Presentation given by Belinda Boulton and Tracy Hughes, Oxford University Hospitals NHS Trust. Reading 'Improving access to seven day services' event on 11th March 2015

1. Care 24/7 Project
‘’Meeting Local
Challenges 7 Days A
Week’’
Belinda Boulton, Head of Transformation
Tracey Hughes, Project Manager

3. ‘Care 24/ 7’ Transformation Project
• National Reviews – National Clinical Standards
• Whole System Involvement of Stakeholders
– Urgent Care Programme Board
– Oxon Clinical Commissioning Group and SSCG
– Risk Summit Open Event (including patients and other
centres)
• Local reviews
– Higher than expected mortality rates at the weekend
– Junior doctors writing to the media
– Challenges related to meeting performance targets

4. Care 24/ 7 Whole Systems Approach
Care 24/ 7
Gap
Analysis
Workforce
Reconfiguration
Reduce the
Demand for
Acute Sector
Based Care
CQUIN £1.3m
Winter Pressures
Funding
Business Cases
Better Care
Funding

5. Care 24/ 7 Local Reviews

6. Care 24/ 7 Project Structure
Clinical Lead & Dedicated Project Manager
Monthly Reporting Through to TME & CGC
Workforce issues highlighted to WOSG
Ratification of new guidance and policies
Information cascade to all levels of the
organisation: site Clinical Leads and intranet
site

7. Handover
IT
Pharmacy
Venue
Documents
Training
Rotas

8. Establishing Current Practice Phase 1
• Reports, observations & feedback made during focus
groups, shadowing Junior Doctors & Night Nurse
Practioner (NNP) across a 7 Day week Out of Hours
(OOH) found
• Lack of general communication/coordination
• Gaps in medical/nursing rotas (responsible for cover)
• NNP Role not utilised
• Junior doctors bleeped for tasks
• Separate doctors/NNP handovers
• IT security issues regarding online take referral lists

9. Handover Action needed….
1. Improve communication/skill mix across 7 days a week
2. Establish suitable MDT and venue for handover
3. Mapping of rotas (gaps in service/handover timings)
4. Determining best use of IT to support (EPR)
a. Electronic patient referral system (prevent s-drive)
b. Record MDT attendance register/report issues or
concerns
5. Developed
a. Handover Guidance Policy/SBAR Tool/Support rota
b. Presented staff awareness briefings & training sessions
c. Business Cases for Rota‘s, Referrals & Staff teams
d. Evaluation process

10. How We Moved Forward
Medical SpR and Night Nurse Practitioners to jointly
manage an MDT handover
• Medics/NNP alignment of shift working patterns
• Organisational Change (OC) Proposal
• A months consultation to challenge the proposal
• NNP Role change to Clinical Coordinator (CC) Role
• CC’s to act as clinical leads
• Staff choices (retire, re-train, re-deploy or be
managed according to role adjustment)
• Recruited CC staff to cover gaps in practice

11. Mapping of Activity Early Days…
Need for….
Business Case approvals for
• Live management of an
electronic rota system
• Live electronic patient
referral to out of hours
(H@N) services
• Increased staffing for
therapies/CC’s
• Paper for Handover
Guidance Policy
Results so far….
• 7 days a week MDT handover
• Medics and MDT feedback
• Clinical discussions regarding
transfers, discharges,
staffing, operational
management
• Monitoring of MDT
attendance register
• Demonstrates Home Before
Lunch

12. Patient Activity Home Before Lunch
November AGM Patients
Last ward
# of
Patients
Average of
LOS
Time of
admission
Time of
discharge
H-WD EAU 273 0.5 14:10:50 16:02:15
H-WD Laburnum 84 9.7 14:10:36 15:35:39
H-WD Juniper 79 10.1 14:43:45 15:34:24
H-WD Oak 70 12.5 12:55:20 15:01:03
H-WD E 52 7.2 14:33:50 15:40:03
H-WD F 20 12.0 15:22:24 15:55:42
H-WD Crit Care 15 4.0 12:57:56 14:34:00
H-WD Childrens 2 1.0 19:20:30 09:32:30
H-DC DCU 1 0.0 10:30:00 20:10:00
Grand Total 596 5.5 14:09:32 15:42:21

13. Clinical Utilisation Review (CUR)
• Steps are to be taken to evaluate the current practice within
the Trust in terms of discharge process mapping
• The CUR will include an interface that clearly represents the
status of each patient in their discharge process.
• The CUR proforma shall highlight any barriers created in
preventing patient discharge
• An EPR proforma is to be developed around ideas taken from
successful software solutions

15. Time of Discharge - HGH
Positive Shift

16. Time of Discharge - JR

17. 7 Days a Week Challenges…..
• Medical Rostering
• Gathering rota mappings for Medics/Ward & Unit Teams
• Lack of a coordinated system
• Organisational Change process timescales
• Handover awareness/guidance mappings
• Multiple staff training and awareness notifications
• Modified handover start
• New venue and support rota
• IT access/updates & staff training for project implementation
• Engaging site team managers to complete allocated tasks
• Sense of support service planning for Switchboard, Pharmacy,
Therapies, Radiology and Ward Relocations

18. Moving forward....
• NHS1Q – OUH innovation
• NHS1Q audits against self assessment
• Business Case approvals
• Rotas, Referrals and Staffing
• End of Life Care to increase specialist palliative care
provision & improve patient quality of care
• Revision of the Patient Safety Academy role
Phase 2 Churchill Hospital challenges - Ward Relocation
• Rota mapping
• Working in silos
• Commencing Phase 3 and 4