The document discusses the implementation of a new weekend ward round model at Torbay and South Devon NHS Foundation Trust aimed at improving consultant availability and patient flow. The new model, which includes three consultants each weekend and revised scheduling, resulted in improved patient outcomes and greater satisfaction among staff. Pilot data showed an increase in discharges on weekends and improved overall performance metrics, although some negative impacts on outpatient services were noted.

1. Seven Day Services
Practical Solutions to
Weekend Ward
Round Rostering
Catherine Lissett,
Clinical Director for Medicine
Torbay and South Devon NHS FT
Webinar hosted by
Sustainable Improvement
NHS England South
September 2017

2. Weekend Working
Our solution
Kate Lissett
CD for Medicine
Torbay & South Devon NHS
Foundation Trust

3. The problem
• Weekends….consultant input to newly
admitted patients and those on
Emergency Assessment Unit only.
• Medical patients on other wards without
formal method of consultant review.
• Poor flow at weekends.
• Juniors feel unsupported on ward cover at
weekends.

4. The Situation
• Moderate sized DGH
• Medical take
– 7 Gastroenterology (weekends only)
– 7 HOP/Stroke
– 3 Respiratory
– 4 Diabetes
• Acute Physicians deliver weekend care on
Emergency Assessment Units

5. CQC
Requires Improvement
“The trust had not ensured there were
sufficient numbers of suitably trained,
competent and skilled staff deployed to meet
the needs of patients at weekends”

6. Old rota
• 2 GIM consultants cover weekend
–8 am – 2 pm (or end PTWR)
–2 pm – 8 pm
• Share overnight on call
• Saturday am WR in particular may not
finish till 4 pm.
• Weekends exhausting…

8. But…
“Weekends are precious”
“We add little when seeing patients on
other teams wards”
“What about the impact on
our speciality work/RTT”
“Why do we need to do this”

9. What helped change
• Embarrassment of poor CQC report
• Understanding relationship between flow and
4 hour performance, and impact of long
trolley waits on our patients
• Challenge: are we delivering the care we
would want to receive
• Choice: two models and a vote
• Departure of “elder statesman”

10. New model
• 3 Consultants on each weekend
• 1 in 7 weekends, 12 hours each weekend
• 8 hours to “take”, 4 hours to inpatients
• Some flexibility in times of escalation
• Option of all TOIL or blended model (less
impact on speciality)

11. New model continued
• Complementary specialities
• Each weekend 1 Gastro, 1 HOP, 1 Diabs or Resps
– 2 work 8 am - 2 pm
First 4 hours take, 2 hours on base wards/speciality
work
– 1 works 12 pm - 6 pm
First 2 hours on ward, 4 hours to base wards/speciality
work
• Supports GI bleed rota
• Tend to work with same people each weekend, more
enjoyable!

12. 6 month trial with assessment of
impact agreed with executive

13. The Impact
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Mon Tue Wed Thu Fri Sat Sun
% Discharges per day
Pilot Period
Corresponding Period
The proportion discharges across whole organisation on a
Saturday rose from 9.6-10.4% and on a Sunday from 7.6-8.0%

14. The Impact
• 40 of 63 days had better ED performance in the pilot period
• A number of initiatives will have had an impact on 1Ed performance and
improvements cannot be attributed to enhanced weekend working alone.

15. Outcomes
• 7 day working performance improved
– 2016 53% of patients had a consultant review
within 14 hours;
– 2017 increased to 69%.
• Happier consultants, even the “anti – group”
– I don’t feel exhausted after a weekend now
– Didn’t we agree to do this on Bank holidays, too?

17. Other comments…
• PTWR completed by 12:00
• Time released to see sick/unstable patients
on base wards
• Decision making less rushed and more
meaningful
• “Feels” safer
• Less stressful
• Early part of the week “feels” better

18. Some negative impact
• Few felt negative impact on work/life
balance
• Negative impact of TOIL on out-patient
and endoscopy waiting time
• Lack of presence on ward due to TOIL
particularly after a BH weekend (amongst
smaller teams)

19. Speaker details:
Catherine Lissett
CD for Medicine
Torbay & South Devon NHS
Foundation Trust
Email catherine.lissett@nhs.net

20. www.england.nhs.uk
For further information
Speaker contact: catherine.lissett@nhs.net
To request webinar recording email: vivrichards@nhs.net
More case studies can be viewed at:
https://www.england.nhs.uk/seven-day-hospital-services/resources/
https://improvement.nhs.uk/resources/seven-day-services/#resources