St Mary’s patient pathway project

Stephan Brusch – Service Development Manager Westminster PCT

Mark Sheen - Community Nurse SpecialistKensington and Chelsea Learning Disability Service

SETTING THE SCENE

• High rates of poverty and deprivation centred in specific wards

• Indices of deprivation (2004) Westminster 39th and K&C 166th out 354 English districts

• Up to 18 year difference in life expectancy for people living in the wealthiest and poorest wards

SETTING THE SCENE cont….

The project involved: • St Mary’s NHS Trust

• Westminster Learning Disability Partnership

• Kensington and Chelsea Learning Disability Service

PAST WORK AND CHALLENGES

• St Mary’s Disability Group

• Teaching, video’s, accessible information

• Limited effectiveness• Difficulties in effecting

a systems change

Opportunity

• Established link with the Modernisation Board at St Mary’

• Body that oversees Transforming St Mary’s

What is Transforming St Mary’s?A programme of coordinated projects addressing the use of new technology, new roles and new processes

The programme uses a structured approach to project and programme management, and each project reports to the Transforming St Mary’s Board Programme Board

Aim - To improve service efficiency and effectiveness of the trust, for the benefits of staff and patients

•Objectives – To ensure patients are treated in the right place at the right time by the right staff, to provide safe, high quality care.

•What are the projects?•IT•Picture Archiving - electronic capture & storage of X-rays •Order Communications - electronic ordering & reporting of diagnostic tests •Electronic Discharge Communication - electronic GP discharge letters•Choose and Book - direct booking of out patient clinics from GP surgeries•Roles•St Mary’s 24 / 7 – redesigning roles e.g. Outpatient Clinic Assistants•Processes•Improving the Patients Journey – streamlining processes and procedures from pre-assessment to discharge

Improving the Patients JourneyAims •To streamline, standardise and improve the processes and procedures of pre-assessment, admission and discharge•Objectives•To reduce length of stay for patients•To increase % of patients who receive pre-operative assessment•To increase % of patients who are given an expected date of discharge

Why did we get involved?

As part of Improving the Patients Journey (IPJ) project the trust was redesigning the patient journey from pre-assessment to dischargeA proposed pathway was designed. What impact did this pathway had on vulnerable patients?

The St Mary’s project:

• A defined patient pathway agreed by community and hospital staff.

Project Objectives- The Outcomes:

• Improved patient experience for people with learning disabilities and their carers

Project Objectives- The Outcomes:

• Decrease the number of inappropriate admissions by increasing the number of people who can be treated in the community.

Community

Project Objectives- The Outcomes:

• Length of hospital stay in line with the general population

Auditing Records:

• We looked at records of people who stayed at St Mary’s.

• We wanted to see what worked well and what didn’t work well.

Consultation:

We arranged a workshop and looked at the following areas:

• Going into hospital • Staying in St Mary’s• Leaving St Mary’s and

A&E

This is what came out of the mapping exercise:

• Pre-admission• Inpatient stay • Discharge and A&E

Pre-admission

Training

Pre-admission

Ensure people have access to primary care

Re-launch communication tool

Pre-admission

Ensure that St Mary’s can identify people with learning disabilities and their support needs.

Inpatient stay

Better information when arriving at St Mary’s .

Better training and information on consent and best interest.

Inpatient stay

Better information while staying in hospital.

Inpatient stay

Better triage in A&E

Accident and Emergency

Training

Accident and Emergency

Better communication at discharge.

Discharge

• We included everything in an action plan and set priorities.

Next Steps:• Transforming St

Mary’s Programme Board

• Partnership Boards

• St Mary’s Disability Group

Reflective Learning Points• Gather data and link to national evidence (audit

and user involvement).• Moving away from focussing on patterns

(people’s behaviour) to influencing processes • Mainstreaming (transferability to other vulnerable

groups, process mapping)• Being politically astute (create win-win situation)• Be a strategic Health Facilitator