Progress so far

Emergency

This workstream investigated the practicalities of creating a combined medical, surgical and diagnostic multidisciplinary "hot" team to manage acute admissions and a "cold" team to manage elective admissions.

They have successfully:

• Implemented lower banded rota patterns and on-call team roles and responsibilities
• Implemented an agreed strategy with A&E consultants to minimise double-clerking of medical patients referred through A&E
• Performed an activity audit of the acute take to guide decision-making.

As part of the mid-project review it became apparent that the emergency workstream's reconfiguration was currently optimal in terms of this hospital's size and structure. During the project period, the ongoing future of key project departments (e.g. A&E) was under threat from external reconfiguration plans; this factor, among others, made it impractical to pursue the hot-cold model initially proposed.

Non-emergency

This workstream has created two new 6-month pilot posts, to investigate whether junior doctor hours can be reduced through the introduction of "Clinical Support Workers" (CSWs). The Royal Surrey are currently recruiting for these posts; one CSW will work on a medical ward, another on a surgical ward. The CSW’s duties will include venepuncture, attending ward rounds, and chasing the results of investigations. They are developing a tailored induction training plan covering clinical and administrative duties. They will evaluate the impact on junior doctors’ hours and tasks through an activity audit. The results will be summarised in a Business Case.

Medicines management

This workstream is investigating whether junior doctors’ hours can be reduced through an increased role of a medicines management technician. A one month pilot study on a medical ward has been performed investigating:

• Using a modified drug chart as the legal discharge prescription (doctor signs)
• Admission and discharge medications being entered on the Electronic Discharge Summary by the medicines management technician.

The results of this pilot are currently being compiled and will also be summarised in the business case.

Nurse led pre-assessment

Junior doctors currently spend a significant portion of time pre-assessing patients for elective surgery. This workstream is evaluating whether much of this work can be performed instead by specialised nurses with expanded roles. They are developing standardised pre-assessment documentation and will fund clinical training on an external course for four nurses to pilot obtaining this increased experience.

Nurse led discharge

They are going to investigate a process of nurse led discharge, through a pilot on wards, with improved discharge planning from the point of admission. This workstream is currently regrouping with a view to agreeing a way forward.