1 / 30

Out of Hours Cover The Peterborough Experience

Out of Hours Cover The Peterborough Experience. AAGBI Linkman Conference 20 th Sept 2011 Dr Phil Das, Peterborough. Introduction. Background 2007 - 2010 Reduction in non consultant grades Ongoing discussion around rotas 2011 Change to OOH Cover inevitable

hoshiko
Download Presentation

Out of Hours Cover The Peterborough Experience

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Out of Hours CoverThe Peterborough Experience AAGBI Linkman Conference 20th Sept 2011 Dr Phil Das, Peterborough

  2. Introduction • Background 2007 - 2010 • Reduction in non consultant grades • Ongoing discussion around rotas • 2011 • Change to OOH Cover inevitable • Internal Opposition and Treachery • External Obstruction • Proposed Trial change • O&G resistance • The way forward Anaesthetic Emergency Cover 2011

  3. Pre 2008 Suspension of HSMP (Highly Skilled Migrant Programme) November 2006 Implementation of MMC August 2007 Implementation of EWTD - 48 hour max. Overall reduction in non consultant grades to run emergency rotas Increased Staff Grades – but 6 of 13 resigned/poached Anaesthetic Emergency Cover 2011

  4. 2008 - 2010 • Ongoing discussions • no trainee after midnight • resident consultant • Cost in lost sessions = 4-5 new consultants • Locums used each year August - October • Nov/Dec 2010 moved to single site hospital Anaesthetic Emergency Cover 2011

  5. Peterborough Hospitals pre 2010 Peterborough Maternity Unit Edith Cavell Hospital Peterborough District Hospital Anaesthetic Emergency Cover 2011

  6. Peterborough City Hospital 2010 Anaesthetic Emergency Cover 2011

  7. Peterborough City Hospital Anaesthetic Emergency Cover 2011

  8. 2011- Peterborough City Hospital Peterborough City Hospital fully open • Single site (at last) • Problems with equipment, operation & processes • Massive £38 million budget deficit • CEO long term sick leave • Job cuts – ‘severance scheme’ • August trainee shortage problem loomed • Warned ‘no money for locums’ Anaesthetic Emergency Cover 2011

  9. 2011- Train of events... 9 April 13th Department Business Meeting. • Clinical Tutor announcement From Monday 18th July there will no theatre trainee after midnight May 12thSpecial Department Meeting • Discussion of ‘no trainee after midnight’ plan • Other hospitals cited in support (Exeter, Taunton) • Opposition from within • Disliked change of hours/workload/responsibilities • Wanted more written details and increased remuneration June 7th Trust CGC Meeting • Presentation by RG – OOH incl. morbidity/mortality in other hospitals vsPeterborough • Agreed to set up ‘Steering Group’ to reduce OOH Surgery Anaesthetic Emergency Cover 2011

  10. 2011- Discussions June 16thDepartment Business meeting • Out of hours cover discussed: • Why change was needed • What changes were proposed Anaesthetic Emergency Cover 2011

  11. Why Change? Reduction in trainee numbers and hours worked Eight novice trainees starting in August - 3 months to train Unable to cover 3 rota tiers full time with staff available Financial Constraints – high cost of locum cover Consultant delivered service forsickest patients OOHdeemed to be best practice. ..... Anaesthetic Emergency Cover 2011

  12. What Change? No resident theatre trainee midnight to 7:30am No change to ITU or Maternity trainee shifts (24hr cover) Theatre cases after 10:30pm consultant decision only More urgent emergencies (while consultant in transit) to be dealt with by ITU anaesthetist. Assistance from Maternity trainee if not occupied on Labour Ward. ITU consultant to come in and assist if appropriate. ..... Anaesthetic Emergency Cover 2011

  13. 2011-Proposed change and treachery June 16thDepartment Business meeting (cont) • Proposed plans for no trainee after midnight • Consultant resident until midnight – on call after June 21st email from obs. consultant anaesthetist (‘Agent X’) to key O&G personnel You may have heard through the grapevine that there are plans afoot to change the way the anaesthetic cover for nights is to be provided…… ......obstetric trainee will be holding the arrest bleep and will also be expected to attend to the sick patients before the anaesthetic consultant arrives..... June 22nd multiple emails (responses escalated up)……. • It is clear that there are significant potential risks.............. (Risk & Lit) • .........we would be severely criticised for having just one anaesthetist on site if anything went wrong (Medico-legal) • .......the plan described by ‘X’ in her email below must be revised as it will not meet these standards and will therefore be unacceptable on safety grounds. (O&G Governance Lead) Anaesthetic Emergency Cover 2011

