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Annual Report 2007 to 2008


  • pg 1
          CARE NETWORK


 “Working in partnership to meet
  the needs of the critically ill in
         West Yorkshire”

April 2007 to March 2008
 Margaret Clark, Network Manager
               Foreword                                  3
1.0            Introduction                              4
2.0            Aims of WYCCN                             6
3.0            Workstreams and Outcomes 2007/08          7
4.0            Achievements                             11
5.0            Finance                                  18
6.0            Conclusion                               19
7.0            Recommendations for 2008/09              19
8.0            Acknowledgements                         19
9.0            References                               19
               Glossary of Terms                        20
               WYCCN Organisation Chart                 21
               WYCCN Team                               22
               Contact Details                          23

WYCCN Annual Report 2007/2008

Welcome to the world of the West Yorkshire Critical Care Network’s 7 th year of
operation. The NHS continues to change at a great rate and to ensure that the West
Yorkshire Critical Care Network meets the growing demands of our population with
professional agility.

The past year has seen reconfiguration of services within hospitals impacting on critical
care capacity, demand and multidisciplinary teams. The Network continues to monitor
such activity and reports findings to individual Critical Care Delivery Groups and the
Strategic Board.

Payment by Results (PbR) is on the horizon for critical care. West Yorkshire Critical
Care Network has been involved in the national pilot which will inform the Department of
Health (DH) and local Trusts on predicted for future funding arrangements.

Outreach Services are growing in strength and numbers to meet the increasing
demands. Local organisations are supporting with additional funding.

Support groups continue to work hard to achieve high standards which is monitored
through compliance to national audits. These have been fulfilled throughout 2007/08
with high quality outcomes and local plans developed to ensure standards are

Local sharing events continue to be successful and future ideas for any further events
will be considered in 2008/09.

Education and sharing events, driven by national and local visions are provided to meet
the optimum care for patients in critical care. The Health Care Assistants day was
launched this year and evaluated extremely well and will continue in 2008/09. Transfer
training for multi-disciplinary teams was also reviewed and has been successfully re-

The Network looks forward to 2008/09 and to working with key stakeholders in a
proactive manner. Thank you all once again for your support throughout the last year.

Margaret Clark
Network Manager

WYCCN Annual Report 2007/2008
1.0     Introduction

        The WYCCN has been operational since 29th January 2001 and operates as a
        managed clinical network. It is an alliance of autonomous partner organisations
        with a common goal to provide high quality services to all critically ill patients
        irrespective of their location.

        The Network provides a critical care services which spans 5 Acute Trusts and 6
        independent organisations. It works across these boundaries and out of West
        Yorkshire to meet the demands of the critical ill patients, which no single
        organisation can meet at peak periods.

        1.1      Network Partner Organisations

        The Network works in partnership with:

        Acute Trusts:

             Airedale General Hospital NHS Trust
             Bradford Teaching Hospitals NHS Foundation Trust
             Calderdale & Huddersfield NHS Foundation Trust
             Leeds Teaching Hospitals NHS Trust
             Mid Yorkshire Hospitals NHS Trust

        Independent Sector Providers:

             Spire Healthcare Hospital, Roundhay, Leeds
             Classic Hospital, Elland, Nr Huddersfield
             Classic Hospital, Methley, Nr Leeds
             Eccleshill Treatment Centre, Bradford
             British Medical Independent (BMI) Healthcare Hospital, Huddersfield
             Nuffield Hospital, Leeds
             Yorkshire Capio Clinic, Bingley


             Bradford & Airedale PCT
             Calderdale PCT
             Kirklees PCT
             Wakefield PCT
             Leeds PCT

        Specialist Commissioning Group (SCG)
        Yorkshire Ambulance Service (YAS)
        Yorkshire & Humber Strategic Health Authority (SHA)
        Yorkshire Intensive Care Bed Bureau (YICBB)

WYCCN Annual Report 2007/2008
         Bradford University
         Huddersfield University
         Leeds University

        We cover a patient population of 2,106,749 and the Network was developed
        based on the patient flows.

        The Network has a good engagement with key stakeholders which enable
        development and implementation of national and local agendas. The Network is
        a conduit, offering independent professional advice to its stakeholders.

