Meet the team
Consultant in Respiratory and General Medicine, Wessex QI Fellowship Alumn
Portsmouth Hospitals NHS Trust
- England - Wessex
- Dr Anna Lithgow
- RN Louise Newman
- Pleural nurse to be seconded from existing staffing.
What is the challenge your project is going to address and how does it connect to your chosen theme?
PHT provides specialist management for the complete spectrum of pleural disease. Geographical and population factors, such as proximity to dock-yards, 15.2% smoking prevalence and a Deprivation score of 27.1 (PHE Fingertips), result in an above average incidence of asbestos-related disease, malignant effusions and pleural infection. Late presentations require complex intervention and lengthy inpatient stays. In 2017 PHT saw over double the national average of mesothelioma cases and we have the UK’s highest admission rate for empyema with LOS 2 days above average. Moreover, malignant effusions confer a poor prognosis, increasing the importance of reducing time spent in hospital.
This project will train a nurse to coordinate a pleural pathway and streamline the patient journey, using innovative solutions with a patient-centered approach. This will: prioritise outpatient care; minimise hospital visits; improve patient experience; and tackle patient flow, bed pressure and treatment time.
What does your project aim to achieve?
For the Patient
- Reduced time to diagnosis and definitive treatment
- A hospital contact, with expert knowledge, for support and reassurance through their journey, supported with digital self-management tools, improving patient confidence.
- Ready access to symptom control measures, reducing anxiety and improving quality of life
- Increased flexibility of care with minimised hospital attendances, admissions and LOS
For the hospital
- Improved patient flow, reduced admissions and LOS
- Patients proactively pulled from the front door
- Early supported discharge
- Introduction of the tPA-DNase protocol in pleural infection
- Higher attainment of the Pleural Best Practice Tariff
- Reduced pleural clinic waiting lists
- Legacy of enhanced training shared with other staff, improving care and reducing complications
For the nursing staff
- Develop new skills and autonomy leading to improved satisfaction and staff retainment
- Work with Trust QI leads, learning and implementing QI methodology, to sustain and expand the project.
How will the project be delivered?
The project will be delivered by the Pleural Nurse with clinical support and over sight form AL and LN. EL will coordinate and manage the measurement plan.
Measure and Understand
- Engage current pleural patients and referrers in discussion about their experiences
- Process map current system
- Learn from Q members experiences in similar projects
- Coordinate diagnostic and treatment pathway:
- Assess pleural referrals to streamline investigations, procedures and clinic visits
- Patient support and guidance based on priorities identified
- Assist IPC patients to use a digital monitoring portal
- Thoracic ultrasound and pleural taps training
- Monthly delivery meeting: reflect on PREMS, feedback and results
- Launch rapid access pleural tap service
- Proactive identification of patients at front door
- Advance training.
- Support inpatient management
- deliver tPA-DNase protocol
- support chest drain care on the wards
- early discharge initiatives
- Develop business case for Pleural Nurse based on project outcomes.
What and how is your project going to share learning throughout?
- What are patients experiences of the pleural service? What is important to them? Do we address their needs? Can findings be applied to other outpatient services or is this specific to pleural patients?
- What is the reception to telephone/ digital interactions compared to face to face meetings?
- Where are the bottle necks and potential waste? Is this common to other outpatient pathways?
- Does a dedicated pathway manager result in a meaningful reduction in time to diagnosis and hospital visits, reducing patient time and cost and hospital resource?
- Do all potential saved hospital visits and bed-days translate into actual reductions? If not, why not? Can identified barriers be shared?
- Does reducing visits/bed-days translate into a financial benefit?
- Does the Pleural Nurse value the experience and wish to continue in the roll? If not, why not?
- Does the pathway have a negative impact on other services in respiratory or elsewhere?
How you can contribute
- Do others have experiences of managing outpatient conditions through digital surveillance?
- What have been the barriers and pitfalls (if any) of implementing such a service?
- Have members any insights from previous experiences of implementing a 'care coordinator' role that is enhanced like this - ie where the coordinator is also part of the delivery team?
|23 Sep 2019||Attend daily pleural lists to recieve training (ongoing)|
|23 Sep 2019||Nurse seconded from current nursing cohort|
|23 Sep 2019||Process mapping exercise|
|24 Sep 2019||Patient engagement exercise (2 weeks)|
|30 Sep 2019||Develop and maintain patient database|
|30 Sep 2019||Review pleural referrals, expediting care (supervised)|
|11 Nov 2019||Attends thoracic US course|
|13 Nov 2019||Commence phase 2|
|11 Dec 2019||Commence work on business case|
|6 Jan 2020||Phase 3 - launch supported IP management|