Challenges & objectives

Challenges

At the Homerton all medical staff finishing their shift currently meet and handover significant problems to the incoming replacement teams, including the Clinical Site Management (CSM) teams. CSMs are nurses with at least five years experience in acute specialties (ICU, CCU, A+E etc) with a portfolio of extended nursing skills. They co-ordinate and deliver care overnight. The multidisciplinary handover currently has no equivalent in the mornings. This pilot will address that deficiency. It will be consultant led, and provide improved educational standards and supervision to the acute team. Attendance will be required by CSM and Critical Care Outreach teams and therapy staff in addition to the medical staff. This will provide a sustainable improvement in the particular issue of multidisciplinary handover and the impact of this on WTD 2009.

Specific objectives of the pilot

Homerton’s specific objectives are to achieve WTD compliance by:

• Creating a team comprising clinicians and managers to implement a new model of care for patients who require urgent care when admitted to the Homerton
• Providing a model which supplies an increase in beds dedicated to the assessment and management of patients admitted through A&E or GP referral, with a corresponding reduction in beds in other departments
• Reducing hours worked by separating the rotas to allow time dedicated exclusively to the care of emergency admissions and time devoted to the development of skills in base specialities
• Supporting the team with nurse, therapist, laboratory staff, radiographer and social work colleagues

Delivering compliance

This pilot will:

• Learn and interface from previous projects at the Homerton that have built on team working
• Create a dedicated team to separate emergency from elective care and stream all emergency admissions
• Develop and train new roles for nurses and other staff
• Increase the provision of beds for patients who require assessment and management, with a corresponding reduction in the beds in other in other departments as there is better immediate care on admission, reducing the demand for general beds on wards
• Improve communication across and within multi disciplinary teams
• Ensure compliance with the 48 hour week for WTD 2009.