Salisbury NHS Foundation Trust

Information delivery system supporting Hospital at Night

Background

Salisbury NHS Foundation Trust provides healthcare services to more than 200,000 people in southwest England. In 2006 the trust was granted NHS Foundation Trust status. The trust provides a full range of services and is the regional centre for plastic surgery, burns and spinal injuries. A recently opened extension offers improved facilities for orthopaedics, plastic surgery and burns. The Hospital at Night team at Salisbury District Hospital has been operational since July 2004.

Overview

Following a risk assessment of communication mechanisms used by the trusts Hospital at Night team, the Hospital at Night Patient List project was developed. The risk assessment of handover to and from Hospital at Night staff highlighted that the content of the verbal information varied in quality and there was no written information from the teams to support verbal handover. It was not possible to accurately audit which patients were handed over or the details of the information communicated. In response, nurses, doctors and IT department at Salisbury NHS Foundation Trust have developed a generic IT system to be introduced hospital wide and allows each team to create defined Consultant or ward based list of patients.

The lists are updated by medical staff and provided patients demographic details, their management plans and actions outstanding, for use by the teams during the day. Selected patients are transferred directly on to the Hospital at Night team from all specialities during the day to create a list for the night teams. The transfer to the night time lists asks for the reasons for the referral to H@N the suggested reviewer and the timeliness of the review. The IT system allows the night team to add information to the patients overnight which is transferred back onto the Consultants list for the following day. The lists are linked to patient results, allowing discharge details to be collated and audit reports to be generated. The generic system provides continuity of practice as staff move between specialities in the Trust.

Challenges

The provision of the generic Hospital @ Night Inpatient List process and system currently covers 3 Clinical speciality teams; the plan is to roll-out this provision to all Clinical Speciality Teams. This supports the national requirement to develop robust hand-over processes to support H@N for “at risk” patients. The provision of the generic Consultant List process and system currently covers 4 Clinical Speciality Teams; the plan is to increase this provision by a minimum of 100%. As part of this, the individual requirements of the Clinical Specialty Teams will be investigated, to ensure that they can be built into the generic system. The current systems are presently used by Medical staff. The plan is to further develop the functionality of the Consultant List product to meet the requirements of other potential users such as nurses & other multi-disciplinary team members.

Delivering compliance

The reduction of junior doctors hours to meet WTD 2009 has led to changes in structure and organisation of the workforce responsible for patient care. Many doctors now work a full or partial shift system and frequently handover responsibility for a group of patients to the next shift. Out of hours, smaller teams of healthcare professionals take over responsibility for patient care. This information delivery system created to support Hospital at Night will, provide a robust mechanism for communication ensuring the responsibility for the patient care is transferred safely from individual or team to another during the 24 hour period and is potentially transferable to other trusts.

The pilot started in August 2007 and is expected to complete in August 2008