Health Service Focus

Improving patient pathways at the ROH

Marion Pavitt, directorate manager for theatres and anaesthetics at the Royal Orthopaedic Hospital NHS Foundation Trust in Birmingham, talks to NHE about the new ADCU.

A new unit is simplifying the care pathway for patients at the Royal Orthopaedic Hospital (ROH) NHS FT. The extended estate is helping to facilitate shorter inpatient stays and freeing up clinical staff time that was previously spent on admin.

NHE spoke to Marion Pavitt, directorate manager of theatres and anaesthetics at the trust.

“It’s been part of a long term estate strategy for the Royal Orthopaedic Hospital – to renew the estate and put new improved facilities in for patients and staff,” she said.

ADCU

A new outpatient department opened in 2011, leaving space for a new admissions and day case unit (ADCU).  This brought together two previously separate departments and aims to help the hospital move towards shorter length stays.

The old outpatients department, now the ADCU, was “virtually rebuilt”, Pavitt explained. “We knocked it back to a shell but still, there’s only a certain amount you can do with an existing building as opposed to a brand new PFI or something like that. But it’s good; really it’s amazing.

“It’s bringing the departments together, making it much easier for patients to identify where they need to go, having a much better, newer facility – much easier to maintain and keep clean.”

Working smarter

The estate developments have been underpinned by a new workforce model to help staff manage the combination of their departments.

Admin staff hours have been extended to avoid clinical staff getting caught up in these duties and a daily debrief system allows the team to discuss any issues and tweak practices to find what goes well.

Having both sets of patients on the new ward had been a challenge for staff, Pavitt said, because “it’s still fairly new”. New cohorts of staff joining the trust and annual holiday time added to the complications.

But Pavitt said: “I think what’s really helped is a positive attitude from the staff. They’re really enjoying working in this fabulous new unit, plus the debrief that they’re doing everyday, all the staff getting involved in that. That’s really helping because they’re able to have their opinions listened to. The level of ownership from the staff is immense really.”

Freeing up clinical staff’s time from administrative duties was “really important”, she added. “I know that the NHS and all public services have tried to remove back office staff and it’s often meant that the clinical staff end up doing the work.”

Shorter stays

Pavitt explained that the upgrade would help to meet future demand for the hospital: “The different ways of working that we’re trying to put in across the whole of the NHS means that our facilities need to be better, much slicker, and to support the processes that we want to put in place. Sometimes the older buildings just don’t do that.”

The emphasis on shorter stays is part of an NHS-wide move towards greater care in the community, and improved integration.

“It’s not just about hospitals. This is about patients and we know that keeping patients in hospital longer than they need to be is not good for the patient and it’s not good for the hospital.

“Patients want to come in the day of their admission and go home as soon as possible. That’s what we’re all working towards in the NHS.”

The right timing

Part of the trust’s estate strategy and the development of the new ADCU involves bringing patients into the unit nearer to the time of their operation. This could boost efficiency, as well as reducing the risks of infection and stress for the patient.

Pavitt explained: “The gold standard we want to meet is that patients shouldn’t wait longer two hours before they’re called in to the theatre for their operation. We’ve got a much slicker process now than we had before and our new ADCU being right next to theatres facilitates that really well.”

Previously patients would be called into the day case unit in cohorts each morning and afternoon, regardless of the precise time of their operation.

Patients often come in from long distances and the need to bring patients for pre-assessment tests makes this target challenging, but the trust is now making good progress towards it.

“We’re trying to refine that even further so it’s two hours. We’re not there yet, we’re moving towards that. We’re hitting about three hours at the moment, which is very good.”

(Image: copyright Elliot Brown)