Hospital at Night

StAZ Study Trip

18 January 2009

Tim LundDivisional Manager

Skills for Health Workforce Projects Team

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@N services

• The “Case for Hospital at Night: the Search for Evidence” demonstrated improved patient safety

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@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; 102:539-546. Author Dr D.J. Beckett et al

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@N

• Indications - 24/7 solutions and hot & cold split/team work support the quality of patient care and can sustain training

H@N introduced H@D&N introduced

National average

HSMR Data at Guy’s and St Thomas’: 2003 - 2008

Confidence in H@N and 24/7 Longevity

• 24:7 solutions appear sustainable at Homerton, Guy’s & Tommy’s, 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

Development of H@N Tools / Support

• H@Nbleep system implemented in small number of trusts

• Robust handover systems available. We are sponsoring Salisbury to roll out H@N handover tool to 20 trusts

• 12 hour H@N e-learning course under development with London Deanery & DH. Core skills and curricula

• Opportunity for blended learning. Sustaining training vital

Particular Value of Simulators

• Full immersion

• Complex multi and inter-professional working

• Particularly when linked to effective behavioural debriefing

Source: London Deanery

Particular Value of Simulators

• Full immersion

• Complex multi and inter-professional working

• Particularly when linked to effective behavioural debriefing

Source: London Deanery

Salisbury Salisbury Handover Handover

SystemSystem

With support from

Salisbury H@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

Hospital at Night List

• Linked to Consultant List or can stand alone

• Correct patient details

• Management plan detailed

• Reason for H@N involvement

• Priority for review

• Accessed throughout the day

• Printed for H@N team

• Auditable

Source: Salisbury

Helping to Make EWTD Manageable

Contacts: Information

• Any Questions?

• Contact me via:

07771 3719180161 2662136

tim.lund@skillsforhealth.org.uk

Further information: www.healthcareworkforce.nhs.uk