        1.2         Network Strategy Board

        The Board meet quarterly and is chaired by our lead commissioning PCT
        (Bradford & Airedale PCT) Chief Executive. The Strategy Board is responsible

             Identifying local plans
             Agreeing workstreams
             Sharing and disseminating information and areas of best practice
             Ratifying guidelines, protocols etc
             Acting as a governing body for the Network

        1.3         Professional Groups

        Within the Network are key bodies of professional groups which meet regularly to
        provide clinical and operational input into the Strategy Board. These groups are:

             Senior Nurses for Critical Care Level 3 and Level 2 Units from acute hospitals
              and independent sector hospitals – meet monthly
             Service Improvement Links from Critical Care Level 3 and Level 2 Units from
              acute hospitals – meet monthly
             Education Group consisting of practice educators from Level 3/2 Units and the
              3 West Yorkshire universities – meet 6 weekly
             Outreach Leads for the Outreach Services in the 5 acute trusts – meet 6

        The groups work collaboratively sharing knowledge and skills, setting priorities
        and monitoring quality through service reviews and auditing outcomes. They
        provide a peer review process to drive change which underpins a continuous
        cycle of improvement. They provide links between organisations and help to
        provide equity of service delivery across WYCCN.

WYCCN Annual Report 2007/2008
        1.4         WYCCN Team

        The WYCCN structure consists of:
             Network Clinical Lead                -      Dr Andrew Cohen (0.2 WTE)
             Network Manager                      -      Margaret Clark (1 WTE)
             Network Service Improvement Lead     -      Karen Dearden (1 WTE)
             Network HCS Lead                     -      Dr Joan Pearson (Unfunded)
             Network AHP Lead                     -      Beverly Snaith (Unfunded)
             Network Coordinator                  -      Kathy Smith (1 WTE)
             Network Administration Assistant     -      Anna Haley (0.3 WTE)
             Network Project Lead (KSF)           -      Maggie Molloy (0.4 WTE
                                                          Secondment for 6 months)

        The cost of the Network team is £253,400.00 and this is currently funded by the 5
        PCTS in West Yorkshire.

2.0     Aims of the Network

        The Network works with its local and wider health community to ensure critical
        care services are equitable and delivered in a safe & effective manner. This goal
        is achieved by:

                Monitoring and evaluating access to critical care via YICBB and local data
                Monitoring capacity and advising on future needs of critical care services
                 with local trusts and commissioners
                Monitoring and evaluating the standards of transfers via YICBB and local
                 data collection
                Auditing against nationally agreed standards and sharing outcomes to
                 inform local planning
                Working in partnership with key stakeholders (see 1.1)
                Monitoring risks associated with the critical care pathway and managing
                 the outcomes
                Monitoring the flow of patients through Level 3 and Level 2 facilities and
                 feeding back outcomes to Strategy Board and local trusts.
                Providing evidence of care to level 2 and level 3 and deteriorating patients
                 within acute trusts at a standard that meets the NICE recommendations 1
                Providing education and training for multi-disciplinary team
                Involving patients and the public in future service developments of critical

WYCCN Annual Report 2007/2008
3.0     Workstreams and Outcomes 2007/2008
        Compliance to ‘Quality Critical Care Beyond Comprehensive Critical Care’ (DH
        2005)2 National Critical Care Stakeholder Forum document is audited annually
        and provides a basis for some of our work streams.

        3.1     The WYCCN is working with the local Yorkshire and Humberside
                Collaborative, PCTs, Acute Trusts and independent hospitals to maintain
                and strengthen its links.

        3.2     Critical Care Delivery Groups are running successfully in different
                formats in 3 out of the 5 acute trusts. The WYCCN is engaged with these
                groups and links with the other 2 trusts regularly in alternative forums.

        3.3     Outreach Services are operational in all 5 acute trusts and funded by
                PCTs. 3 Trusts have increased their funding and services due to
                increased local organizational needs. 1 Trust has a business case
                pending for increasing the service. All services are 7 days per week and 1
                service is now 24 hours and 7 days per week. For more information and
                data on Outreach Services and their successes please see page 10/11.

        3.4     Transfers

                3.4.1 WYCCN Transfer Guidelines are operational. Documentation has
                      been revised, however, publication of amended guidelines are on
                      hold pending changes to the YAS documentation.
                3.4.2 Transfer training is on-going for multi-disciplinary teams with a
                      multi-disciplinary WYCCN wide faculty.
                3.4.3 Transfer Training Competencies have been piloted in one area and
                      shared across WYCCN.
                3.4.4 CEN compliant trolleys with locally agreed transfer equipment are in
                3.4.5 Transfer bag annual audit is carried out by SILs in line with ICS
                      standards for best practice.
                3.4.6 Audit of transfers continuous from YICBB and Global Measures
                      monthly audit – and data shared at Strategy Board and in ‘Network
                      News’, the WYCCN monthly newsletter.
                3.4.7 Work is on-going with the national group looking at international
                      repatriations and equity of their access to critical care.

