical, support service and therapy to determine how future flexibility /requirement for rota working to ensure 7 day cover can be built in. Cost proposals and consider ensuring all new staff employed on these contracts. October 2014 Dir HR Determine new approaches to collating feedback re. weekend or midday use of hospital/admission September 2014 Head of Governance Determine key service interdependencies October 2014 Dir Ops/Clinical Leads Determine extent to existing Hospital Out of Hours team roles/responsibilities could be extended to support 7 day working October 2014 Dir Ops/Clinical Leads Determine priority services for pilot of any new arrangements. October 2014 Dir Ops/Clinical Leads Identify training/recruitment needs (eg. Upskilling). Cost proposals. October 2014 Dir Ops/Clinical Leads Commence/continue discussions with support services and therapies regarding options to secure 7 day working including generic workers, extended new rotas. Determine KPIs for each service change December 2014 Dir Ops
Cost preferred options and explore potential for pilot a part of 2014/15 Operational Resilience & Capacity Planning. Discussions with Surgeons and Physicians regarding options to secure 7 day working including alternative skill mix to manage work and release consultant time, extended hours, new rotas. Determine KPIs for each service change Cost preferred options and explore potential for pilot a part of 2014/15 Operational Resilience & Capacity Planning. November 2014 Medical Director Determine extend to utilisation of Telemedicine/tele-coaching might support the delivery of admission avoidance, earlier/supported discharge and 7 day working (Registrar sponsor and Ambulance Sponsor identified and working to support project). May 2014 and ongoing as service options are developed Dir Strategic Development Determine general management and senior nursing support required to deliver 7 day working November 2014 Dir Ops/Dir Nursing Risks to achievement Risk Mitigating actions Level of Risk Silo service and/or Trust approach likely to result in failure arising from inability to impact on treatment regimes/treatment in alternative settings Identify internal critical service interdependencies Ensure a planned and whole Trust project approach with regular overview of Trust-wide service by service/speciality progress Ensure a health and social care economy planning and pilot approach H Financial affordability of proposals including constraints imposed by Consultant Contract and Agenda for Change Ensure realism concerning service/speciality requirements and underlying aim of ensuring equity of ongoing treatment Focus on solutions which deliver within existing contractual arrangements or require minimum contractual amendment (eg. extended hrs may reduce on call payments thus becoming cost neutral) H