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Hospital at Night StAZ Study Trip 18 January 2009 Tim Lund Divisional Manager Skills for Health Workforce Projects Team Hospital at Night • Multi-disciplinary team working: right person, risk skills, right place, right time • 2003 – 2005: Piloted and evaluated. National support in partnership with the London Deanery • 2008 Survey: three quarters of trusts report having H@N services • The “Case for Hospital at Night: the Search for Evidence” demonstrated improved patient safety Hospital at Night Update • More evidence of Hospital at Night teams improving patient care • Observational study at Edinburgh Royal Infirmary for 14 nights before and after implementing H@N found that: - Patients were reviewed more frequently by senior medical staff - Significant inter-specialty differences in response times eradicated - Reduction in adverse patient outcomes from 17% to 6% (Defined as unplanned transfer to critical/cardiac arrest in the 18 medical/surgical wards and the Combined Assessment Unit) • Source: QJ Med 2009; 102:539-546. Author Dr D.J. Beckett et al Hospital at Night and 24/7 • Bid for longer term study focussing on patient safety. Partners: Imperial, London Deanery, Royal Colleges, I.C. • Targeted consultancy support to trusts still trying to establish H@N • Indications - 24/7 solutions and hot & cold split/team work support the quality of patient care and can sustain training HSMR Data at Guy’s and St Thomas’: 2003 - 2008 National average H@N introduced H@D&N introduced Confidence in H@N and 24/7 Longevity • 24:7 solutions appear sustainable at Homerton, Guy’s & Tommy’s, South Devon & Royal Liverpool & Broadgreen • Award winning solutions in place for about two years • Consistent with Quality and Productivity agenda • Wide support from stakeholders for quality solutions Development of H@N Tools / Support • H@Nbleep system implemented in small number of trusts • Robust handover systems available. We are sponsoring Salisbury to roll out H@N handover tool to 20 trusts • 12 hour H@N e-learning course under development with London Deanery & DH. Core skills and curricula • Opportunity for blended learning. Sustaining training vital Particular Value of Simulators • Full immersion • Complex multi and inter-professional working • Particularly when linked to effective behavioural debriefing Source: London Deanery Particular Value of Simulators • Full immersion • Complex multi and inter-professional working • Particularly when linked to effective behavioural debriefing Source: London Deanery Salisbury Handover System With support from Salisbury H@N Handover Tool • Multi-professional tool sponsored by Workforce Projects Team • Designed by clinicians & developed by the users at all levels to ensure maximum utility • Meets info governance and data protection requirements • Provides a focus for handover. Handover list accessible across hospital by appropriate staff can be updated real-time! Source: Salisbury Hospital at Night List • Linked to Consultant List or can stand alone • Correct patient details • Management plan detailed • Reason for H@N involvement • Priority for review • Accessed throughout the day • Printed for H@N team • Auditable Source: Salisbury Helping to Make EWTD Manageable Contacts: Information • Any Questions? • Contact me via: 07771 371918 0161 2662136 [email protected] Further information: www.healthcareworkforce.nhs.uk