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