WYCCN Annual Report 2007/2008
        3.5     Care Bundles – WYCCN continues to work with the National Care

                   Surviving Sepsis: the 24 hour surviving sepsis care bundle has been
                    rolled out in all Level 3 areas and is monitored monthly and compliance
                    has evidently improved.

                                                                                                                   SEPSIS CARE BUNDLE AUDIT - Across West Yorkshire

                          Average % of Compliance to Sepsis CB Audit by Month





                                                                                          Jan 07       Feb 07    March 07     April 07     May 07     June 07    July 07    Aug 07    Sep 07    Oct 07    Nov 07    Dec 07

                   Surviving Sepsis: the 6 hour sepsis care bundle has been highlighted
                    by the WYCCN ‘At Risk’ Strategy Group and various units in trusts
                    across West Yorkshire have commenced the bundle using adapted
                    screening tools. Areas where it has been developed include some
                    A&Es, MAUs and HDUs.
                   Ventilation Care Bundle: This is standard practice on all Level 3 units
                    and continues to be audited monthly showing an average 97%
                                                                                                                           VENTILATION CARE BUNDLE AUDIT
                                                                                                                Average Compliance across WYCCN ~ April 2007 to March 2008



                          Average % Compliance





                                                                                            April 07     May 07     June 07      July 07     Aug 07     Sep 07     Oct 07    Nov 07    Dec 07    Jan 08    Feb 08    Mar 08

WYCCN Annual Report 2007/2008
                   WYCCN Care Bundles include:
                                 o End of Life Care Bundle – shared nationally and being
                                    reviewed.     Available on WYCCN website –
                                 o Nutrition Care Bundle – local up take
                                 o Renal Care Bundle – local up take
                                 o Tracheostomy Care Bundle – local up take
                   Participated in National Care Bundle audit in critical care across

        3.6     NICE Guidelines1 – the WYCCN supports the ‘Acutely Ill Patient in
                Hospital’ through Outreach Services. The WYCCN launched these
                guidelines from 2 events held in November 2007 and January 2008
                supported by approximately 180 delegates. Individual road shows have
                been held in Calderdale and Huddersfield Trust. A project group has been
                developed to take the work forward within each Acute Trust and
                independent sector hospital in WYCCN. All Outreach teams have an
                educational programme to deliver the modified early warning score
                (MEWS) to wards and departments.

                Local documentation has been developed to incorporate the MEWS tool
                and an algorithm for ‘Call for Help’ which can be instigated by any level of
                staff. The application of the MEWS was audited by WYCCN Outreach
                teams and results are available.

                ALERT™ Courses, as recommended in the NICE 2007 document, are
                delivered monthly by a multi-disciplinary faculty and offered to all
                stakeholders within and outwith critical care.

        3.7     Diagnostic, therapeutic and clerical infrastructures

                The results of the audit were variable to local needs. One area was
                identified by the WYCCN and reported back to their Critical Care Board
                Meeting.     The impact of having the infra-structure removed was
                detrimental to the collection of data for future funding and audit work. This
                is being actioned.

WYCCN Annual Report 2007/2008
        3.8     Independent Sector Healthcare Providers

                3.8.1 WYCCN has worked collaboratively with acute care providers and
                      independent sector hospitals to ensure that the emergency planning
                      document integrates the services to meet the potential over
                      whelming demand.
                3.8.2 Service level agreements have been agreed between independent
                      sector hospitals and their local NHS healthcare providers.
                3.8.3 Risk assessments have been addressed regarding the potential
                      transfer of bariatric patients from independent sector hospitals to
                      acute trusts.
                3.8.4 Transfer arrangements between independent sector hospitals and
                      their local NHS hospitals have been agreed and are evident in the
                      WYCCN Transfer Guidelines.
                3.8.5 WYCCN is in the process of collaborating with Independent
                      hospitals regarding their compliance with the recommendations in
                      the ‘Acutely Ill Patient in Hospital’ document (NICE: 2007).

        3.9     Payment by Results for critical care services are currently being piloted
                across the United Kingdom (UK) by the Department of Health (DH) and
                WYCCN is participating in this pilot. We have engaged with all Level 3
                and most Level 2 areas with regard to the collection of all 34 fields of the
                Critical Care Minimum Data Set (CCMDS). 3 acute trusts (4 units) have
                participated in the pilot project and the WYCCN process has been one of
                validation of local data to improve the standard of the CCMDS data
                collection. This has been invaluable to the whole process. The data has
                been analysed and compared with current funding arrangements. The
                pilot finishes in July 2008 and there will be a report published by the
                Network in September 2008.

