Implementing Collins at Frimley
Mrs. Geeta MenonDirector of Medical Education
Frimley Park Hospital NHS Foundation Trust
Collins report
Stakeholder Discussion Groups
• Chief Executive Officer and Medical Director
• Clinical Directors, Heads of service, FTPDs and Consultants in charge of rota
• Trainees
Initial response
• Changing the mind set of colleagues
• Discussion around training and service provision
Key themes and challenges• Options of integrating community placements
• Service delivery and effects on rota
• Links within the community
• Opportunities
Trauma & Orthopaedics
• Fracture neck of femur pathway
• Working with physiotherapist and occupational therapist
Surgeons
• Upper GI and Breast surgery
• Phyllis Tuckwell Hospice
Urology
• Community urology clinic with specialist nurse
• Incontinence clinic
Obstetrics &Gynaecology
• Community midwife
Paediatrics
• Community paediatrics
Ophthalmology
• Diabetic screening programme
Pilot• Urology
• Trauma and Orthopaedics
• Surgery
Results of Pilot
• Pilot in T&O and Urology
• Trainees views
NOF Fracture Pathway
Dr. Serjevan Kalsi, Dr. Leila Mohamed, Dr. Thorrmela Vijayaseelan
F1 Doctors Orthopaedics, Frimley Park Hospital
Pathway Outcomes
• Reduce variation in length of stay, reduce mortality and re-admissions
• Surgery within 24 hours at FPH• Early mobilisation• Multi disciplinary team• Discharge
– Farnham/Fleet– Home +/- Care package
Farnham/Fleet
• Rehabilitation Centres• Small Wards• Consultant Led Beds• F1 Review Daily• 1-1 Consultant Contact• Daily Physio/OT input• Experienced Nursing Staff
Home• No Orthopaedic follow up
• No further OT input – Extra facilities in place
• Physiotherapy Outpatients
Intermediate Care Team
• ‘Promotion of independence & Safety first’• Aims to build confidence in the home
– Initial Interview– Mobility– Transfers– Domestic activities and Activity tolerance
Advantages of Project• Realistic process of discharge
• Highlighted gaps in holistic care
• Not just a simple social history
• Are patients coping?
• Recognising potential follow up
Disadvantages of Project
• Difficult to get time off– Trauma, Post Trauma, Oncall Dedications
• Difficult to co-ordinate visits
Recommendations
• Incorporated into Rota/Taster Weeks • MDT Attendance
• Presentation at Trauma Meetings
Thank you
Community Experience
Dr Emma Humphreys
FY2 Urology
Frimley Park Hospital
1 day at Fleet Community Hospital Bladder Cancer CNS Haematuria Clinic Flexible Cystoscopy Intravesical BCG Consultant OP clinic
Advantages
Off-site so free from ward jobs Enthusiastic nurse willing to teach More time for learning Able to carry out procedures Observation of other OP Ix OP clerking new pts 1 to 1 with Consultant DOPS/CEX
Difficulties
Rota challenges Liaising with DNs Incontinence clinic proved impossible Relevance to job Mostly observation
Recommendations
Build into rota 5 days in 4 month placement sufficient Placements to be organised Utilise experience of Nurse Specialists
Thank you
Results of Pilot
• Trainers and service provision
• Community
• Roll out to all posts in August 2012
Take home message
• No easy answers• Engagement from
- Leadership i.e CEO Medical Director- Middle management i.e Clinical Directors, Heads of Service, FTPDs, Consultants in charge of rotas- Trainees
• Feedback