Implementing Hospital at Night in NHS Lothian

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• Implementing Hospital at Night in NHS Lothian
• NES Workshop
• 9th June
• Stirling

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Implementing Hospital at Night in Lothian

• Drivers behind Joan Donnelly
• implementation of HaN Better Acute Care in
  Lothian
• Project Manager
• Integrating simulation into Graham Nimmo the
  training Consultant In Acute Medicine
  ICU/Deputy Director SCSC
• Developing training Janet Corcoran
• Hospital at Night Educational Lead for
  Nursing and AHPs

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Why Hospital at Night?

• Review of Acute Services Better Acute Care in
  Lothian Sept 2002
• Review driven by a number of factors
• Financial savings
• Service viability
• Workforce
• EWTD/new Deal
• Consultant and GMS Contracts
• Equality of service and access across Lothian
• Review of estate in Lothian
• Meeting waiting times/national targets
• Note At this point MMC was still an unknown
  factor and not included

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Why Hospital at Night?

• BACiL process
• Workgroups of clinicians, patients, support staff
  
• Patient pathways
• Process redesign new roles
• Analysis of historical, current and forecasted
• Patient activity
• Workforce
• Finance
• Detailed analysis of Doctors in Training to try
  and meet target of EWTD compliant rotas by 2009

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Innovative ideas
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Hospital at Night Group

• Focus on WGH 600beds
• National Precedents
• Present rota management
• Training Service Delivery
• Regional/specialty commitments
• Audit
• Funding 10 Nurse Practitioners

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Key Challenges

• The specialist training scheme will suffer
• I need my own team!
• No one understands our specialty
• That specialty can do it, but were too
  specialised
• These are my patients , they should be looked
  after by my doctors
• What about my beauty sleep?
• You need a doctor for that, no nurse can do it

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Audit Results

• Speciality specific activity overnight low
• Overspill of daytime work into evening high
• Most activity not requiring medical input

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How have we gone about it?

• Negotiation
• Re negotiation
• Reassurance
• Information giving
• Inclusion

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Team will be

• 1 SpR
• 3 SHOs/FY2
• 3 Senior Nurse Practitioners
• No PRHOs/FY1s

(presently on call offsite) (presently 5 SHOs
onsite) (presently no SNPs onsite) (presently 5
PRHOs on site)
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Key challenges now-

• Numbers on rota to reduce effect on daytime
  activity
• Timescales to prepare daytime/evening rotas
• Education and training of those who will
  participate
• Support of the SNPs for whom this is a new venture

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Planning of Education

• Audit/Pilot Sites/FY1/KSF
• Dr Graham Nimmo
• Communication
• Collaboration
• Internal/External

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Generic Modules

• Bsc (Hons) SCQF 10
• 30 week double modules
• 3 weeks intensive theory
• 3 weeks clinical practice/Consultant mentor
• Active learning sets
• Assessment Clinical competencies
• Summative Portfolio KSF
• Formative assessment Scottish Simulation Centre

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Simulation and H_at_N Training

• Session 1
• Emergency scenarios
• Management
• Protocols
• Recording
• De-briefing

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Control Room

• One way mirror
• Monitors
• Phone link
• Video
• Computers

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Debriefing

• Situation
• Physiology
• Pharmacology
• Team working
• Safety and error
• Supportive
• Constructive
• Safe

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Simulation and H_at_N Training

• Session 2
• Team working
• Decision making
• Task management
• Situation awareness

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Simulation and H_at_N Training

• Session 3
• H_at_N induction
• Multi-professional
• Technical and non-technical
• elements

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Framework

• Focus on Life long learning
• Built into a flexible career pathway
• Individual learning needs
• Changing service requirements
• Academic intellectual, professional progression

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G/F Grade Hospital _at_ Night Higher degree of
responsibility Autonomy
BSc Honours Generic Skills Senior Practitioner
BSc Level continuous professional development
E-grade, Expanded clinical decision Making
skills/clinical skills
Post registration Clinical orientation
Lv administration/cannulation
D-grade Competent practitioner
Pre-registration training
Student
HNC Senior Clinical support worker access to
nursing course
Access year two as student nurse
Higher level of responsibility Devolved autonomy
Expanded roles
Level 3 SVQ Senior Clinical Support workers
Expanded Roles
Level 2 SVQ Trained clinical support workers
Number of clinical skills Venopuncture, ECGs
Trainee support Workers
Pre Employment Training Health care Academy
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• MSc - Choice of modules depending on career
  choice
• Clinical
• Educational
• Management
• Research

MSc qualification Consultant Practitioner
QMUC MSc Level Advanced practitioner pathway
Advanced Practitioner Qualification
G-Grade Experienced High
degree of autonomy Skills theory
very high standard
Napier MSc Level Advanced practitioner pathway
BSc Honours Generic Skills Senior Practitioner
G/F Grade Hospital _at_ Night Higher degree of
responsibility Autonomy
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Informing Curriculum Development Training

• Immediate need for curriculum development
• Audit Large Scale in collaboration with MMC
  steering group workforce planning
• To identify service need in relation to further
  development of roles
• Non-registered, registered nurses, allied health
  professionals and different levels of medical
  staff

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Key Challenges Actions

• Challenges
• 1.Traditional boundaries
• 2. Impact on service
• 3. Transferability

• Action
• Opportunity to develop a flexible career pathway
• 2. Long term evaluation
• 3. Collaboration