2012 Procurement and Secondary
Care Winner and Finalists
The winner in the Procurement and Secondary Care category supported by the University of Leeds Medical Technologies IKC was Alison Woodhead, a Paediatric Diabetes Dietician based at Bradford Teaching Hospitals NHS Foundation Trust who has developed an E-learning programme on carbohydrate counting for ward staff.
This interactive training package equips paediatric ward staff with the necessary knowledge and skills to confidently manage the dietary aspects of type 1 diabetes, such as carbohydrate counting.
The programme is divided into five sections and takes approximately 30 minutes to complete. Staff can access the programme via the electronic training system used by Bradford Teaching Hospitals NHS Foundation Trust. The programme content was assembled and then developed into an E-learning programme with assistance from the Trust E-learning Manager.
The impact of the programme is that:
Staff can update their knowledge and skills with regard to carbohydrate counting.
Ward staff – the interface between the Paediatric Diabetes team and the family of a child with diabetes - gain confidence in managing the dietary aspects of diabetes to ensure safe patient care.
Carbohydrate counting is more accurate. This is important as inaccurate counting can result in incorrect insulin doses being administered, with the potential to cause hyperglycaemia or hypoglycaemia.
The E-learning programme complements the mandatory training sessions on diabetes, introduced in 2012, which staff are required to attend every two years.
Other finalists in the Procurement and Secondary care category were Dr. Kit Chow from Chesterfield Royal Hospital NHS Foundation Trust, Dr. James Griffiths from Barnsley Hospital NHS Foundation Trust, Julie Hoole from the Mid-Yorkshire NHS Trust and Veronica Allinson from Calderdale and Huddersfield NHS Foundation Trust.
Dr Kit Chow is a Consultant Radiologist at Chesterfield Royal Hospital NHS Foundation Trust who has developed and implemented a modernised integrated pathway for neck lumps.
The rapid access neck lump clinic has developed a pathway where all patients are triaged by a team of consultants - thyroid, maxillo-facial and ENT - who then allocate the patient to the appropriate Head & Neck (H&N) speciality for detailed clinical examinations.
Patients receive same-day ultrasound examination and, if appropriate, a same-day ultrasound-guided biopsy plus a follow-up appointment. Patients not requiring a biopsy are given a written ultrasound report and reviewed for same-day discharge.
The impact of the new pathway is that:
The H&N team aims to get the clinical diagnosis right first time, reducing patient uncertainty and making better use of clinician resources.
Patients with uncertain neck lumps traditionally receive a palpation-guided FNA, which is approximately 30% accurate and uses expensive imaging facilities. With this new service, ultrasound technology is used and a cytologist provides clinical support and a same-day provisional opinion. This practically eliminates the need for diagnostic surgical excision of neck lumps.
There are also cost-savings associated with the new pathway as an excision biopsy costs up to £1,690, whereas an ultrasound-guided core biopsy costs just £57. Whereas it would cost £42,250 for only 25 patients to have surgical excisions, it would cost £5,700 for 100 patients to receive ultrasound-guided core biopsy - a saving of £36,550.
Dr James Griffiths is a Consultant in Emergency Medicine at Barnsley Hospital NHS Foundation Trust who together with a team in the Emergency Medicine department have implemented a Point-of-care troponin testing service.
Current monitoring for suspected low-risk cardiac chest pain is a 12-hour troponin test, often requiring inpatient admission. The results of the Randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial suggested that the use of point-of-care (POC) cardiac marker panels in the ED can reduce hospital admissions.
The diagnostic process is protocol-driven, controlled and plannable, involving collaborative working across the hospital. Turnaround time, from taking blood to availability of results is now only 20 minutes in the case of a POCT in the ED.
As a result of implementing this service, 354 /552 patients were discharged from the ED. 5% re-attended and only three patients (0.5%) were found to have ECG changes or raised cardiac enzymes. The increased throughput of the ED, combined with the decrease in demand for acute beds, may have contributed to a better performance by the Trust in meeting the Department of Health’s ED operational standards. POCT champions maintain quality control and staff training and ED staff from other hospitals have visited to see the POC testing in action.
Julie Hoole is the Lead Macmillan Head and Neck Cancer Project Manager/Nurse Specialist at The Mid Yorkshire Hospitals NHS Trust who has developed and implemted a home alcohol detoxification programme for head and neck cancer patients.
Head and neck cancer patients with an alcohol dependency spend seven days in hospital detoxifying before undergoing surgery and reconstruction. After surgery, they remain in hospital for a further 10 days. As patients can often be the main family carers, being away from home for longer than necessary is problematic.
A pathway has been developed and piloted with the wellbeing team at Spectrum in Wakefield who specialise in alcohol abuse and dependency. Patients requiring detoxification are supported at home, removing the need for hospital admission before surgery. The patient’s family also receive help with their dependency issues, increasing the patient’s chance of successfully maintaining detox following surgery.
The successful pilot has led to a bid to fund a specialist nurse through Macmillan for three years, auditing the effectiveness of the service both as a regional - and possibly national - Gold standard.
The impact of the service has been:
Financial savings for the Trust by reducing hospital admissions.
Patients readily comply with a detox programme in their home; less medication is required and patients reduce dependency themselves.
The pathway has been accepted at the Head and Neck Yorkshire Cancer Network as the Gold standard.
Veronica Allinson is a Clinical Nurse Specialist/project leader at Calderdale and Huddersfield NHS Foundation Trust who has developed an educational programme designed to replace ineffective hospital appointments has been developed as an alternative method of follow-up for low to moderate-risk breast cancer patients.
The programme consists of four morning sessions over a four week period, covering various health and lifestyle-related topics, including how to re-access the clinician or key worker if needed. Suitable patients are provided with the skills, knowledge and confidence for future self-management, saving unnecessary hospital visits and creating more capacity for new patients.
A pilot study, funded by Breast Cancer Care and the Yorkshire Cancer Network, tested patient acceptability of the programme and evaluations are on-going. The project has been rolled out as routine follow-up practice in the Trust and is now being extended to other Trusts in the network.
The impact of the programme has been that:
An effective and diverse programme allows patients to focus on getting their lives back to normal.
Reduced hospital visits and better use of PCT clinician resources. The programme is being introduced across all the Trusts in the Yorkshire Cancer Network.
Patients have a demonstrably better quality of aftercare. Their understanding of the disease is improved and all information needs are met in a friendly and supportive environment.