        3.10    Workforce Planning – New ways of working and engaging with local
                Trusts with new roles is challenging. A project is planned for 2008/09 in
                one of the Teaching Hospital sites to pilot one of the new roles.

        3.11    Capacity Planning – WYCCN has high occupancy levels in some units
                which commissioners are aware of. These figures have been compared
                to local surrounding areas and confirm the high activity rates.
                Reconfiguration of services within 2 trusts is impacting on local
                organisations’ activity and capacity resources. A review of capacity within
                one organisation has resulted in increasing staffing levels to open further

WYCCN Annual Report 2007/2008
                The WYCCN collects monthly data on capacity as well as carrying out a 2
                      week audit of patient flow information across all Level 2 and Level 3
                areas. This information has been discussed with commissioners, on
                request, to support local trusts when entering negotiations with PCTs
                during the capacity planning process. One WYCCN Trust successfully
                secured funding to increase capacity for Level 2 and Level 3 services to
                meet their local needs.
                The WYCCN audits annually compliance with the National Confidential
                Enquiry into Patient Outcome and Death.       From this audit local
                recommendations and plans are developed and share across the Network.

4.0     Achievements

        4.1     Outreach Services

                Education – The recent recommendations by NICE 2007 for the care of
                the acutely ill patient in hospital is embedded into the practice of the
                Outreach teams. The teams are different but are all offering local training
                and education. Outreach teams support the WYCCN and local faculty of
                ALERT™ Course trainers. They have educated, audited and fed back to
                their organisations the importance of MEWS to detect the patients at risk.
                Outreach teams are pivotal in reducing sub-optimal care outside the walls
                of critical care.

                Future Plans – To share education packages to ensure we have a
                      standard approach to improve education through outreach services.

                Training – the team have completed a competency training package for
                band 6/7 Outreach nurses using the KSF outline. This is currently going
                to the RCN for ratification. This will ensure West Yorkshire provide a team
                of highly trained staff to meet patient’s complex needs outside the walls of
                critical care.
                Future Plans – the KSF competency training package will be used for
                professional development and planning.
                Sharing – The WYCCN Outreach teams have been accepted at the
                National Outreach Forum (NOrF) and the British Association of Critical
                Care Nurses (BACCN) to present and show a poster on the development
                and future of the outreach service.
                Future Plans – To continue to strive for improvement in the services for
                acutely ill patients post critical care and outside the walls of critical care.
                Workload – The WYCCN monitors the activity of the services across the 5
                acute trusts – see below:

WYCCN Annual Report 2007/2008
                                       OUTREACH ACTIVITY - Year on Year Comparisons - 05/06 'v' 06/07 'v' 07/08








                         No of Outreach Pts seen No of Outreach visits made      Total No of referrals to   Total amount of time spent   Total time spent on educ
                                                                                        Outreach                  on visits (hours)      (pts, staff & relatives) in
                                                                                   Outreach Activity

                                                          April 05 to March 06     April 06 to March 07     April 07 to March 08

                Workforce – Outreach Services are increasing their workload annually.
                Local organisations have recognized the strengths of outreach teams
                within the acute environment and are encouraging and supporting their
                development. 3 out of the 5 acute trusts have increased the funding to the
                service. 1 trust is currently reviewing the service and developing a
                business case. This will allow expansion of hours to meet the increased
                demand. Funding from our local PCTs continues to be monitored by

                Future Plans – To increase staffing levels and to develop 24/7 services
                where these are required and their value recognized by acute trusts.

                Rehabilitation – The aim is to ensure patients psychological and
                physiological needs are being met during their hospitalization and post
                discharge. Critical Care Outreach teams follow up all post critical care
                Level 2 and Level 3 patients. The Outreach teams link with patients and
                relatives via ‘Follow Up Clinics’ inform practice and information is fed back
                to critical care units about the service they are delivering from the patient
                and relatives perspective.

                Future Plans – To work with groups of Allied Health Professionals to
                implement the DH guidelines1 when they are published later this year and
                to continue to follow up patients post-discharge to inform and improve our

        4.2     Education

                The WYCCN Education Group consists of Senior Critical Care Clinical
                Educators from all 5 acute Trusts, independent sector hospitals and the 3
                local universities in West Yorkshire.

