A staggering 68% of surgical beds saved, thanks to a series of improvements in ambulatory care

Staff from the Acute Surgical Unit (ASU) at the Royal Lancaster Infirmary have made significant improvements to patient flow and care through the surgical department.

More than 2,481 patients from July 2017- March 2018 were seen in the Surgical Emergency Ambulatory Care Unit (SEAC) at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT). Only 788 (32%) of those patients required a hospital admission after assessment – freeing up beds on the wards for acutely unwell patients in need of care.

Ward Managers Sharon Atkinson and Helen Baines, have spearheaded the expansion of the Surgical Emergency Ambulatory Care Unit (SEAC) over the past 18 months, and have been instrumental in driving forward the progress seen by the SEAC Unit.

The SEAC unit has seen positive changes including:

Moving to a larger bay area accommodating up to 20 patients at any time and allowing more timely and efficient assessments

Opening up capacity to assist with discharges from the hospitals four surgical wards. This allows the wards to free up beds for planned surgeries, while the discharged patients, who are awaiting medication and transport home, have a comfortable and welcoming environment.

Extending the clinical skills of two existing Advanced Nurse Practitioners who can now carry out physical assessment and diagnosis, prescribe medication and order patient scans, while awaiting senior reviews. This has allowed patients to be seen more quickly through a triage system.

The allocation of a Clinical Support Worker (CSW) with enhanced clinical skills such as taking bloods and inserting urinary catheters. The CSW can now cover day and night shifts alongside the nursing team and work closely with surgical doctors to chase resultsand assist the surgical team with minor procedures such as the drainage of abscesses

A new treatment room has been introduced for examinations, dressings and assessments of patients

The adoption of paperlite electronic referrals from the emergency department.

David Barrett, Clinical Leader for the Acute Surgical Unit, UHMBT, said: “The ward management team are incredibly proud of the ongoing efforts of the staff that work in SEAC and the ward. From the cleaners, ward clerks, CSWs, nurses, ward management, doctors and surgeons; a huge effort has been put in by all to ensure the smooth and efficient running of the unit.

“This hard work has allowed us to prevent 70% admissions which used to be routinely placed in beds – meaning, a saving of consistently ~200 beds per month over the nine months that the unit has been fully operational, which is particularly impressive at a time when beds are at a premium across the Trust. The praise the staff receive from patients is excellent, and we feel this is well deserved, for their remarkable efforts to improving care within the surgical department.”

Mark Tomlinson, a Clinical Lead, and Wendy Craig, both Consultant General Surgeons at UHMBT, provided medical leadership for the transformation work. Mark said:“This positive change in modernising safe and efficient assessment of surgical patients has shown benefits to patients and staff alike – all the staff who have helped drive the improvements are to be commended, in helping bring our Surgical Emergency Ambulatory Care (SEAC) unit in line with some of the country’s best.”

Wendy added: “SEAC is a continuously evolving service whereby we wish to build further on our improvement methodology. We welcome all feedback from users through the friends and family tests, and from staff, ensuring that we involve everyone in its progress and improvement. Health Informatics / business analytics have supported the data collations justifying the improvements, and we look forward to more work to further streamline processes.”

ASU sees a wide variety of patients from the Emergency Department and GP’s under a broad range of specialities including; general surgery, urology, orthopaedics, maxillo facial, and ear, nose and throat. This includes things such as; appendicitis, cholecystitis, sebaceous cysts, abscesses and bowel obstructions.

The unit also see fractures and swollen joints from the orthopaedic team; nose bleeds and ear infections from the ENT team; facial swelling, facial fractures and dental abscesses from Max fax; and urinary retention, urinary infections, catheter problems (including changes), and renal stones from urology.

Patient feedback has included:

“Throughout the whole experience I was treated with dignity and respect by efficient and friendly staff of all grades, in a clean and well organised area. I cannot praise everyone involved enough.”

“Felt very welcomed, very friendly atmosphere was very caring. Not just a patient, felt like family.”

“Staff were very pleasant, very friendly and did what they could. Explained as much as possible where they could. One of clinical support workers in lounge – Michelle especially was very pleasant and assuring. Very kind with all the patients. Explained things thoroughly.”

Cat Smith, MP for Lancaster and Fleetwood, said: “Thanks to the hard working NHS staff who have seen such a phenomenal improvement in ambulatory care. It’s timely that we see this as we approach the 70th birthday of our National Health Service and I thank all the staff who work hard to ensure our national treasure is constantly striving for improvement.”

David Morris MP for Morecambe and Lunesdale, said: “Today’s news is a testament to the hard work, dedication and innovation of the staff at the Royal Lancaster Infirmary. No one wants to have to go into hospital and this service means that hundreds of people have avoided unnecessary admission by getting the care, treatment and investigations they need quickly and efficiently on Ambulatory Care meaning that they can get home sooner to recover. Well done to all of the staff who have worked hard to deliver this project.”

Dr Andy Knox, Director of Population Health and Engagement, said: “This is such excellent news and shows what kind of innovation can really take place when nurses, managers and surgeons work together. It is absolutely what we’re about in Bay Health and Care Partners – better health and wellbeing for the people of Morecambe Bay whilst our teams work in a more efficient way. A massive thank you and well done to all involved.”

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