Improving Patient Experience & Reducing SSI’s · Improving Patient Experience 5 What do we want?...

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Improving Patient Experience & Reducing SSI’s

Ms Daisy Allchurch, Dr Sarah Hammond, Dr Puneet Ranote

About St George’s and our Challenges:

• The Trust is in Financial and Quality Special measures- theatres mentioned in CQC

• There have been multiple theatre transformation programmes in the Trust and therefore there was scepticism for further work

• 29 theatres and 400-450 cases completed per week across the major elective specialties

• Partnership with Four Eyes in June 2017 showing an initial opportunity of 22%

• Staff already feel they are working flat out so messaging around productivity/efficiency has to be sensitive

Theatre Transformation programme

▪ Focus on quality not just productivity

▪ Quality work streams ▪ Reducing SSI ▪ Improving patient safety through mdt training ▪ Reducing our avoidable OTDC ▪ Patient experience

Improving Patient Experience

5

What do we want?

For patients to help us focus on the changes that matter most to them We wanted to take a thorough and robust approach and actually embed patients’ experience and views into our quality, care and performance objectives.

What we did?

• Collected 150+ patient surveys from across the surgical pathway to identify opportunities for improvement

• Conducted x2 patient panels to ask for more descriptive information with anaesthetists, surgeons, nurses and others listening to patients and asking questions face to face in two 90-minutes sessions:

• What went well? • What could we do differently - and better? • Are we focussed on the right priorities? • What do you think of our plans to improve?

What the Data told us – what we do well:

▪ Many patients highlighted the great experience, care from nurses at all stages of the pathway and the work of consultants – many of whom they named and thanked

▪ Overall experience of surgery at STG – 9/10 ▪ Clear instructions on fasting times – 95% Yes

▪ Quotes:

▪ “Overall the service availed to me was excellent and I have nothing but praise for every member of the team who attended to me.”

▪ “The surgery side was brilliant and organised very well, as it was an emergency Caesarean section”

What the Data told us – what we could improve:

▪ Was your original admission date changed? Yes - 23.53%

▪ Did you attend a pre-op appointment before your surgery? No – 29.82%

▪ Some themes emerged from survey comments and Patients Panels which highlight opportunities for improvement, specifically:

▪ Communication: how prepared patients feel for surgery, procedural explanation, difficult or lack of contact with PPC’s, availability of procedure specific material, being told in advance about the lengthy walk from SAL to theatres

▪ Dignity: Feeling exposed and the provision of gowns for patients walking from SAL to theatres

▪ Environment: depressing waiting rooms, uncomfortable chairs, what was on T.V

What we did dignity and environment! ▪ Introduced reusable patient dressing gowns to not only

provide some modesty, but also to provide some comfort and warmth as the days get colder!

▪ We trialled the patient dressing gowns in our Surgical Admissions lounge (SAL) in order to immediately improve the peri-operative experience of up to 45 patients who pass through the lounge each day!

▪ We collected feedback from our patients ▪ 98% agreed the gowns improved dignity ▪ 92% said they were score warmth 8/10

▪ Mindful of channel choice - no Jeremy Kyle

“I love them. So much better

☺”

“ A very g

ood

Idea.”

“A great Idea. Keep them going please!!”

“A welcome addition. The hospital is warm and the gowns are comfortable.”

“Fantastic!!”

“Great patient care, the new gowns make a great addition!!”

“Great Idea!!”

“A very nice gown, lovely feeling and warm.”

“Very comfortable at a scary time!

Thank you.”

“Excellent.”

“Fantastic, so much more dignified- thank you!

“Great improvement.”

“Lovely, like a Spa!!”

Patient Comments

Macmillan Surgery School Pilot



• 10 million people in UK undergo planned surgery every year

• Patients are at risk of complications as a result of their physical health

• 2 million people living with cancer in England

• Estimated 3.4 million by 2030


St George’s & Macmillan: Cancer Care Partnership for Patient

Experience


• Acute Oncology Service (AOS) Redesign Project

• Surgical Pathway Experience, modelling patient centred care, Values Based Standard (VBS) Project

• Workforce Development: Clinical Nurse Specialist (CNS) Availability, Macmillan Support Workers Pilot

• Patient and Public Involvement (PPI) Pilot.


Evidence base:• Imperial PREPARE (upper GI cancer)

• Reduced complications from 80%-35% • Reduced length of stay from 14 to 11 days

• Central Manchester ERAS+

• Reduced chest infections from 19% to 8% • Reduced length of stay from 12 to 9 days


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Get Set 4 Surgery ‘prehabilitation’


• Supported • Healthier • Activated • Ready • Empowered

St George’s SHARE sessions


SGH session:• 2.5 hours every Thursday afternoon, patient can bring a ‘plus one’ for support.