                A monthly calendar of training events is continuing and changes to meet
                the challenges of critical care.
WYCCN Annual Report 2007/2008
                                                      The programme offers training and education to a multi-disciplinary
                                                      population from Healthcare Support Workers (HCA) to Medical Staff. The
                                                      events offered in 2007/08 were:

                             Date                                                                                                 Education Study Day
                             Mon 16th April 2007                                                                                Heartbeat & When it Fails
                             Wed 13th June 2007                                                                  Observation & Assessment of the Highly Dependent Patient
                             Fri 6th July 2007                                                                                Healthcare Assistant Study Day
                             Fri 14th Sept 2007                                                                             Bereavement & Breaking Bad News
                             Mon 15th Oct 2007                                                                   Observation & Assessment of the Highly Dependent Patient
                             Wed 7th Nov 2007                                                                                  Can I Help You Breathe Sir?
                             Tues 4th Dec 2007                                                                                      Urine Output Poor!
                             Tues 15th Jan 2008                                                                  Observation & Assessment of the Highly Dependent Patient
                             Mon 11th Feb 2008                                                                                    Does the Brain Matter?
                             Fri 14th Mar 2008                                                                                          Heartbeat

                                                                                                             BREAKDOWN OF ATTENDEES - STUDY DAYS
                                                                                                                    April 2007 to March 2008


          Number of Attendees by Category







                                                                  07              l0
                                                                                       7                    07                  07                       07                       07               07                08                       08                          08
                                                             pr                 Ju
                                                                                                        p                  ct                       ov                       ec               ec                 n                        b                          ar
                                                            A                                         Se                  O                        N                     D                   D                Ja                     Fe                             M
                                                         at                CA                    ve                  bs                        e                    ne                  CA               bs                     in                               at
                                                    be                 H                       ea                   O                    a   th                   ri                   H                O                  ra                               be
                                                  rt                                        er                                        re                         U                                                        B                              rt
                                             ea                                            B                                         B                                                                                                              ea
                                            H                                                                                                                                                                                                      H
                                                                                                                                                              Study Days

                                                                                                                 Number of Attendees                     Nurse         Dr/SHO/PRHO/Shadowing                   Other

WYCCN Annual Report 2007/2008
                The WYCCN also offers the ALERT™ Course which has been running for
                the past 6 years, with a multi-disciplinary faculty from all critical care areas
                across West Yorkshire. The attendees for these are listed below:

                                                                       BREAKDOWN OF ALERT COURSE ATTENDEES
                                                                               April 2007 to March 2008







                                             Apr 07           May 07         Jul 07           Sep 07             Nov 07     Jan 08   Mar 08
                                                                                          ALERT Courses

                                                                                 TOTAL    Nurses   Doctors   Others

                The WYCCN also offers regular Transfers Training Courses which again
                has a multi-disciplinary faculty from across West Yorkshire and aims to
                improve the knowledge of staff and ultimately patient care whilst
                undergoing transfer to another unit / hospital.

                                                                   BREAKDOWN OF TRANSFERS TRAINING ATTENDEES
                                                                                  2007 to 2008



                  Number of Attendees




                                                      Total                      Nurses                               Drs            Other

                                                                                          Jan 07   Jun 08    Jul 08

WYCCN Annual Report 2007/2008
                The WYCCN offers many other ad-hoc study days / sharing events which
                meet the needs of current issues within the NHS local and national

                Future Plans – to continue to evaluate our education programmes and
                deliver events on a monthly basis. The WYCCN also aims to secure
                funding for these events centrally. We will continue to work with the
                universities and share information to inform future developments within
                their programmes and to plan an Education Roadshow with the
                universities providing information to post-registration staff which will
                debate the current and future pathways of education.

        4.3     Senior Nurses

                The WYCCN Senior Nurses Group consists of Senior Critical Care Nurses
                / Matrons from Level 2 and Level 3 areas across West Yorkshire,
                Independent Sector representatives and representation from the allied
                health professions across West Yorkshire. The group meets monthly to
                share good practice and current local and national issues.

                4.3.1 Audit: The WYCCN Senior Nurses Group audit against nationally
                      agreed criteria/documentation annually.          This year they have
                      completed the following audits:
                       Quality Critical Care Beyond Comprehensive Critical Care
                         (DH: 2005) [QBCCC] – results shared and utilized to inform
                         local plans.       Also shared nationally to help National
                         Stakeholders Forum to build a national picture of compliance.
                       National Confidential Enquiry into Patient Outcome and
                         Death (DH: 2005) [NCEPOD] – results shared and common
                         areas highlighted for service improvement.
                       Patient Flow Audit – 2 week audit in July which coincides with
                         the DH KH03a critical care audit. Analysed and shared with
                         individual units to inform Trusts and CCDGs. Also shared
                         collectively with Commissioners, PCTs, Acute Trust Chief
                         Executives and SHA to inform them of patient flow activity within
                         Critical Care in West Yorkshire.
                       National Patient Care Standards (for first 24 hours) audited
                         across WYCCN, completed and shared. Identified common
                         areas across WYCCN which could be improved upon i.e. patient
                4.3.2 Activity / Projects: The group has also participated in:
                       Collaboratively writing a patient discharge assessment form to
                         be used as a good practice guideline incorporating the
                         recommendations from the ‘Acutely Ill Patient in Hospital’ NICE
                         Guidelines (NICE: 2007). This is on the WYCCN website:
                       Consulted on and distributed an ‘Infection Control Booklet’ for
                         relatives / carers visiting critical care areas.

