"Minutes from Network User Partnership Meeting"
Minutes from North West London Enhanced Recovery Meeting 6th April 2011, 2:00 – 4:00p.m. Venue: Seminar Room 3, Medical Education Centre - Level 6, St Marks Hospital Meeting Chair: Name Role or title Organisation Daniel Callanan (DC) Enhanced Recovery and patient North West London Cancer Involvement Lead Network (NWLCN) In Attendance: Jo Archer NWLCN Nurse Director NWLCN Victoria Frosdick Orthopaedic Physiotherapy Team CMH (NWLH Trust) Lead Sheridan Hanson Therapy Manager - Mount Vernon Hospital ERP MSK Coordinator - Hillingdon Hospital Sarita Yaganti Primary Care Imp. Lead NWLCN Robert Reichert Consultant Breast Surgeon NWLH NHS Trust Ian Holloway Orthopaedic Surgeon NWLH NHS Trust Giles Hellawell Consultant Surgeon NWLH NHS Trust Alison Coggan Service Improvement Project Hillingdon Hospital Facilitator Aileen Reidy General Manager NWLH NHS Trust S. McLreary CNS – Breast Care Charing Cross Hospital Amar Sidhu ERP N. Practioner Imperial Tina Beish DGM NWLH NHS Trust Catherine Enderley- GM NWLH NHS Trust Brawn Miriam Kadry Consultant Anaesthetist West Middlesex Julian Jacob Therapy Lead Imperial Sue Lepp Urology CNS NWLH NHS Trust Jennifer Burch Lead Nurse NWLH NHS Trust Manju Khanre CNS NWLH NHS Trust Sarah Collet Lead Cancer Nurse Ealing Hospital Trust Lee Robinson Project Support NWLCN 1. Welcome and apologies Daniel Callanan (DC) welcomed attendees and introduced himself as the Chair of today’s meeting. Minutes of the first meeting were agreed. For reference, TOR attached below: \\wpct.local\Shared\ WLCN\Enhanced Recovery\Network Enhanced Recovery Group\TOR\NWL Enhanced recovery gro 1 Presentations from the North West London NHS Trust 2. T & O Enhanced Recovery Project Mr Ian Holloway, Consultant Orthopaedic Surgeon at North West London NHS Trust, provided the first presentation. Mr Holloway is based between Northwick Park and West Middlesex Hospitals. He specialises in Knees and Hips, currently overseeing around 600 cases a year. Patient satisfaction and pain scores are measured throughout the pathway. He explained how a full protocol is currently being completed for patient pathways. 56% of cases are seen by a physiotherapist on day 0 (Zero). They are looking into the financial repercussions of introducing physiotherapy earlier. One idea they are looking at is extending the working day for physiotherapists so more day zero patients will be seen. He explained the benefits of using Derma bond and an effective dressing to help seal and keep wombs bone dry. This is a process they currently use as standard. Within the presentation was post-op footage showing immediate significant progress made by a patient, with Mr Holloway mentioning how managing patients expectations pre-op helped recovery post-op. Currently, the vast majority of patients are out of hospital by day three. There had been significant progress over the last few years and calculations had shown that even since October 2010 the average amount of bed days had dropped by a day. (Dr Holloway put a rough financial figure on the saving of £240,000 per year. Although this saving had yet to be realised with no beds closing.) He explained how they try to avoid using PCA as it can make patients sick. PCA had only been used in 3 of 62 cases so far in 2011. Post Op infection rate – “generally never, last few months had a 0% infection rate.” Dr Holloway’s team had stopped using drains as standard protocol. For Hips, this had been standard for the past two years and for Knees over the past 18 months. He explained that the dressing added after knee operations significantly helps. Most Patients currently have general anaesthetic, but Dr Holloway would like to use more spinally administered anaesthetic. He found that they had very few exceptional cases when patients would stay in for over a week. These were a few very unfit patients at Northwick Park. He explained that all patients meet the pre-op haemoglobin criteria which clearly helped reduce recovery times. He also highlighted how post-op care was crucial. Future Plans: He thought that his team would look at effect of pre-morbid fitness and update the statistics on readmission rates. Note: Mr Holloway’s presentation will be made available on the North West London Cancer Network’s website in due course. 