Service Innovation Bulletin
Acute Trusts Archive
- Early Supported Discharge Service – Stroke Care Pathway
- Endometrial, Vulval, Ovarian and Cervical (EVOC) Cancer Support Group
- ENT and Hearing Clinic for Children with Down Syndrome
- Protocol for the treatment of constipation in patients in ICU
- COPD – Hospital at Home Service, Short Stay Unit and Nurse Led Ward
- A Specialist Nurse-Led Intervention to Treat and Control Hypertension and Hyperlipidemia in Diabetes (SPLINT)
- 'Little Angels' Breastfeeding Peer Support Scheme
- Young and Pregnant Service
Early Supported Discharge Service – Stroke Care Pathway
Royal Liverpool and Broadgreen University Hospitals NHS Trust
An Early Supported Discharge Service for stroke patients has been established as a component of the stroke care pathway. Specialist stroke services (including the Acute Stroke Unit, the Stroke Rehabilitation Unit, Physiotherapy, Speech and Language Therapy, Occupational Therapy and Dietetics) work in partnership with the voluntary sector and dedicated City Council services to ensure that stroke patients have access to tailor-made care planning for a period of six months prior to discharge from the Acute Trust. There are plans in place to incorporate Social Work and Clinical Psychology services into the pathway shortly.
Patient care is at the centre of the service; all aspects of the pathway including the Early Supported Discharge Service are genuinely patient led. On discharge from the Acute Trust, patients now receive dedicated rehabilitation as required.
The involvement of the City Council has not only helped to provide a resource centre offering day care places and respite beds, but has also assisted in implementing plans to address issues relating to employment and welfare benefits for stroke survivors.
Over a five month period 279 patients have been through the stroke care pathway. Of those, 190 have been supported through the Early Supported Discharge Service.
Endometrial, Vulval, Ovarian and Cervical (EVOC) Cancer Support Group
Liverpool Women’s Hospital NHS Foundation Trust
EVOC is a support group for women with gynaecological cancer; operating as a registered charity the group is facilitated by gynaecology/oncology Clinical Nurse Specialists and service users.
It is thought to be the only existing locally based support group, offering support for all four gynaecological cancers. Patients diagnosed with a gynaecological cancer are given information about the support group by their key worker (Nurse Specialist) at the NHS Trust.
The group is held approximately four times a year; speakers are invited to present information, a resource library is available for women to use and ‘taster’ sessions for complementary therapies are offered. This support group facilitates continued support for women in the ‘recovery phase’ and allows women to discuss issues with others with similar experiences.
ENT and Hearing Clinic for Children with Down Syndrome
Central Manchester and Manchester Children’s Hospitals NHS Trust
A dedicated clinic for the promotion of healthcare for children with Down syndrome (in particular to treat and improve hearing). Children with Down syndrome often have poorly managed hearing problems, resulting in poor development of speech and language.
This service has a dedicated team of professionals with a focus on a full understanding of the difficulties and problems associated with Down syndrome. The service provides a centre of excellence and expertise in the management of ear, nose, throat and hearing problems in children and adults with Down syndrome.
This service was highly commended in the 2006 North West NHS Innovation Awards 2006 managed by TrusTECH
(in the Service Innovation Category).
Protocol for the treatment of constipation in patients in ICU
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Management of constipation in critically ill patients can be overlooked and the effects can be far reaching. Prior to the introduction of the protocol an initial audit indicated that the incidence of constipation in ICU was high and, importantly, could cause failure to wean patients from mechanical ventilation.
The effects of the introduction of the protocol are expected to include: a reduction in unpleasant discomfort and complications for patients (such as distention, vomiting, restlessness, gut obstruction and perforation); reduced risks of ventilator associated pneumonia due to a reduction in prolonged ventilation and ventilator associated lung injury.
It is also anticipated that whilst there may be an increase in the use of laxatives, there should be a reduction in the numbers of patients requiring costly preparations such as Total Parenteral Nutrition (TPN) (as non-constipated patients have reduced gastric aspirates and therefore do not require TPN).
COPD – Hospital at Home Service, Short Stay Unit and Nurse Led Ward
Wrightington, Wigan and Leigh NHS Trust
There are three elements to this Chronic Obstructive Pulmonary Disease (COPD) service offering improved and personalised care for patients. By combining a ‘Hospital at Home Service’, a Short Stay Unit and a Nurse Led Ward, it reduces the number and length of hospital admissions.
- Hospital at Home Service
- for patients with acute exacerbation of COPD
- Led by specialist nurses
- Consists of an acute-assessment service and an early-discharge service
- Also includes assessment for long-term oxygen therapy, discharge and nurse-led follow up clinics*
- Open between 9 am and 5pm (Monday–Friday)**
*An alternative to follow up in a respiratory-chest-physician clinic six weeks post-exacerbation (appropriate patients also have a radiology and oxygen review)
**Outside of these hours patients are referred to the emergency floor or Short Stay Unit and are assessed the following day by a specialist nurse
- Short Stay Unit
- for patients with respiratory and chest pain conditions
- Consists of 20 beds (10 allocated to respiratory patients; 10 to chest pain patients)
- Nurse-Led Ward
- for patients (18 and over) who: are low risk; do not need acute care (but are not ready to return home or into residential care) or need end of life care
- Established off the acute site
A Specialist Nurse-Led Intervention to Treat and Control Hypertension and Hyperlipidemia in Diabetes (SPLINT)
Salford Royal Hospitals NHS Foundation Trust
Patients attending the diabetes centre at the Acute Trust for their annual review with raised blood pressure (BP), raised cholesterol or both are referred to a Specialist Nurse-led clinic. The Specialist Nurse advises the patient about the reasons for the visit, targets for treatment, the reasons for the targets, medication is reviewed and other key factors such as poor control of diabetes are noted. The patient attends the clinic until the targets are achieved. This service is delivered as an adjunct to hospital-based care.
The national service framework for diabetes sets clear standards for the provision of diabetes care. These standards currently are not achieved by many diabetes services (obstacles to providing effective diabetes care include the large number of patients affected and the challenging targets for BP, lipid and glucose control). Good diabetes care is known to lead to cost effectiveness and reductions in the development and progression of diabetes-related complications.
Improvements associated with this service include: a higher number of patients achieving their targets after one year, compared with those patients not attending the Specialist Nurse-led clinics; a reduction in morbidity and mortality; and cost benefits.
'Little Angels' Breastfeeding Peer Support Scheme
East Lancashire Hospitals NHS Trust & 'Little Angels'
A multi-faceted approach to the promotion and sustainability of successful breastfeeding. It includes the training of healthcare professionals alongside peer support workers who hold volunteer status, to work within the hospital and community setting. A non-profit making business enterprise has been developed (‘Little Angels’).
The aim of the initiative is to promote and support the initiation of breastfeeding and increase and sustain breastfeeding duration rates at 6–8 weeks and 7–9 months with a focus on mothers less likely to breastfeed. The community business now facilitates one-to-one support for breastfeeding mothers in the locality.
It is believed that this approach is the first of its kind because it is totally mother led – mothers provide support withinthe hospital setting (in addition to the community). Funding and collaboration for the scheme is multi agency – the supporters are paid (community non-profit making business) and they employ a health professional to work for them.
Young and Pregnant Service
Pennine Acute Hospitals NHS Trust
A specific service for young parents under the age of 17 – offering support and maternity care during and after pregnancy. The service aims to support quantifiable improvements in fetal and maternal outcomes within this client group, in line with the national service framework guidelines/recommendations.