impact of dynamic dtc’s
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Impact of Dynamic DTC’s
Transformation of Kidderminster Hospital
1st September 2003
David Evans
Project Director
Worcs Acute Hospitals NHS Trust
Worcestershire
3 PCTs South Worcestershire pop 280,000 Redditch and Bromsgrove pop 150,000 Wyre Forest pop 110,000
1 Acute Trust WRH 450 bed PFI Alexandra 340 bed DGH Kidderminster DTC and other services
Electives v Emergencies
Which is the priority? Conflict between medicine and surgery Cancellations through lack of beds Patients cared for in inappropriate areas Waste of time and resources - day to day crisis
management Stressful for patients and staff
Services at Kidderminster DTC - short stay elective surgery Diagnostics Clinics Midwifery led maternity unit Minor Injuries Unit/Primary Care Centre Cancer services Renal Dialysis Unit Intermediate care beds Therapy services Education Centre
Activity Strands at Kidderminster
Local Primary Care
Elective Wyre Forest Elective Worcs
Elective Patient Choice
KidderminsterHospital
IS-DTC
The Design - Ground Floor
Main Entrance
Atrium
Café
MIU/PCC
Oral/Maxillofacial Department
The Design - First Floor
Outpatient Functions Consulting rooms Radiology Cancer Services Ophthalmology Renal Dialysis Rehabilitation and therapy services Clinical Measurement
The Design - Second Floor
Treatment and Intervention Operating Theatres Intervention Rooms Short stay elective beds Other inpatient facilities Staff rooms and changing facilities
The Design - Third Floor
Support Services Office accommodation Pathology Laboratories Education Centre
Midwifery led Maternity Unit
Project Status
Nov 24th - Phase 1 handover Dec 15th - Outpatients, Radiology and MIU/PCC
open Dec 22nd - 1st operating and endoscopy lists Jan 5th - Phase 2 starts Aug 2004 - Phase 2 handover Oct 2004 - Phase 2 opens
DTC aims Separation of emergencies and electives High quality health care facility Quick access to treatment and diagnostics Flexible facilities Patient centred - one stop approach Patient flows and navigation ‘Wow’ factor Wellness model Focusing on the predictable Transforming the patient experience
Changing the culture
Patient centred care Reduced waiting times Partnership working Breaking down the barriers Flexible/multiskilled working Smarter not harder Process and systems Individual responsibility Healthcare is not rocket science
COLORECTAL ACTION PATHWAY DIAGNOSTIC TREATMENT CENTRE
KIDDERMINSTER HOSPITAL
Pt presents to GP & fulfils referralcriteria A or B
A Change of bowel habit to looserstools and/or increased frequency ofdefaecation without rectal bleeding &
persistent for 6 weeksOVER 60 YEARS
B Rectal bleeding persistentlyWITHOUT anal symptoms
OVER 60 YEARS
Referral madefor flexi
sigmoidoscopyplus or minusbarium enemawithin 14 days
Flexisigmoidoscopyperformed and
NO biopsytaken
Report of flexisigmoidoscopy
and bariumenema sent toreferring GP
Flexisigmoidoscopyperformed and
BIOPSY taken
Pt proceeds toBarium Enema
SAME DAY
Pt attends GP surgery forresult of flexi
sigmoidoscopy andbarium enema +/or biopsy
x-ray dept booksBarium Enema
BIOPSYNEGATIVE
BIOPSYPOSITIVE
BARIUMENEMA
NEGATIVE
BARIUMENEMA
POSITIVE
Report sent toGP and 14 dayoffice clerk toensure urgentappointment
with consultant
Changing roles Scheduler
understands whole journey, books patients, compiles lists, close links with clinical staff, strong customer care aspect
Nursing Multi-skilled, competency based, nurse discharge
PSP project case management, assess, diagnose and initiate treatment
Surgeon customer?, credentials?, audit, little involvement in post op care
Anaesthetist increased blocks, recovery care, clinical responsibility for DTC?
Radiographer Assistant
Process not Function
•Rehabilitation
•Low Dependency
•Respite
•Shared Care
•Home Care
•Social Care
Patient HotelA&E Diagnostic
Investigation
Critical Care
Acute Inpatient
Care
Intermediate Care
Facilities
Hospital at Home
Ambulatory- 23 hr investigations & surgery
Outpatients
- Generalised- Specialised- One Stop
Secondary Care Community
Primary Care
Co
mm
un
ity
+
Pri
ma
ry C
are
Primary Care
Community
Chest Pain Elderly
Assessment
Medical Surgical
areas
Peri Acute Care
Hospital at Home
DTC Business
Managed as a business unit of Trust Activity targets Income targets and generate surplus
Patient Choice Order book High quality care, facility and behaviour Market services and facilities Evening and weekend working Flexible staff
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