2011 Acute and Secondary
Care Winner and Finalists
The winner in the Acute and Secondary Care Category was Michelle Cooke and her team from Hull and East Yorkshire Hospitals NHS Trust for their work developing a QIPP approach to Intravenous Iron administration in the community. People with chronic kidney disease often suffer from anaemia. Michelle is a renal nurse responsible for managing patients requiring intravenous iron infusions to maintain correct haemoglobin levels. If left uncorrected anaemia has a significant impact on quality of life and ability to function and work normally. Under the old system patients had to attend hospital as a day-case with nurse supervision and a 3-5 hours IV infusion of iron. The approach Michelle and colleagues have pioneered at Hull involves using a novel preparation of iron as an injection given in a Health Centre local to the patients home and in the future in the patient’s home by the district nurse along with other therapies. This novel therapy requires a maximum of a one hour visit in total.
The other finalists in the category were Mark Devonald from Nottingham University Hospitals NHS Trust, Tony Carter and his team from Harrogate and District NHS Foundation Trust, Anna Radford from Hull and East Yorkshire Hospitals NHS Trust and Catherine Free and her team from the University Hospitals of Leicester NHS Trust.
Mark Devonald and his team have developed an electronic alert system to identify and stage acute kidney injury (AKI). Acute kidney injury is rapid deterioration in kidney function caused by conditions such as sepsis, trauma and surgery and is associated with significant mortality. A national study highlighted deficiencies in diagnosis and management of acute kidney injury. Mark and his team at Nottingham developed a fully automated, real time electronic alert system covering every aspect of potential kidney injury. The alert system has led to a significant improvement in the detection of acute kidney disease and has been of particular value to non-kidney specialties such as surgery and orthopaedics.
Tony Carter and his team have developed the York Plantar Faciitis fast track education sessions. Plantar fasciitis is a painful and debilitating heel condition and is one of the most common musculo-skeletal foot problems affecting the adult population. Using the traditional approach patients often waited over 6 months for an individual appointment with a podiatrist. Under the fast track scheme 10 patients at a time were invited by letter to attend a fast track clinic where they are provided with information on treatments, exercises and advice. Each clinic finished with a lively communal debate and patients would then continue with evidence based treatment at home. A clinical follow up was available for any patient who wanted one. The impact is that, patients are routinely seen within four weeks of referral with two clinicians managing the clinical care of 10 patients in a 1 hour group appointment rather than the usual 45 minute individual appointment. To date the cancellation rate for this clinic remains very low and between 85% and 90% of patients attending the fast track clinics do not seek follow up appointments.
Anna Radford from Hull and East Yorkshire Hospitals NHS Trust has developed a multifunctional bowel management mannequin. Children suffering from chronic constipation such as spina bifida patients as well as other inflammatory bowel disease will have often spent considerable time in hospital. The first time parents have to perform any ‘plumbing’ procedures is actually on their own child. Fear of ‘doing it wrong’ is a difficult hurdle. Anna with support from colleagues is developing a teaching aid with a fully functioning mannequin complete with ‘ileostomy’ and other features such as colonic enemas. The intention is that parents of younger children will feel confident in performing these procedures on their own children and therefore reducing reliance on medical staff in the community and in hospital. Older children will be empowered and feel able to be part of their own care so that non-compliance will be reduced therefore reducing the risk of complications and the need for additional treatment, including redo-surgery.
Catherine Free and her team at the University Hospitals of Leicester NHS Trust have developed the Leicester Ambulatory Pulmonary Embolism Service. Pulmonary embolism (PE) and suspected PE are a major cause of admission to hospital. The symptoms of PE include chest pain and Shortness of Breath which commonly have other causes which, if PE was excluded, would not necessitate admission to hospital. Traditionally, PE has required admission to hospital for investigation and treatment. A nurse-led ambulatory PE service was commenced in June 2010 whereby patients referred with suspected PE are assessed using a clinical probability score and D-dimer levels. Patients with a low clinical probability of PE and normal D-dimers can be discharged without further investigation. In those with elevated D-dimer levels or a high clinical probability of PE, further imaging, either with VQ scan or CTPA, is arranged. If the investigation cannot be performed on the same day, the patient is discharged on low molecular weight heparin (LMWH) to return the following day. If PE is excluded an alternative diagnosis for the symptoms is sought and the patient is discharged back to the GP. If a PE is confirmed, the patient is commenced on warfarin and allowed home. The service has received 417 referrals in the last 12 months and saved 386 hospital admissions, leading to a saving of £130,000 and freeing up beds for more acutely ill patients and relieving pressure on the Clinical Decisions Unit. Patients are also better supported as the specialist nurse is able to provide telephone support and advice for those who need it.