Award winners

Deflection of non-life threatening ambulance calls from emergency department to PCT

NHS Stockport

Dr Ash Patel

The number of emergency calls is rising in many areas and calls are often for minor problems. Attendance at Stockport accident and emergency unit has increased by three per cent since 2007 and the number of admissions by 19 per cent. The Stockport Early Intervention Service (EIS) was set up in September 2009 and is a primary care facility which treats patients with more minor conditions, relieving pressure on the hospitals. Currently patients at the EIS are referred by GPs but this proposal would allow it to accept cases brought in by the ambulance service, thus diverting cases away from accident and emergency. Paramedics would receive training in how to select appropriate patients using a medical referral model. Of the 67,000 patients who visited Stockport’s emergency department in 2008/9, it is estimated that over 3,000 could have been treated at the EIS.

Telestroke delivery 24/7 across Lancashire and Cumbria

North Cumbria NHS Trust

Dr Paul Davies

In Lancashire and Cumbria about 4,000 patients a year will have a stroke and about 1200 will have a stroke-like episode. Strokes can cause lasting damage and have a major impact on people’s lives. Thrombolysis is the only approved medical therapy for acute ischaemic stroke, however it should be given within three hours after the stroke and, in order for patients to receive it, they must first be assessed by a stroke consultant. As there are relatively few such specialists in the UK, it makes it difficult for hospitals to deliver thrombolysis on a 24-hour basis. This proposal would use broadband technology to connect hospitals with a remote network of stroke specialists. The physician, who would be based at home outside working hours, would be able to see CT scans and carry out a live consultation with the patient and local medical teams. Telestroke networks have been established in the US, Europe and Scotland. The service would cover 10 hospitals in Lancashire and Cumbria and the aim is to increase the proportion of stroke victims who receive thrombolysis from 0.5 per cent to 10 per cent.

Providing enhanced speech and language therapy using computer technology

NHS North Lancashire

Veronica Southern

Around one third of stroke victims will require speech and language therapy and the national strategy recommends that they receive at least two hours per week but demand for services makes this difficult to achieve. Traditionally patients have been treated in a one to one setting or in small groups. Mrs Southern, a speech and language therapist, has started a pilot group using computer technology to provide enhanced therapy to a group of patients at the same time. The group relies on assistance from volunteers and premises and equipment loaned from Blackpool Council. The Stroke Association is keen to work with her but funding is required for software and hardware. This proposal would extend the scheme and allow patients to be offered computer therapy while in hospital, then move on to therapy groups where they have access to laptops loaded with the software. They will also be able to book in to use the equipment at other times. Using computer technology, patients can take more control over their therapy and the amount they practise and be able to monitor their success.

Anticipatory Care Calendar for people with learning disabilities and dementia

Merseyside and Cheshire Cancer Network, hosted by NHS Wirral

Tracie Keats

Approximately 28,000 people in the North West have severe learning disabilities. People with learning disabilities often have physical health issues missed as health professionals see a persons behaviour as a problem. Often people with learning difficulties are unable to communicate verbally when they are experiencing a physical health problem. It can also be difficult for their carers (social staff and relatives) to spot when these people are experiencing health problems. The Anticpatory Care Calendar has been developed to provide social care staff with a system for recording a person's normal symptoms and changes in their symptoms. It also provides guidance on what actions they should take using a traffic light system. Use of the calendar reduces the health inequalities experienced by people with learning difficulties and empowers their carers. The funding was requested to roll out the calendar to 3 areas (Merseyside and Cheshire Cancer Network, Greater Manchester and Cheshire Cancer Network, and Lancashire and South Cumbria Cancer Network). Whilst the calendar was developed for people with learning disabilities, it has also been piloted for use with dementia patients.

Implementation of a system-wide pathway for the management of heart failure

Liverpool Heart and Chest Hospital NHS Foundation Trust

Jay Wright

About 2-4% of the population have heart failure. Their symptoms can be severe, they often have a poor quality of life, they are frequently admitted to hospital (average length of stay 13.2 days), have a high mortality rate, and their care costs about 5% of the total NHS expenditure. Funding was requested to implement a clinical pathway for the treatment of patients with heart failure, which spans primary, secondary and tertiary care. Such implementation requires a system (Network Orange) that can record patient information and links to other systems (EMIS and CCAD) to ensure that the patient care is seamless. A paper version of the pathway is already in place. A similar system implemented in Colorado resulted in a 70% reduction in admissions and a 34% decrease in mortality rate. Matched funding will be provided by the PCT. Implementing the pathway could result in a reduction in 13,000 bed days over 12 months, based on 5,000 patients.

