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HOSPITAL VISITS

HOSPITAL VISITS. ACUTE PROJECT TEAM Margaret Arnott Karin McInnes Hamish McLaren Derek Nelson David Stewart. HOSPITAL VISITS. GLASGOW SHEFFIELD LEEDS NORWICH DUNDEE SOUTHAMPTON BOURNMOUTH CAPETOWN. SHEFFIELD. POPULATION 500000

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HOSPITAL VISITS

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  1. HOSPITAL VISITS ACUTE PROJECT TEAM Margaret Arnott Karin McInnes Hamish McLaren Derek Nelson David Stewart

  2. HOSPITAL VISITS • GLASGOW • SHEFFIELD • LEEDS • NORWICH • DUNDEE • SOUTHAMPTON • BOURNMOUTH • CAPETOWN

  3. SHEFFIELD • POPULATION 500000 • TWO HOSPITALS NORTHERN GENERAL ROYAL HALLAMSHIRE • ONE A&E (AT NORTHERN) • APPROX 35 MEDICAL ADMISSIONS TO NORTHERN DAILY

  4. SHEFFIELD PROS • ACUTE ADMISSIONS WARD IN CLOSE PROXIMITY TO A&E • CHEST PAIN ASSESSMENT UNIT IN A&E • SPECIALTY TRIAGE BY ALLOCATION NOT REFERRAL

  5. SHEFFIELDPROS • EMERGENCY RECEIVING ON SITE WITHOUT A&E NOT PERCIEVED AS A PROBLEM • SHO TIME DISCOUNTED FROM CLINIC PLANNING • HOSPITAL PURCHASE OF CONTINUING CARE BEDS

  6. SHEFFIELDCONS • NO ASSESSMENT AREA • STILL BOARDING OUTSIDE MED DIV • STILL BLOCKED BEDS • TENSIONS WITH HALLAMSHIRE

  7. LEEDS • POPULATION APPROX 750000 • TWO HOSPITALS LEEDS GENERAL INFIRMARY ST JAMES’ HOSPITAL • BOTH HAVE A&Es • 50-80 ADMISSIONS PER HOSPITAL PER DAY

  8. LEEDSPROS • CLINICAL DECISIONS UNIT • MEDICAL ASSESSMENT UNIT • SPECIALTY TRIAGE BY ALLOCATION

  9. LEEDSPROS • ALL BEDS ON BOTH SITES SINGLE CORPORATE ASSET • EFFECTIVE BED MANAGEMENT • REAL TIME ELECTRONIC BED MANAGEMENT • PAST EXPERIENCE USED TO PREDICT DAILY ADMISSIONS

  10. LEEDSPROS • HOPITAL PURCHASE OF CONTINUING CARE BEDS

  11. CLINICAL DECISIONS UNIT12 BEDS • RUN BY A&E • 10 WTE E GRADES • OPEN 24/7 • LARGELY NURSE RUN • TREATS PROTOCOLISED CONDITIONS ONLY • 2000 ADMISSIONS PER ANNUM • IMPROVES TURNOVER TIMES FOR PROTOCOLISED CONDITIONS

  12. CLINICAL DECISIONS UNITCONS • LACK OF PHYSICIAN INVOLVEMENT • NEED FOR INCREASED MEDICAL INPUT • RESOURCE INTENSIVE

  13. MEDICAL ASSESSMENT UNIT • 12 TROLLEYS • SEPARATE FROM CDU • RUN BY PHYSICIANS • FOR PRE-ADMISSION ASSESSMENT OF GP REFERRED MEDICAL EMERGENCIES • OPEN 0900-2300

  14. MEDICAL ASSESSMENT UNITCONS • UNECESSARY SEPARATION FROM CDU • VALUE IN PREVENTING ADMISSION NOT OBVIOUS

  15. LEEDSCONS • MAIN DRIVER FOR CDU WAS A&E TROLLEY WAITS RATHER THAN WHOLE SYSTEM RE-ENGINEERING • STILL LOTS OF BOARDERS • STILL BED BLOCKING • CONSIDERABLE RESOURCES REQUIRED FOR INNOVATIONS • LACK OF PHYSICIAN COMMITMENT TO CHANGING SYSTEM • BED MANAGEMENT CONSUMES CONSIDERABLE NURSING RESOURCE

