Hospital at Night StAZ Study Trip

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Hospital at NightStAZ Study Trip

• 18 January 2009
• Tim Lund
• Divisional Manager
• Skills for Health Workforce Projects Team

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Hospital at Night

• Multi-disciplinary team working right person,
  risk skills, right place, right time
• 2003 2005 Piloted and evaluated. National
  support in partnership with the London Deanery
• 2008 Survey three quarters of trusts report
  having H_at_N services
• The Case for Hospital at Night the Search for
  Evidence demonstrated improved patient safety

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Hospital at Night Update

• More evidence of Hospital at Night teams
  improving patient care
• Observational study at Edinburgh Royal Infirmary
  for 14 nights before and after implementing H_at_N
  found that
• - Patients were reviewed more frequently by
  senior medical staff
• - Significant inter-specialty differences in
  response times eradicated
• - Reduction in adverse patient outcomes from 17
  to 6 (Defined as unplanned transfer to
  critical/cardiac arrest in the 18
  medical/surgical wards and the Combined
  Assessment Unit)
• Source QJ Med 2009 102539-546. Author Dr D.J.
  Beckett et al

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Hospital at Night and 24/7

• Bid for longer term study focussing on patient
  safety. Partners Imperial, London Deanery,
  Royal Colleges, I.C.
• Targeted consultancy support to trusts still
  trying to establish H_at_N
• Indications - 24/7 solutions and hot cold
  split/team work support the quality of patient
  care and can sustain training

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HSMR Data at Guys and St Thomas 2003 - 2008
National average
H_at_N introduced
H_at_DN introduced
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Confidence in H_at_N and 24/7 Longevity

• 247 solutions appear sustainable at Homerton,
  Guys Tommys, South Devon Royal Liverpool
  Broadgreen
• Award winning solutions in place for about two
  years
• Consistent with Quality and Productivity agenda
• Wide support from stakeholders for quality
  solutions

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Development of H_at_N Tools / Support

• H_at_Nbleep system implemented in small number of
  trusts
• Robust handover systems available. We are
  sponsoring Salisbury to roll out H_at_N handover
  tool to 20 trusts
• 12 hour H_at_N e-learning course under development
  with London Deanery DH. Core skills and
  curricula
• Opportunity for blended learning. Sustaining
  training vital

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Particular Value of Simulators

• Full immersion
• Complex multi and
• inter-professional working
• Particularly when linked to
• effective behavioural debriefing
• Source London Deanery

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Particular Value of Simulators

• Full immersion
• Complex multi and
• inter-professional working
• Particularly when linked to
• effective behavioural debriefing
• Source London Deanery

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Salisbury Handover System
With support from
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Salisbury H_at_N Handover Tool

• Multi-professional tool sponsored by Workforce
  Projects Team
• Designed by clinicians developed by the users
  at all levels to ensure maximum utility
• Meets info governance and data protection
  requirements
• Provides a focus for handover. Handover list
  accessible across hospital by appropriate staff
  can be updated real-time!
• Source Salisbury

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Hospital at Night List

• Linked to Consultant List or can stand alone
• Correct patient details
• Management plan detailed
• Reason for H_at_N involvement
• Priority for review
• Accessed throughout the day
• Printed for H_at_N team
• Auditable
• Source Salisbury

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Helping to Make EWTD Manageable
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Contacts Information

• Any Questions?
• Contact me via
• 07771 371918
• 0161 2662136
• tim.lund_at_skillsforhealth.org.uk
• Further information www.healthcareworkforce.nhs.u
  k