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Delivering a Consultant led 7 day ward round

Delivering a Consultant led 7 day ward round. Mr Jim Smallwood MS FRCS Consultant Surgeon and Clinical lead University Hospital Southampton. University Hospital Southampton- NHS Foundation Trust (944 beds). 1.3 million population 3 million population - Cardiac - Neuro - Paeds

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Delivering a Consultant led 7 day ward round

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  1. Delivering a Consultant led 7 day ward round Mr Jim Smallwood MS FRCS Consultant Surgeon and Clinical lead University Hospital Southampton

  2. University Hospital Southampton- NHS Foundation Trust (944 beds) • 1.3 million population • 3 million population - Cardiac - Neuro - Paeds - Trauma • 120, 000 emergencies 140,000 inpatients • 60 level 3 ITU beds • 250 major trauma calls 1 year

  3. Department of Surgery(7 sub specialities) Sub Con No. Specialisation Upper GI 3 * Cancer (Erals) Lower GI 8 * Cancer (Erals) * Rec Cancer * Intestinal failure Hepato Biliary 6 * Cancer (Erals) * Neuroendocrine Urology 8 * Cancer * Reconstruction (Erals) Vascular 6 * Centre * Non-invasive * Interventional MAX FAX 4 * Cancer * Skull Base ENT 9 * Cancer * Cochler * Paeds 25 of 48 Consultants under 45 4 of 48 Consultants over 50

  4. Consultant meeting February 2012 • Emergency work escalation (20-50 /day) • Trauma Centre due to start (250 trauma calls /year) • Sub speciality care out of hours • Clash between acute and elective work load • Effect of case mix complexity, double operating, lap surgery • Training, threat to training numbers, FYI compliance • Emergency ward- multiple team rounds, delays, handovers

  5. Outcome • Separation in weekdays of Acute surgical service from sub speciality work. 3 then 4 consultants to be appointed. 2. 1st and 2nd on GI surgeons 7/7. 3. Sub speciality consultant ward rounds Saturday and Sunday. (7 consultants present Saturday and Sunday AM) 4. Consultant of the week for non-GI specialities where emergency work small volume. (Urology, Vascular) 5. Within 12 week SPR rolling rota 3 weeks on Acute Unit. - Reassess within one year -

  6. Management 1. Increase in Consultant numbers Acute 3 Urology 2 Upper GI (1) HPB (1) Fellows (2) 2. Increase in PA’s and supplements Some on 13 PA’s Some on 8% supps More Consultants!? 3. Infrastructure a. Bed numbers increase by 21 b. 2nd theatre teams c. Evening consultant anaesthetist

  7. Outcomes • Length of stay acute unit • Length of stay surgical unit • FYI compliance • Registrar training feedback • Patient pathway improvement e.g stones, low abdo pain • Mortality and morbidity

  8. Process change • Week-end discharge • Modification of electronic system e-prescribing • Better ward staffing

  9. Challenges • Increase in transfers • Young consultants on ASU and training • ASU accumulation of large numbers • Elderly and social care • Unwieldy electronic systems

  10. Conclusions • Consultants must lead changes to ensure 7/7 care • Consultants must participate out of hours • Consultants must drive changes locally • Consultants must participate in whole system changes that are inevitable

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