WYCCN Annual Report 2007/2008
                         All Senior Nurses invited to and good representation at the
                          National Critical Care Networks Conference in April 2008.
                4.3.3 Future Plans: to continue to meet regularly to share both local and
                      national critical care issues. The group also highlights and engages
                      with challenges and aims to provide in a fair and equitable services
                      across West Yorkshire.

        4.4     Service Improvement

                The WYCCN Service Improvement Lead has the responsibility of ensuring
                critical care services are audited regularly and improvement projects
                developed to ensure continuous improvement in service delivery and
                patient care. An example of some projects which have been completed
                and which are on-going throughout 2007/08 are:

                4.4.1 Morbidly Obese Patients Strategy Group: This WYCCN wide
                      group has been specifically looking at this group of patients, the
                      effect that their weight has on other conditions, their care and stay
                      in critical care environments. This is developing into the provision
                      of a study day in June 2008 on the subject as well as a link nurse
                      on each Level 3 unit who has been provided with a resource file
                      highlighting considerations for this group of patients. The group
                      continues to meet to share publications / new knowledge and good
                      practice in this ever increasing area of need.
                4.4.2 Patient Flows in OrthoPlastics HDU, St James’s: This group
                      aimed to look at patient flows into and out of OPHDU at LTHT with
                      the ultimate aim of instigating nurse-led discharge from the unit
                      within agreed criteria. This project was successfully completed
                      between 2007/08.
                4.4.3 Admissions Criteria, Ward 58, Renal HDU, LTHT: The WYCCN
                      SIL worked alongside this unit with the aim of developing an
                      admissions and discharge criteria following reconfiguration of
                      services and increased demand on the unit.                 This project
                      commenced in November 2007 and is on-going.
                4.4.4 Patient Flows Project, Bradford: The WYCCN SIL collaborated
                      with Bradford ICU to look at the patient flows. The results of this
                      project were used to inform commissioners and ultimately to gain
                      funding for increased Level 3 and Level 2 beds.
                4.4.5 Level 1 Care, Ward 2B, Pontefract: The WYCCN was contacted
                      to work on a project with potentially ‘at risk’ patients, particularly as
                      there is no Level 2 or Level 3 unit at Pontefract. The project
                      instigated staff training and a Level 1 Patient checklist. The project
                      was audited by means of a pre-project staff confidence
                      questionnaire and the project group are in the process of re-auditing
                      to show improvements in care and staff confidence and to highlight
                      any further small scale change improvements which may be
                4.4.6 Non-Invasive Ventilation (NIV), Ward 8 HDU, Leeds General
                      Infirmary: Due to reconfiguration of services and an increase in
WYCCN Annual Report 2007/2008
                        Level 2 beds this unit would like to introduce NIV for patients. This
                        would require new equipment, staff recruitment and training of staff.
                        This project is well underway, staff recruited and training on-going.
                        It is planned that NIV will be implemented on Ward 8 HDU by July

        4.5     Service Improvement Links (SILs)

                The Service Improvement Link group is led by the WYCCN Service
                Improvement Lead and consists of Senior Nurses from each critical care
                area across West Yorkshire who have 4 main aims to their workstreams
                alongside WYCCN. These are:

