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The practicalities: Rotas, flexible working and clinical engagement

The practicalities: Rotas, flexible working and clinical engagement. Jonathan Odum MD FRCP Medical Director Royal Wolverhampton NHS Trust. Mortality Financial Year Trends 2008 - 2013.

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The practicalities: Rotas, flexible working and clinical engagement

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  1. The practicalities: Rotas, flexible working and clinical engagement Jonathan Odum MD FRCP Medical Director Royal Wolverhampton NHS Trust

  2. Mortality Financial Year Trends 2008 - 2013 *All figures are for the basket of 56 diagnosis groups that account for over 80% of in-hospital mortality

  3. Mortality Trends - SHMI *All figures are for in-hospital and 30 days post discharge mortality

  4. Top 10 Diagnosis Groups by Deaths Volume

  5. Mortality Weekend and Weekday Admissions Trends HSMR *All figures are for the basket of 56 diagnosis groups that account for over 80% of in-hospital mortality

  6. Following a review of the data: Revised our process for reviewing in-hospital deaths within directorates Mortality Review Committee (clinical) Mortality Review Advisory Group (executive)

  7. Reviewed process for managing emergency medical admissions and in-patients: Weekday process: Routine WR, Acute Medical Take, On-Call Weekend process Acute Medical Take, On-Call, (Routine WRs??)

  8. Medical Sub-specialties: Acute medicine Renal * Gastroenterology Respiratory Stroke * Diabetes Care of Elderly Haematology * Cardiology * (* Saturday and Sunday cover)

  9. Proposal for Routine Weekend Working To provide the same level of consultant review of in-patients across all clinical areas in medicine at weekends as during the week. (!)

  10. Weekend working definition: To have a routine consultant review/ward round on Saturday and Sunday in all medical wards To provide sub-specialty in-reach to the hospital and AMU

  11. Aims of Weekend Working: To reduce weekend SMR ?? Continuity of clinical management Review of “new” ward admissions Identify and manage “sick” patients Review escalation plans Discharge of patients Sub-specialty in-reach to AMU and hospital

  12. All consultants in all specialties: Agreed with the principle without question CDs in medical specialities were asked to review consultant job plans and revise them to accommodate the routine weekend working Date for implementation?

  13. All Specialties: Consultants generally on ~12 PAs/week Robust job planning exercise undertaken across directorates in medicine Scepticism about implementation? Additional consultant appointments x 8.2 wte

  14. Requirements: 1. Diabetes consultant – 1 wte 2. Renal consultant -1 wte 3. Respiratory consultants – 2 wte 4. Care of Elderly consultants- 3 wte 5. Acute Physician consultant-1 wte 6. Oncology consultant-0.2wte

  15. Business case taken to the RWT Trust Board requesting financial support for £1m to appoint 8.2 wte consultant physicians to implement the weekend working. Following approval at TB, the BC was taken to the CCG where (after some debate) it was approved and supported as part of the QIPP process

  16. Aims of Weekend Working: (To reduce weekend SMR ??) Continuity of clinical management Review of “new” ward admissions Identify and manage “sick” patients Review escalation plans Discharge of patients Sub-specialty in-reach to AMU and hospital

  17. Medical Sub-specialties: Acute medicine* Renal * Gastroenterology * Respiratory * Stroke * Diabetes * Care of Elderly Haematology * Cardiology *

  18. Measured Outcomes at RWT: Increased discharges Reduced LOS Reduced readmissions Continuity of management Qualitative component Speciality in-reach to AMU (and elsewhere)

  19. CCG monitoring and reporting requirement Unplanned admissions to ICCU Cardiac arrests Mortality by day of admission Daily discharge rate LOS Readmissions after weekend discharge

  20. Issues to consider: Radiology Pharmacy Pathology Specialities Medical outliers “Winter” wards Junior doctors Monitoring of WRs….

  21. Thank You and Any Questions

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