This presentation describe how Salisbury NHS Foundation Trust have developed their seven day service provision, with a focus on urgent and emergency patients being seen by a consultant within 14 hours of admission. Live tracking systems are used to monitor and enable escalation. Admission processes and pathways have been streamlined and ambulatory care models have been prioritised leading to improvements in flow and patient experience.

1. Seven Day Services
Practical tips to achieving
clinical standard 2 –
Time to Consultant review
Dr Christine Blanshard Medical Director &
Claire Gorzanski, Head of Clinical Effectiveness
Salisbury NHS Foundation Trust
Webinar hosted by
Sustainable Improvement
NHS England South
September 2017

2. Patient-Centred & Safe FriendlyProfessional Responsive
NHS 7 Day Services
Standard 2 – Time to Consultant review
Dr Christine Blanshard, Medical Director
Claire Gorzanski, Head of Clinical Effectiveness
September 2017
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An outstanding experience
for every patient

3. Patient-Centred & Safe FriendlyProfessional Responsive
Salisbury District Hospital
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4. Patient-Centred & Safe FriendlyProfessional Responsive
Local, regional, spinal
cord injury area
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5. Patient-Centred & Safe FriendlyProfessional Responsive
Our 7DS journey
2013
• Standards – operationally led – no traction
• Relaunched as quality standards – clinical engagement
• Culture of improvement, engagement & clinical leadership
• Pinned to our vision: “an outstanding experience for every patient”
2014
• Self assessment against the standards
• Workshop – agreed priorities
2016
• Re-assessment against the standards
• Workshop – agreed priorities
• Business as usual – linked the standards to new appointments and service changes
2017
• Incremental change – 6/7 theatre staffing
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6. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 –
Time to consultant review
• All emergency admissions must be seen and have
a thorough clinical assessment by a suitable
consultant as soon as possible but at the latest
within 14 hours of admission to hospital
• September 17 survey – definition of a consultant
includes doctors on the GMC specialist register
who are eligible to become consultants
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7. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 – Suitable consultant
A suitable consultant is one who is trained and
competent in dealing with emergency and acute
presentations in the speciality concerned and is able to
initiate a diagnostic and treatment plan
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8. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 – time to consultant
review within 14 hours of
admission
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9. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 - improvements
• Streamlined clinical processes on admission
- trained nurses to take bloods & ECGs
- lab turnaround for AMU/SAU 1 hour
- Radiology process redesign
• Chairs & trollies in AMU
• Refurbished/expanded SAU
• AMU/SAU dashboard – all patients
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10. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 –
AMU dashboard
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11. Patient-Centred & Safe FriendlyProfessional Responsive
Standard 2 – improvements
• Consultant delivered models in ED, AMU and SAU,
obstetrics & resident 24/7 paediatric consultant led service
• Consultant presence AMU 12 hrs weekday, minimum of 6
hours weekends. SAU – surgeon of the day
• Two physicians for acute take & acute wards at weekends
• Additional cover on bank holiday weekends
• Focus on ambulatory care pathways (medicine 30%, surgery
– 50%) VTE, TWOCs, gynaecology emergencies, plastics
trauma
• Older people’s assessment liaison (OPAL) team in ED/Short
stay unit
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12. Patient-Centred & Safe FriendlyProfessional Responsive
Future plans 17/18
• Expansion of AMU & extend acute physician
hours to 21.00
• Board investment – 2.0 wte acute physicians
• Further increase ambulatory care pathways
with STP partners
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13. Patient-Centred & Safe FriendlyProfessional Responsive
Summary
• Clinical engagement & leadership
• Culture of improvement
• Share the results & learning
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14. Patient-Centred & Safe FriendlyProfessional Responsive
Our journey – plain sailing
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15. www.england.nhs.uk
For further information
Speaker contact: claire.gorzanski@salisbury.nhs.uk
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