Team working, handover and escalation for WTD

Ten pilots looking at supporting multidisciplinary working in the hospital setting are underway and information on their progress is now becoming available.

Working Time Directive demands new ways of working to be introduced that reduce the hours that junior doctors work and approaches such as Hospital at Night have shown how this can be achieved. Any new way of working also needs to ensure that protocols are in place to ensure continuity of care for patients and back up for staff in their new approaches.

As part of the WTD 2009 national work, ten pilots are now underway looking at team working, handover and escalation. The pilots are exploring ways in which hospitals can support new approaches that will allow the introduction of the 48 hour week in a safe and controlled way. “It was identified that there was a real need to support continuity of care in developing work around WTD 2009. The nine pilots have a good spread of objectives that will provide learning for most NHS organisations,” says Nigel Burgess, WTD portfolio project manager at Skills for Health - Workforce Projects Team, “They look at how to ensure that systems around handover between teams and the need to escalate in a critical situation can take place effectively and how team working across the day can best be managed. It looks at how to provide the back up and systems that multidisciplinary teams (MDTs) need.”

These are the second tranche of WTD 2009 pilots and include organisations that range from large teaching centres through to district general hospitals and PCT community approaches to mental health trusts.

Moving Hospital at Night to the day

Several of the approaches look at aspects of moving successful Hospital at Night schemes into the daytime with the same principles of team working. Royal Liverpool and Broadgreen University Hospitals, Royal Surrey County Hospital and Airedale NHS Trusts are all looking at extending the approach over other parts of the working day.

At Airedale for example, establishing scheduled and unscheduled adult care teams will allow work 24 hours a day every day across conventional speciality boundaries. The teams will be made up of doctors from diverse backgrounds, highly skilled nurses and health care assistants. The pilot centres on a two team approach: TUSKERS (team for unscheduled care and emergency responses) and SPECTORS (scheduled planned care team of organised responders). “This team working builds on and expands the Australian model of specialty specific training to promote learning beyond narrow specialities,” explains Nigel, “It’s taking in international best practice and ways of working that might be useful for the NHS.”

Ensuring a smooth handover and cross cover

With the team approach to WTD compliance comes the need to provide a clear handover between shifts. The pilot at Northampton General Hospital will focus on introducing a weekend team so that the frequency of the whole hospital handover will be reduced by 50% at weekends. Previously the night team would handover to the whole hospital on both Saturday and Sunday mornings.

A different approach to cross site cover is at Whittington Hospital which is looking at the feasibility of a cross site joint surgical consultant on call rota to provide out of hours cover across site with Royal Free Hospital (managed by the Royal Free Hampstead NHS Trust) which is geographically close by. At South Devon, WTD is being integrated so it is a key driver in trust wide configuration plans around redesigning services. The approach at Countess of Chester is also focusing on trust wide work and team approaches.

Taking team work outside the hospital

Although the ways of working in the hospital setting is a key driver of WTD, there are approaches that use the community as a whole which may be useful for trusts to consider. “By keeping patients out of hospital you can obviously have an impact on the work you need to do in the inpatient setting which in turn reduces dependence on medical teams”, says Lisa Navin, senior project manager at the Workforce Projects Team. In the pilot currently underway at Brent Teaching Primary Care Trust, the district nursing service has developed the vision of ‘Ward in the Community’.