Teamworking, Handover and Escalation pilot - progress in Surrey

The Royal Surrey County Hospital (RSCH) in Guildford is a single site district general hospital with a full range of services including accident and emergency.

Following on from the successful implementation of Hospital at Night, the Royal Surrey County Hospital is one of the Teamworking, Handover and Escalation pilots focusing on how the hospital is organised by day.

The pilot is developing an emergency care team focussed on the patient care pathway from admission to discharge, incorporating diagnostics and liaison with community/social care. Elective care will be managed by a second team. More structured management of patient care will enable a review of how junior doctors are used and develop the competencies necessary for their training whilst moving towards WTD 2009 compliance.

RSCH, in January, held a half-day educational event led by Professor Hilary Thomas, medical director and Eleanor Murray director of organisational development and human resources. Information stands were also manned by project leads detailing their WTD work streams.

The event attracted an audience of over 50 people across the afternoon, made up of junior doctors, consultants, nursing staff, AHPs particularly radiographers, physiotherapists and OTs, general managers and the HR Team.

The main aims of the afternoon were to raise awareness of the project and to encourage staff to sign up to engage with one or more of the workstreams. There was a main presentation and poster display, plus posters and laptop presentations for each workstream on separate stands. Ideas, comments and suggestions were captured through message and contact boards. Workstream leads manned the stands and talked about the project and explained progress to date and what they are trying to achieve.

Our solution: Hospital by Day

• ‘Hot’ Emergency Team and ‘Cold’ elective team
• Multidisciplinary: medical, nursing staff, therapists, pharmacists, diagnostics, primary, community and social care.
• Team led discharge planning
• Handover & escalation protocols between emergency and elective teams and H@N teams
• Junior doctor training bleep free and protected during elective work
• 7 new F1 doctors in August 2006 - merged rota and generic working at night
• Junior doctors spend less time ‘joining up’ services
• Analyse each working pattern against re-designed service.

Benefits for staff

• Reduced hours for junior doctors
• Better training
• Improved handover
• Supports MMC
• Better supported team working
• Development opportunities for non medical staff
• Greater job satisfaction.

Benefits for patients

• Timely, safer care
• Cared for by a designated team
• Shorter waiting times
• Sick patients escalated more quickly
• Improved liaison with primary & social care
• Prompter, planned discharge
• More joined up care.

How will we do it?

• Engage senior clinicians and junior staff
• Engage nursing and allied health professionals
• Extended roles in nursing, AHPs, pharmacists, diagnostics and primary care liaison
• Improve handover: Emergency to H@N and Elective teams
• Review protocols for escalation & handover
• Enhance team approach to managing patient flow
• Increase use of technology: telemedicine
• Appoint a high level experienced project manager
• Use Prince methodology to quality assure work
• Develop better relationships with primary care, social care & voluntary groups
• Become ambassadors for the project and share our learning.