                4.5.1 Risk Management: The group takes forward any risk management
                      issues which arise locally or nationally including sharing good
                      practice. An example of this is the annual audit of the Transfer Bag
                      carried out by this group. During 2007 the SILs group undertook,
                      with their colleagues, a ‘Safety Climate Survey’ which highlighted
                      areas for improvement in sharing safety issues, but also highlighted
                      the high quality of management of these issues already in practice.
                4.5.2 Care Bundles: It is the responsibility of the SILs to carry out
                      monthly audits on the Ventilator and Sepsis Care Bundles (see
                      page 8 for more information). These are reported, analysed and
                      fed back by the WYCCN. Discussions and project work from these
                      audits are carried out as and when necessary.
                4.5.3 Patient and Public Involvement: The WYCCN SILs group has
                      carried out an audit in critical care areas across West Yorkshire
                      against a nationally recognized ‘Patient & Public Involvement’
                      document. Action plans against this audit are formalized. The
                      group are also able to utilize feedback from patients / carers obtains
                      at ‘Follow-Up Clinics’ which is reported to the WYCCN monthly.
                      This data informs the development of small scale change
                      improvement projects relating to patient / carer experience. The
                      SILs have also carried out a bereavement audit which highlights
                      how      each     unit    manages       bereavement     and     where
                      suggestions/practices can be shared. The WYCCN Strategy Group
                      also has an ex-patient public member on it’s Board.
                4.5.4 Small Scale Change Projects: This group is responsible for
                      highlighting any such projects and carrying out a change
                      improvement cycle. This ensures a continuous improvement in
                      patient care at a local level.
                4.5.5 Future Plans: The SILs group intend to continue with the 4 main
                      workstreams above as well as continuing to share good practice. A
                      new project for the future is to look at weaning protocols. The SILs
                      will also develop some posters of contact details / websites of help
                      organisations relating to critical care conditions. These posters will
                      be laminated for visitors rooms.

WYCCN Annual Report 2007/2008
        4.6     Conference Events

                4.6.1 July 2007: Workshop for Critical Care Forward Planning for
                      Pandemic Influenza was hosted by WYCCN and attended by 120
                      delegates from across the whole of Yorkshire and Humberside.
                      Chaired by Nicola Heppenstall the event evaluated very well with
                      some very productive group working which later contributed to the
                      Yorkshire & Humberside Emergency Planning document.
                4.6.2 September 2007: WYCCN Team Building Event – Network
                      Knockout. 8 teams participated from critical care areas across
                      West Yorkshire. Some 50 attendees being involved and prizes
                      awarded for many categories.
                4.6.3 November 2007: 1st Launch of NICE Guidelines (2007) ‘Acutely Ill
                      Patient in Hospital’ – chaired by Chief Nurse of Leeds Teaching
                      Hospitals NHS Trust. This event was extremely popular and
                      attendees had to be capped at 100 delegates. This was therefore
                      repeated in January 2008.
                4.6.4 January 2008: 2nd Launch of NICE Guidelines (2007) ‘Acutely Ill
                      Patient in Hospital’ – chaired by WYCCN Lead Manager. This
                      event was supported by some 80 delegates from across West
                      Yorkshire and from outside West Yorkshire.
                4.6.5 April 2008: The National Critical Care Networks sharing event for
                      2008 was hosted by WYCCN. The Director for the event was the
                      WYCCN Manager with a design team drawn from WYCCN,
                      Manchester and Cumbria Critical Care Networks. The event was
                      held at the Royal Armouries in Leeds with a varied, lively and up to
                      date agenda delivered by various nationally recognized critical care
                      experts including Sir George Alberti from the Department Health.
                      Some 300 delegates attended from across England, Wales and
                      Northern Ireland.
                4.6.6 Registrars Award June 2007: This was supported by the WYCCN
                      and the winner was Dr Guy W Glover who worked collaboratively
                      with Dr Stephen J Fletcher on the performance of the Whisperflow
                      CPAP generator.

5.0     Finance

        The WYCCN is hosted by Mid Yorkshire Hospitals NHS Trust and located at
        Dewsbury & District Hospital. The Trust finance and IT departments continue to
        support our services and I would like to thank them for their continued

                             ACTIVITY                         COSTINGS
                 WYCCN Salary & Running Costs                    £253,400.00
                 Outreach Services                               £890,517.87

WYCCN Annual Report 2007/2008
        The WYCCN events are sponsored by a variety of medical equipment and
        pharmaceutical companies and I would like to take this opportunity to thank them
        for their continued support.

6.0     Conclusion

        Critical Care Services aim to provide patients, carers and staff with quality care in
        a safe, timely, effective and efficient manner.

        For patients the aim is for them to get better quickly and return to a healthy
        status. For carers the aim is to have clean environments with competent and
        compassionate staff. For staff the aim is to work in a good learning environment
        with opportunities for improving skills and education as well as working in a good
        team and delivering evidence based care.

        The WYCCN feels that the services provided across West Yorkshire meet these
        aims and the WYCCN strives to underpin some of the service development to
        enable staff to continue to achieve these aims.

        There is ever increasing scrutiny of our NHS systems and we need to ensure that
        we deliver evidence based care and our staff are competently trained in the field
        of Critical Care.