3. Urology Enhanced Recovery Project Mr Hellawell, Consultant Surgeon at North West London NHS Trust, gave a presentation on Enhanced recovery within Urology. Mr Hellawell explained the general principles and overview of the operations he performs. He highlighted the significant progress that had been made with the introduction of the ‘green light laser’ which had allowed days cases to become the standard, which was unheard of before this operational technique came in. The main benefit of the new laparoscopic method is that the operation has very little bleeding and operation time had been reduced significantly. They were at case 99 at Northwick Park. 2 He explained how 70% of patients are now day cases. Early results show that the average patient’s time in hospital has dropped from 4 days to 2.9 days. He thought this would drop further as his team gain from experience. The first 15-20 cases had a variety of staff which has now settled into a consistent team. He felt the shorter in times were appreciated by nurses and patients. Mr Hellawell highlighted that the pre-op protocols for patient information was crucial. (Note: Reference made to the North West London Hospital document in presentation) He stated that prostate op-preparation was also extremely helpful and cuts the number of complications. At NWLHT they use an MRI scan as part of their surgery prep which has been beneficial. There were not any limitations with different body types. Operation body position - Head down cases not preferential. Horizontal better on day cases. (refer to presentation; esp. learning curve slide and op information, ie minimal Trendelenburg lift/ water tight process) As a reassurance to all patients, Mr Hellawell gives his phone number to all patients. To date he had not received a call. He noted that TTA’s should not effect discharge date. The nurse team start early on patient prep so they are always ready for the 8am start which is crucial for day cases. Note: Mr Hellawell’s presentation will be made available on the North West London Cancer Network’s website in due course. 4. Breast Team – 23 Hour surgical pathway Mr Reichert, Consultant Breast Surgeon based at Northwick Park, presented on his teams work on the ’23 hour surgical pathway’. Please see the attached presentation: \\wpct.local\Shared\ WLCN\Enhanced Recovery\Network Enhanced Recovery Group\meetings\April\Mr Reichert pres.p Additional points to note: Mr Reichert noted that drains are not used at Kings and his thoughts were that is the way to go procedurally. At Northwick Park they very occasionally send home patients with a drain and the HART nurses are all trained to remove in these cases. The King’s team will be presenting at the next Breast TWG on the 23rd May. 5. Colorectal Enhanced Recovery Project Jennifer Burch works as Lead Nurse supporting the Colorectal Surgeons at St Marks Hospital. Please see the attached presentation: \\wpct.local\Shared\ WLCN\Enhanced Recovery\Network Enhanced Recovery Group\meetings\April\J Burch Pres.pdf A few additional points to note: 3 At St Marks they have around 250 cases a year which are shared between two surgeons. She highlighted that 95% are out of bed walking the day after surgery and that patients are strongly encouraged to be active. Drains – Mainly just used on Pelvic Surgery cases. They never send a patient home with a drain. 6. CQUINS For a full breakdown of the indicators please see the document attached below: CQUINs for London ERP sent Piers 24.1.2011.xls DC has talked to the Associate Director of Commissioning for NHS North West London, Hannah Mills. The general message was that they were not ready to discuss CQUINs with the group as they are working their way through the indicators themselves. The group briefly discussed the commissioning process which begins in May 2011 and it is expected that the North West London Cancer Network would take up a commissioning support role in the coming months. 7. How to improve primary care engagement A general discussion around primary care’s role with ERP took place, with some of the key points including: GPs could help set patient expectations Ensure general co morbidities such as diabetes are under control before referral Would be beneficial for GPs to be aware of contact details of ERP staff, to improve relationships and understanding at primary care level. Could invite commissioners to this forum to support engagement primary care Providing incentives for primary care involvement – can a portion of the savings made by ERP are redirected to primary care? GP access to services such as dieticians before referral to acute care? More clear cut how primary care involvement would be appropriate for T&O patients- diagnostics prior to referral such as x-rays In terms of cancer, acute teams should further consider primary care’s role following discharge. managing patient expectations Action: If any members of the group have thoughts on exactly what they want / would be helpful from primary care, please can they email them to email@example.com. Meeting Close- Agenda Items not covered will be considered for the next meeting. Date of next meeting: The next Enhanced Recovery meeting will be held on the 5th May 2011 at Hillingdon Hospital NHS Trust. The meeting will take place in the Lecture Theatre within the post graduate centre at Mount Vernon Hospital (Click here for a map) 4