  16. NORWICH • CATCHMENT POPULATION 600,000 • ONE HOSPITAL AND ONE A&E (NEXT NEAREST A&E 25+ MILES) • 40- 60 MEDICAL EMERGENCY ADMISSIONS DAILY • 80% GP REFERRED

  17. NORWICHPROS • Purpose built medical and surgical assessment areas (29 beds and 6 trolleys each) • 3 acute medicine physicians • SHOs on 6 monthly attachment as part of medical rotation • Anaesthetist SpR on rotation • First Acute Medicine SpRs

  18. NORWICH GOOD NEWSGP calls to nurse • Dedicated nurse and phone line to switch board • Some pre admission diversion possible • Structured info for receiving team

  19. NORWICH PROS • Hybrid MAA and MAW very near A&E • Direct GP admission to CCU • Formal DVT clinic run by haematologists

  20. NORWICH CONS • Value of MAA not fully exploited • Complex and confusing interface with medical specialties and continuing care • Not as much protocolisation and use of care pathways as might be expected • Not as much fast tracking as might be expected

  21. DUNDEE • Population 260,000 • Covers a vast geographical area • Responsible for A/E at Perth Royal Infirmary • Approx 17 – 35 Medical Admissions per day

  22. DUNDEEPROS • 24 /7 Cover By A/E Consultants • 6 WTE A/E Consultants In Post • Dedicated Acute Care Physician • GP triage nurse-led phone system obtaining discharge information pre admission • Acute Admission Nurse Consultant • Direct admission to the Assessment Unit for GP referrals and by A&E staff

  23. DUNDEECONS • No Trolley / Seated Area Within Assessment Area • Limited Triage on patients arrival at Assessment Area • No Bed Managers In Post • Long Trolley Waits In AMAU

  24. SOUTHAMPTON • One hospital and one A&E • Catchment population 550000 • Average 45 admissions per day

  25. SOUTHAMPTONPROS • Establishment for 3 Acute Medicine consultants and other dedicated acute medicine staff • GP calls taken and triaged by AM consultant with active admission avoidance protocols • Active assessment area with few admissions from it to wards • Very attractive plans for new combined assessment/admissions unit

  26. SOUTHAMPTONPROS • Assessment unit in A&E • Pro active nurse led management in assessment unit • District nurse run initiation of anticoagulants • Thrombolysis nurse

  27. SOUTHAMPTONCONS • Interface medicine/A&E not as integrated as might be expected • Still age related admissions direct to MFE(due to change soon) • Bed blocking due to problems with community care placements

  28. BOURNMOUTH • One hospital and one A&E (which does not take major trauma) • Catchment population 260000 • 20% > 80years

  29. BOURNMOUTHPROS • 2 Acute Medicine consultants and 2 staff grades • All GP calls to senior triage nurse • Very active nurse-led admission avoidance system • Dedicated nurse-led DVT clinic • Direct admission of GP referrals to assessment unit • All medical referrals seen in assessment unit

  30. BOURNMOUTHPROS • Emergency Clinics for new and follow-up patients run by acute receiving physicians • Good access to exercise testing via rapid access chest pain clinic (nurse supervised) • Good access to endoscopy • GI bleeding service

  31. BOURNMOUTHPROS • Well staffed discharge lounge • Contrast x-rays carried out by radiographers • C.A.R.T.

  32. BOURNMOUTHCONS • Little integration of A&E/Medicine • Bed blocking due to difficulties with community placement of elderly patients • Some difficulties with specialist triage due to lack of beds

  33. CAPETOWNGROOTE SCHUUR HOSPITAL • Social and medical systems very different from UK • Tertiary referral hospital for Cape Province • DGH function for population of 300000

  34. CAPETOWNGROOTE SCHUUR HOSPITAL • No A&E Department as such • Common entrance for emergencies (with metal detector!) • Triage (by security staff) to Trauma Unit, Medical Emergency Unit or Surgical Emergency Unit

  35. GROOTE SCHUUR HOSPITALMedical Emergency Unit • 30,000 assessments per year • 12 bed assessment area • One acute medicine consultant • Dedicated registrars,SHOs, CSMOs and PRHOs • Resuscitation of medical cases undertaken by physicians

  36. CONCLUSIONS • “It’s the same the whole world over” • Wide variations in practice • Haven’t found the Holy Grail (i.e. somewhere where the whole system works)

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