Worcestershire Acute Hospitals NHS Trust20104793735

							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
     IS-DTC



Elective Wyre Forest     Kidderminster       Elective Worcs
                         Hospital



                   Elective Patient Choice
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 referral
                                                 criteria A or B


 A Change of bowel habit to looser                                             B   Rectal bleeding persistently
stools and/or increased frequency of                                               WITHOUT anal symptoms
defaecation without rectal bleeding &                                                 OVER 60 YEARS
        persistent for 6 weeks
          OVER 60 YEARS



                                                   Referral made
                                                       for flexi
                                                   sigmoidoscopy
                                                    plus or minus
                                                   barium enema
                                                   within 14 days

          Flexi                                                                             Flexi
    sigmoidoscopy                                                                      sigmoidoscopy
    performed and                                                                      performed and
      NO biopsy                                                                           BIOPSY
         taken                                                                              taken




    Pt proceeds to             x-ray dept books                      BIOPSY                              BIOPSY
    Barium Enema                Barium Enema
     SAME DAY
                                                                    NEGATIVE                            POSITIVE




                                                                                                       Report sent to
      BARIUM                        BARIUM                                                             GP and 14 day
      ENEMA                          ENEMA                                                              office clerk to
     NEGATIVE                       POSITIVE                                                           ensure urgent
                                                                                                        appointment
                                                                                                       with consultant




    Report of flexi
    sigmoidoscopy                            Pt attends GP surgery for
      and barium                                    result of flexi
    enema sent to                               sigmoidoscopy and
     referring GP                            barium enema +/or biopsy
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                                                        Ambulatory
                                                                              - 23 hr

                                                                              investigations
                                                                                & surgery
                          Chest Pain
Community +
Primary Care




                           Elderly                                            Outpatients
                                                                    Acute     - Generalised
                          Assessment    Diagnostic     Critical               Patient Hotel
                A&E                                     Care
                                                                  Inpatient   - Specialised
                           Medical     Investigation                Care      - One Stop
                           Surgical
                            areas                                             •Rehabilitation
                                                                              •Low
                                                                              Intermediate
                                                                               Dependency
                                                                                  Care
                 Peri                                                           Facilities
                                                                              •Respite
                Acute
                Care                                                          •Shared Care
                                                                              •Home Care
                                                                               Hospital at
               Hospital
                                                                                 Home
                                                                              •Social Care
               at Home
Primary Care                              Secondary Care                            Community
Community                                                                            Primary
                                                                                      Care
DTC Business
   Managed as a business unit of Trust
             targets
     Activity
     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