• Structured advice on - diet - activity/breathing exercises - psychological preparation • ‘What to expect on the day’ and surgical specifics • Peer support and Macmillan information stands

• All delivered by MDT; anaesthetist/surgeon/CNS/dietician/physio/psychologist


Macmillan surgery school sessions will be supported by a DVD and booklet containing similar information….

Macmillan Surgery school

DVD

Booklet


‘Psychological’ Prehab • Specific

Psychological constructs

• Broader Surgery School ethos/delivery

Holistic context • Preparation beyond

the physical Evidence Based • Impact on outcomes

Expectations •Normalising

challenges/concerns

• Illness perceptions

Activation & Empowerment •Self-efficacy &

Motivation •Symptom

Management

Psychological Wellbeing •Fears/Anxiety &

Low Mood/Depression

•Prevent/Minimise Mental Health issues

•Management/ Techniques

Patient-Centredness & Holistic Care •Communication &

Accessing Support •Modelling


Benefits of

Activity

Improves strength

Improves balance

Reduced risk of many

diseases including cardiovasc

ular disease, type 2

diabetes, stroke.

Improve functional abilities

Reduces symptoms

of depression

and anxietyIncreased

Confidence

Social Benefits: Meet new people, support

each other

Improved quality of

life

Improve quality of

sleep

Improves self

esteem

Improved body image

Reduces body fat

and lowers cholestero

l

Diaphragmatic Breathing Deep Breathing Exercise


Some of our feedback so far:

Exercise and catheter…catheter was a real worry for me, but not

now!

What did you find most helpful?

The whole session…excellent very helpful

All of it!

To be able to ask questions and meet other people

All of it was very good for me and will help me on my

way….Thank you to all of the speakers

I was able to find out things I hadn’t

thought of… Very helpful and reassuring

for me, a relative of someone going to have surgery

Macmillan Surgery School Impact EvaluationOutcome Impact Data source

Patients feel empowered to influence the outcomes of their surgery

-Actively involved -Set expectations -Self management -Increase confidence -Sense of control

-Pre-session questionnaire -Feedback sheet at SS and post op -Completion of pt diary -Staff feedback

Communication & coordination of care across surgical pathway

-Effectiveness -Better use of health resources -Improved efficiency

-Discharge time/date -Readmission rate -Preop- time spent with surgeon/preop nurse/CNS -Staff perception of patient’s understanding and engagement with their care

Improvements in patients’ post operative physical wellbeing

What effects have occurred as a result of active participation in pre-hab

PQIP data

Process of implementing MSS pilot

-MSS Team experience of implementation -Embedding the MSS session into the surgical pathway

-Team feedback -Quantative data (#pts referred/booked/attended

Do the 3 tools developed support patient experience

-DVD -Booklet -Pt Diary

-Views/clicks of electronic documents -Pt/staff feedback

Does MSS meet with wider stakeholders expectations

-Alignment with national and local drivers

-Key stakeholders feedback -Review of current national and local strategies

Reducing Surgical Site Infections in T&O

Reducing Surgical Site Infections in T&O:

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BUT THERE IS MORE TO DO!

• We put together an MDT consisting of T&O Surgeons, Consultant Anaesthetists, Theatre Team Leader & Clinical Infection Nurses in order to complete the ‘One together’ assessment toolkit

• The ‘One together’ assessment toolkit has been designed to demonstrate infection prevention compliance across the surgical pathway. It a supports staff in addressing challenges identified throughout the pre, intra and post-operative stages of surgery.

• The tool also acknowledges the difference in practice across differing specialities & has been derived from national evidence-based guidelines or expert recommendations from professional bodies

•

Surgical Site Infections (SSI) – T&OWhat the data tells us:

• We completed a ‘warming audit’ to assess the patients temperature when they arrived, what the patients temperature was when it was last recorded on the ward and the time (was it within an 1 hour of the patient being transferred to theatre?

Presentation title / St George’s University Hospitals NHS Foundation Trust

What we are doing:The assessment showed us we needed to focus on:

1.1. Patient Washing – we are including information about the important of washing into the POA, theatre checklist, and tell patients during our ‘48 hour reminder calls’

3.2 Pre-Operative Patient Warming – we are ensuring theatres have enough thermometers in the Anaesthetic rooms so all patients temperate can be taken before surgery

7. Surveillance of Surgical Site Infection – infection control nurses now reporting on all major long bones & we are exploring a self-reporting tool for surgeons

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Surgical Environment – After an audit of traffic & number of people in theatre we are;

• putting signs on theatre doors to ensure that doors to the operating theatre remain closed while an operation is in progress,

• Moved trauma drugs out of theatre

• Exploring the option of putting locks on theatre doors to limit the amount of traffic in and out of the operating theatre

• ‘No go zone’

Thank You! &

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Improving Patient Experience & Reducing SSI’s · Improving Patient Experience 5 What do we want?...

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