7.0     Recommendations for 2008/09

               Work with the changing commissioning framework
               Work as professional advisors locally and nationally to deliver NHS agendas
               Work with local Yorkshire & Humberside SHA to achieve local goals
               Work with all key stakeholders to meet local targets
               Review patient pathways, putting patients at the centre of care
               Set and work with agreed standards of care

8.0     Acknowledgements

        WYCCN team would like to thank all key stakeholders for their continued support
        and enthusiasm in the ever changing environment that is ‘the NHS’.

        Thank you also to Bradford and Airedale PCT our lead organisation and Mid
        Yorkshire Hospitals NHS Trust for their continued hosting arrangements.

9.0     References
                   Acutely Ill Patient in Hospital (NICE: 2007)
                   Quality Critical Care Beyond Comprehensive Critical Care’ (DH: 2005)
                   National Confidential Enquiry into Patient Outcome and Death (2005)

WYCCN Annual Report 2007/2008
                                GLOSSARY OF TERMS
Acronym/                 Meaning
DH                       Department of Health
WYCCN                    West Yorkshire Critical Care Network
SHA                      Strategic Health Authority
PCT                      Primary Care Trust
YAS                      Yorkshire Ambulance Service
ALERTTM                  Acute Life Threatening Events Recognition & Treatment
MEWS                     Modified Early Warning Score
YICBB                    Yorkshire Intensive Care Bed Bureau
Red Alert                When Level 3 bed availability goes to 4 beds for a 24 hr period.
PbR                      Payment By Results
WYSCG                    West Yorkshire Specialist Commissioning Group
HDU                      High Dependency Unit
ICU                      Intensive Care Unit
Level 0                  Patients whose needs can be met through normal ward care in
                         an acute hospital.
Level 1                  Patients at risk of their condition deteriorating or those recently
                         relocated from higher levels of care, whose needs can be met
                         on an acute ward with additional advice and support from the
                         critical care team.
Level 2                  Patients requiring more detailed observation or intervention
                         including support for a single failing organ system or post-
                         operative care & those stepping down from higher levels of
Level 3                  Patients requiring advanced respiratory support alone or basic
                         respiratory support together with support of at least 2 organ
                         systems. This level includes all complex patients requiring
                         support for multi-organ failure.
CCMDS                    Critical Care Minimum Data Set
LTHT                     Leeds Teaching Hospitals NHS Trust
OPHDU                    OrthoPlastics High Dependency Unit

WYCCN Annual Report 2007/2008

  NETWORK CLINICAL LEAD                               NETWORK MANAGER
                      Links with:                                    Links with:
              WYCCN Strategy Board                             Department of Health
    National Critical Care Network Clinical Leads                        SHA
                Department of Health                               Commissioners
        WYCCN Critical Care Lead Clinicians                              PCTs
                   WYCCN Matrons                      National Critical Care Network Managers
               Intensive Care Society                         WYCCN Strategy Board
          Royal College of Anaesthetists                     WYCCN Education Group
                         PCTs                                 WYCCN Outreach Teams
                                                          WYCCN Critical Care Managers
                                                       WYCCN Critical Care Lead Clinicians
                                                           WYCCN Critical Care Matrons
                                                     Independent Sector Hospitals in W Yorks
                                                                 ICS, BACCN, RCN
                                                          National Outreach Forum (NOrF)
                                                          WYCCN Transplant Coordinators

                                                            Service Improvement
                                                              Lead/Nurse Lead
                                                                          Links with:
                                                          Local Critical Care Matrons, Managers and
                                                                         Senior Nurses
                                                              WYCCN Service Improvement Links
                                                                     WYCCN Project Leads
                                                              WYCCN Allied Health Professionals
                         Network Coordinator               Independent Sector Hospitals in W Yorks

                      Administration Assistant

     Links with multi-disciplinary agencies across the UK to support the work of the Network

WYCCN Annual Report 2007/2008
     Who’s who in the West Yorkshire Critical Care Network

       Margaret Clark
                                           Dr Andrew Cohen
      Network Manager                      Network Clinical

       Karen Dearden                          Kathy Smith
                                          Network Coordinator
     Improvement Lead

                                 Anna Haley
                            Administration Assistant
WYCCN Annual Report 2007/2008
                   “Working in
              partnership to meet
              the needs of acutely
                  ill patients in
                West Yorkshire”
     For any information regarding the contents of this report or the work of the
     West Yorkshire Critical Care Network please contact the Network Office on:

                                         Tel: 01924 512280
                                         Fax: 01924 512282




                                West Yorkshire Critical Care Network,
                                   Ground Floor, Bronte Tower,
                                   Dewsbury & District Hospital
                                      Halifax Road, Dewsbury
                                             WF13 4HS

WYCCN Annual Report 2007/2008

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