Quality Care - everyone, everytime
 

Seven Day Services

The Trust has committed to meeting new standards to deliver equitable services 7 days a week and this page explains more about this.

This film outlines the four priority clinical standards across urgent and emergency care and reflects the views of staff across trusts who already meet the standards every day of the week.

Over the last ten years, a growing body of national and international evidence has emerged, that links poor outcomes, including a higher risk of death, for patients admitted to hospital at the weekend or out of hours, around the world.

What is the evidence?

National evidence shows, for example, that patients are 16% more likely to die if they are admitted on a Sunday compared with a Wednesday. The risk of death for patients admitted on a Sunday compared with a Wednesday is 37% higher for acute and unspecified renal failure, 8% higher for urinary tract infections and 7% higher for a fractured neck of femur .

Clearly the five-day service model offered in many NHS hospitals no longer meets justifiable patient and public expectations of a safe, efficient, effective and responsive service.

“It would be useful if our traumas and crises limited themselves to office hours. Life would be simpler and safer if we only suffered strokes or multiple traumas, if we only found lumps or pee’d bloody urine, or if we only had heart attacks, mental health crises and babies from Mon 9am-Friday 5 pm. But our illnesses and conditions don’t limit themselves to office hours. So why does the NHS?”

Fiona Carey, Cancer Patient and National Patient Representative

What are the standards we should be reaching?

In December 2012 NHS England published Everyone Counts: Planning for patients 2013/14. It stated, for the first time, that the NHS will move towards routine services being available seven days a week.

Sir Bruce Keogh has facilitated the development of 10 standards which aim to improve clinical outcomes for patients admitted to acute hospitals, regardless of the day of their admission. The NHS commitment is to roll out the seven-day service hospital clinical standards across England's population by 2020, starting with the 4 Priority Standards

The diagram below shows how the 10 standards, if implemented, will lead to improvement of acute hospital care with the priority standards ringed

 

10 Standards 2

Standard 2 – every admitted patient is assessed within 14 hours by a consultant - and Standard 8 – every patient sees a consultant everyday (unless unnecessary) - are seen as particularly core.

If we can meet these standards, based on national evidence:

  • Mortality rates will improve;
  • Length of stay will reduce;
  • Readmission rates will reduce;
  • Patients will be more satisfied; and
  • Quality and patient safety will improve in.

Within that audit the IOW NHS Trust is focusing on the 4 priority standards:

  • Time to 1st consultant review;
  • Access to diagnostics; and
  • Access to consultant directed interventions.

How is it being implemented?

A six monthly audit against the standards has allowed us to identify gaps. With knowledge of these gaps we have been worked with operational departments to develop solutions.  The diagram below  shows the implementation progress so far.

Implementation Progress v5

How are we currently doing?

We have audited our achievement against the standards a number of times – these happen in the spring and autumn. Those audits show around 1 in3 do not see a consultant within 14 hour and around 1in 4 do not see a consultant every day when ideally they should.  Predictably this is far worse at weekends and in the evening, and varies by speciality.  For example on-going reviews are as high as 82% during the week but fall to just 7.5% at the weekend.

For standard 2 this is about “Middle of the Pack” compared to other Trusts but we sit less favourable for other standards.

As well as our last audit results: NHS England Results
If you want to have the specific performance of your department feel free to call (3008/ 07887/994297) or email to: Oliver.Cramer@iow.nhs.uk

What action is happening to improve the situation?

We have a project team working with operational staff on a range of initiatives; these include improved access to diagnostics, better documentation, improved clinical coverage, and developing new pathways standards.

To reach the 4 priority standards we need your help:

Medical Staff:

Review patient on a daily basis and document in line with guidance of GMC and Academy of Royal Medical Colleges - peruse the admission paperwork and complete in FULL

Clearly document:

  • Date and time of discussion about initial review with the patient
  • Date and time of review
  • Frequency of review required (Twice daily/ Once daily/ no review/ next review on …)- in line with Keogh standards
  • Who to perform ongoing review (delegate – i.e. Reg acceptable if patient stable)
  • Please also define delegate: ST3/FY2/ Advanced Nurse/ Other health care professional
  • Patient was informed of review outcomes/ changes to care plan

Service Clinical Leads:

Think about and introduce pathways for those patients who don’t need to be seen by a consultant (e.g. fractured neck of femur (FNOF), acute abdominal pain )

All Staff:

  • Support the documentation requirements; clarifying gaps with colleagues when missing.
  • Watch the video to understand the context and engage with changes aimed at improving 7 day access. If you identify ideas, discuss them with your manager.
  • Highlight, if you’re concerned that a patient isn’t seen regularly by a consultant during their stay.
  • Encourage others to read this page.

Where can I get more Information or Resources?

NHS Improvement website: https://improvement.nhs.uk/resources/seven-day-services/

And a final word from former NHS Medical Director Sir Bruce Keogh:

HELP WANTED: Please let us know if you wish to be involved in the audit as we appreciate any help! We have one planned at the start of May and then another late this year. For more information you can contact us internally via ext. 3008 or email Oliver.Cramer@iow.nhs.uk.  Many thanks!

 

 

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