Endoscopy Services at a North West of England Foundation Trust
An NHS hospital Trust, located in the South East of England, with a 501-bedded District General Hospital providing a comprehensive range of acute and specialist services to a local population of 258,000 people.
In 2016 the Trust, despite some earlier work, was experiencing long waiting lists coupled with data quality issues. This meant that the Trust was under significant pressure to quickly reduce its waiting times so that it could continue to meet its 18-week NHS targets.
Recognising that they needed support, the Trust’s management team contacted us at 18 Week Support, seeking a service that could be mobilised rapidly. The service needed to be flexible, be able to operate at scale whilst delivering the highest NHS clinical and quality standards.The service also needed to be underpinned by highly efficient operating procedures. Above all, the solution could not expose the Trust to any risks while reducing its waiting lists. In 2016, we began our partnership with the Trust providing 18 Week Support teams over 24 weekends. During that time, 18 Week Support introduced around 65 staff – consultants and specialist nurses – across a range of clinical specialities including General Surgery, Vascular, Colorectal, ENT, Endoscopy, Oral Surgery and Dermatology.
In order to understand where the hospital’s pressure points were and how its Consultant body worked on a day-to-day basis, we initiated a number of fact-finding meetings. One of the key findings was that the Trust was experiencing some difficulties segmenting its patients into relevant specialities. So, in line with our aim of offering a flexible solution, we made sure that at every outpatient clinic over the weekend, a variety of consultants were available.This meant that the patient could be seen by the right consultant in the right clinic without having to arrange a further appointment.
At clinics, patients were seen by a consultant and then listed for a procedure, if appropriate, scanned by a sonographer, and had their pre-assessment carried out by a specialist nurse. All on the same day. This meant that these patients would not have to return for any further appointments until the time of their treatment.
Throughout our time at the hospital, we had the full support of the Trust’s management team. Regular meetings and conference calls were also held to keep track of our progress, as well as monitor patient outcomes and patient satisfaction.
To keep disruption to an absolute minimum, we adhered to the same guidelines and practices as the Trust and used all the same procedures. This ensured that there was a seamless transition between our work and that of the Trusts.
Feedback from patients clearly demonstrates the level of service provided:
“ What was a difficult time for my wife and I was made 100% easier. My thanks to the whole team, you did an amazing job and should be very proud.”
“ Everyone was really clear about what was happening and put me at ease.”
“ The team stopped me feeling nervous! They were kind, caring, helpful, professional – all in all brilliant, and very hard working.”
“ All the staff are a credit to their profession and to the NHS.”
The time that 18 Week Support spent working with the Trust enabled it to deliver an efficient seven-day service to its patients and significantly reduce the waiting lists in a cost-effective manner. Over one weekend, we saw 275 outpatient patients and carried out 50–60 day cases. This produced some significant time-saving initiatives for outpatients, as well as a number of positive outcomes in both perioperative and post-operative stages of care.
• Consultant delivered pre-op consultation and a nurse-led pre-op assessment on the same day
• Surgery date was discussed with patient on the day of pre-assessment
• Patient consent was obtained in clinic and reobtained on day of surgery
• No conversion to open cholecystectomy
• No biliary tract injuries
• No post-op wound infections
• 6 post-operative admissions:
3 for urinary retention
2 for high comorbidities
1 for motor block
• Consultant-led outpatient appointments
• Histology results reviewed and acted upon
• Patient satisfaction forms completed