Early warning system

Met Office

Gary Derbyshire

Around 34,000 patients in Rochdale suffer from chronic pulmonary obstructive disorder (COPD), costing the health service £1.3 million a year. Each year 700 COPD sufferers are admitted to hospital in the area. There is a strong link between hospital admissions and environmental factors such as extreme weather and circulating infections. This service by the Met Office takes into account cold weather, the virus load in the community and seasonal patterns and alerts people by remote telephone call when environmental conditions are likely to put their health at risk. It also advises them of simple measures they can take to stay well. This proposal, from the Met Office in conjunction with NHS Heywood, Middleton and Rochdale Primary Care Trust, would see COPD patients in the area linked up to the service.

Oesophageal doppler

Central Manchester University Hospitals NHS Foundation Trust

Dr Daniel Conway

Major surgery is the equivalent of running a half marathon. Over 30,000 patients die each year following surgery and recovery can take months. An oesophageal doppler is a medical device placed in the mouth during the operation to monitor heart function. It can alert the anaesthetist if the patient is becoming dehydrated and helps guide fluid replacement, ensuring that the patient’s tissues have optimal bloodflow without fluid overload. This in turn helps reduce complications and death rates, and can cut the length of hospital stay by around two days. However oesophageal dopplers are not as widely used as they might be. Dr Daniel Conway has been involved in a number of projects to encourage their use. This proposal would provide funding for the team to support training for anaesthetists and raise awareness of the benefits. For more information see www.howtowhyto.nhs.uk.

OSCAR - Optimising Surgical Care and Assessment Record’

Royal Liverpool University Hospitals NHS Trust

Dr Steve Lake

A small but significant proportion of all operations are cancelled on the day of surgery because patients are not fit to undergo the treatment. Optimising Surgical Care and Assessment Record (OSCAR) is an innovative computer tool designed, developed by the preoperative assessment team at Royal Liverpool University Hospitals NHS Trust. Patients are seen by a nurse four weeks before the surgery is due to take place and OSCAR is used to record their vital signs and medical and social history. It recommends patient management guidelines based on NICE principles. It highlights any necessary preoperative investigations and can identify high-risk surgical patients and refer them to the anaesthetic assessment clinics. Using this technique, the Trust has succeeding in reducing cancellations from five per cent to 1.4 per cent of all operations, generating a cost saving of around £375,000. The proposal would extend the use of OSCAR to other areas.

Patientrack

Patientrack

Sam Hollander

Funding was requested to facilitate sharing of good clinical practice by enabling Central Manchester University Hospitals NHS Foundation Trust staff to help other Trusts in the region to adopt 'Patientrack'. This software records early warning scores of critically ill patients and alerts appropriate clinical staff of any changes in the scores so they can react accordingly. The worse the patient's condition is, the higher the seniority of the doctor called to attend the patient's bed side. Use of the software has been shown to reduce length of stay by about 2 days per episode of patient care, reduce the use of intensive care unit critical care beds, and prevent avoidable cardiac arrests.

PROMS 2.0

Trafford Healthcare NHS Trust

Bibhas Roy

There are 1.8 million orthopaedic follow-up appointments in England per year.  It is proposed that use of PROMS 2.0 (patient reported outcome measures web based questionnaire) could release about one third of these outpatient appointments.  Patients would complete the questionnaire on their condition post-surgery, and only those patients who need to see the surgeon would then be followed up in an outpatient clinic.  Funding was requested for costs associated with rolling out PROMS 2.0 to eight NHS Trusts in the region for patients undergoing shoulder surgery.

Talking Leaflets

The Pennine Acute Hospitals NHS Trust and NHS Oldham

Jon Skellington, Festina-Lente

Talking leaflets were developed by Pennine Acute Hospitals NHS Trust (PAH) in response to the need to provide patient information (e.g. on endoscopy) in a number of different languages.  The leaflets consist of recorded information that is accessible by ringing a geographical telephone number.  Use of the talking leaflets should: reduce patient did not attend (DNA) rates; reduce the lack of understanding that some patients have about their treatment when English is not their first language; reduce the number of failed procedures due to patients not complying with the preparation instructions (e.g. fasting); reduce interpreter time; and overall improve the patient experience and choice (through informed decisions).  About 1,500 patients have used the talking leaflets to date over an 18 month period.  The funding was requested to expand the range of talking leaflets provided to encompass five areas: maternity; diabetes; stroke; hip and knee; and high volume invasive procedures.