Lung Improvement Programme – Transforming Acute CareLiz Norman Senior Respiratory Nurse SpecialistElizabeth.Norman@nhct.nh...
Improving access to specialist care                             What we did – RNS     • Independent facilitator     • Use ...
Why focus on acute care?• The RNS team identified the following:  – Patients are the reason we do our job  – Every inpatie...
Recovery post austerity measures     Number patients seen by Respiratory Nurse Specialists           80           70      ...
Length of stay by ward and site                                                                             Length of stay...
NIV• In Situ:   – Established Physio led service   – Robust protocols   – Consultant support for difficult decision making...
NIV• Mapping event – identified delays (door to mask  time)• Walked through the process on the shop floor  – This identifi...
NIV• Root cause analysis for specific problems• Individuals taught when necessary• Education package targeted two groups: ...
Learning•   Project management•   Time to reflect and develop•   Using evidence and local data to inform decisions•   Link...
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Breakout 4.3 Building a caring future - Liz Norman

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Breakout 4.3 Building a caring future - Liz Norman
Lung Improvement Programme – Transforming Acute Care Senior Respiratory Nurse Specialist
NHS London Respiratory Team Lead
Consultant Respiratory Physician, Whittington Health & NHS Islington
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine
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Transcript of "Breakout 4.3 Building a caring future - Liz Norman"

  1. 1. Lung Improvement Programme – Transforming Acute CareLiz Norman Senior Respiratory Nurse SpecialistElizabeth.Norman@nhct.nhs.uk0191 293 4253 3 Streams • NIV – reducing door to mask time • COPD Extended Care Bundle • Increasing access to specialist care • Door to mask time • Specialist care • LOS • Readmission rates 1
  2. 2. Improving access to specialist care What we did – RNS • Independent facilitator • Use of data to drive change • Identified what got in the way of doing the job • Time –often doing the bare minimum • Fragmented day/week, overstretched and interrupted • General dogs body for extra work no one else picks up • Lack of understanding from others about the role and time pressures • Managing patient expectations • Session held to ‘drill down’ barriers • Identified what we could do to change and RNS key aims Using job plans for more efficiency• Sessional job plans for structure and focus• Demand and capacity work with OSM• Identified peaks and troughs in work pattern• Restructured each RNS week -Based on information from mapping event, RNS priorities and demand and capacity figures – Reduced O/P clinics – now working to full capacity – Reduced Supported discharge visits – freed up time for work identified as a higher priority (FoH) – Organised time for admin and teaching – Prioritised acute care/assessments for inpatients as key to quality patient care and staff/job satisfaction 2
  3. 3. Why focus on acute care?• The RNS team identified the following: – Patients are the reason we do our job – Every inpatient should have a specialist assessment – Assess all patients and see all newly diagnosed patients – Promote early discharge – Identify sick patients – prompt NIV – ensure sick patients transferred to a respiratory ward – Promote self management – Reduce length of stay – Reduce re-admissions Data –% COPD patients stay on a respiratory ward 3
  4. 4. Recovery post austerity measures Number patients seen by Respiratory Nurse Specialists 80 70 60 50 2009 40 2011 30 2012 20 10 0 Aug Sept Oct Nov Month Implementing a Care Bundle• Aim: – 6 quality standards for all patients with COPD – Design of the document – Engaging staff to implement - Target those with the least resistance! Those who already input with the patient we used the pharmacists! – Staged roll out – Data collection – recruit your audit team – Feedback on performance 4
  5. 5. Length of stay by ward and site Length of stay WGH P = 0.66 NTGH P = 0.0046 14.0 12.0 10.0Days 8.0 6.0 4.0 2.0 0.0 Bundle bundle Bundle bundle Bundle bundle Bundle bundle Bundle bundle Bundle bundle Bundle bundle Bundle bundle Pre Pre Pre Pre Pre Pre Pre Pre Mean Median W2 Mean Median W17 Mean Median W18 Mean Median W2 WGH W17 WGH W18 NT NT W24 NT W24 NT WGH WGH Readmissions 30.0% Re - Admissions with respiratory cause 30 day readmissions 25.0% 90 day readmissions Readmission rate 20.0% 15.0% 10.0% 5.0% 0.0% bundle pre bundle bundle pre bundle bundle pre bundle bundle pre bundle W2 WGH W17 WGH W18 NT W24 NT 5
  6. 6. NIV• In Situ: – Established Physio led service – Robust protocols – Consultant support for difficult decision making• Aims: – Controlled oxygen as default throughout the hospital – Minimise delays “door to mask time” Predicting mortality in AECOPD requiring ventilation Steer, Gibson, Bourke: ERS 2012, NIV prize 6
  7. 7. NIV• Mapping event – identified delays (door to mask time)• Walked through the process on the shop floor – This identified simple steps for improvement – i.e supply of blood gas syringes• Used data to inform decisions – Local data – Research evidence on mortality – Continuous feedback – data collected NIV – Reducing Door to Mask Time • Human factors: clinician and physio – Inappropriate extended controlled O2 trials – Feedback and support • Organisational – CXR request by triage nurse? • Median time from assessment to CXR = 19.5 – 65 mins 7
  8. 8. NIV• Root cause analysis for specific problems• Individuals taught when necessary• Education package targeted two groups: – Consultants & Emergency care staff – Physiotherapists – Education package focused on improved decision making – Emphasised support available/treatment protocols Median door to mask time 8
  9. 9. Learning• Project management• Time to reflect and develop• Using evidence and local data to inform decisions• Linking national and local data• Identifying risks and gaps• Knowing what is good• How to manage change• The strategy can be applied to other conditions/departments 9

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