  14. 2011- Trial to go ahead but ... June 30th 20 out of 21 generalists voted to implement Trial change to evening & night cover for 3 months from August July 19th Guidelines and Scenario docs circulated before department meeting Guidelines and Scenario docs forwarded to O&G by ‘Agent X’ July 20th email + 2 page letter from O&G. I understand that you have taken an anaesthetic trainee off the night rota and clearly there is now a gap in the service provision. There are clear safety standards documented around Anaesthetic provision on Labour Ward......... Anaesthetic Emergency Cover 2011

  15. 2011-Trial postponed July 22nd Department Business Meeting Documents for trial of OOH cover approved July 26th Trial supporting documents circulated widely July 27th & 28th Multiple email replies (escalated up to management)….. …concerned about the provision for cover for the Trauma Team. (Trauma Lead) …. formally express my concerns as the Matron …..who will take responsibility when the first patient dies? ....I fear there is an increased likelihood of no one turning up to manage the airway Trial start postponed • To obtain more supporting evidence • Locums to fill gaps Anaesthetic Emergency Cover 2011

  16. 2011-O&G obstruction August 3rd CGC Meeting. O&G presented Risk Assessment Document ... Significant Hazards Non adherence to NHSLA maternity standards in relation to ‘safer childbirth’ RCOG 2007 …………………… Adverse Effects • Unnecessary stress for staff. • Maternal death • Severe disability to baby • Death of baby • Adverse reputation to Trust • Risk of litigation to Trust Reinforced decision to postpone trial Anaesthetic Emergency Cover 2011

  17. 2011-crucial CGC meeting Evidence gathering .......... September 6thCGC meeting O&G + ‘Agent X’ in opposition Presentation addressing issues raised by O&G Out of Hours Emergency Cover 2011

  18. Addressing The O&G Concerns Safety Issues and feasibility At least 15 other hospitals run a system of cover with no theatre anaesthetic trainee 24:00 to 08:00 No increase in adverse incidents related to change Published Documents ‘Breached guidelines’ 18 Anaesthetic Emergency Cover 2011

  19. Clinical Negligence Scheme For Trusts - Maternity Anaesthetic Emergency Cover 2011

  20. Safer Childbirth – Minimum Standards...RCOG 2007 Anaesthetic Emergency Cover 2011

  21. High Quality Women’s Healthcare. RCOG 2011 Anaesthetic Emergency Cover 2011

  22. Guidelines For Obstetric Anaesthetic Services. OAA/AAGBI 2005 Anaesthetic Emergency Cover 2011

  23. Common Themes Staffing The duty anaesthetist should be immediately available for the obstetric unit 24 hours per day. No change Duties If the anaesthetist has other responsibilities, these should be of a nature that would allow the activity to be delayed or interrupted should obstetric analgesia or anaesthesia demands arise. The new scheme documents specify this. Responsibilities The duty anaesthetist for obstetrics should not, in addition, be responsible for the intensive care unit or other anaesthetic duties. No sole responsibility for other duties. Anaesthetic Emergency Cover 2011

  24. Guidelines for provision of anaesthesia & critical care services between 18:00 and 08:00 Changes to appease O&G. A. General Principles • The maternity trainee may occasionallytake on some more general responsibility between midnight and 08:00 but must be immediately available at all times to attend the labour ward. B. Scenario Guidelines 1.Cardiac arrest calls • c. If the ICU trainee is not immediately available ...........should also arrange to fast bleep the maternity trainee (who maybe able to respond if not occupied on the delivery unit). 2.Assistance in theatre for complex case such as polytrauma or ruptured AAA • ICU trainee -> Maternity trainee -> ICU consultant Anaesthetic Emergency Cover 2011

  25. Consequences of No Change Risk Management Considerations Difficulty obtaining locums at a time of increased demand Variable quality of locums sent – unlikely to be as good as our owntrainees Locums unfamiliar with layout and procedures in hospital Locums may turn up late or not at all Consultant having to ‘act down’ if no locum – loss of routine sessions ..... Anaesthetic Emergency Cover 2011

  26. Consequences of No Change 2 Financial Considerations  Locum Costs 2009 - approx £180,000 (£14,000 pw) Locum Costs 2010 – approx £123,000 (£9,519 pw) Locum Cost 2011 (interim) - approx £6,300 pw Locum Cost during Trial £0 Anaesthetic Emergency Cover 2011

  27. 2011-CGC meeting decision September 6thCGC meeting. • Approval given to commence the Anaesthetics Emergency Cover Out of Hours Trial on Thursday 8th September 2011 • Email announcement and supporting documents sent out Emails in response………. • (whatif)…a 2nd urgent Obstetric case requires a theatre immediately(O&G Cons.) • …. concerns … we do not have staff trained to anaesthetic standard covering every night (Trauma Lead) • I hope this will not have an impact upon the Medical Registrar at night (Respiratory Physician) • Unfortunately, taking out this one inexperienced trainee seems to have had a catastrophic effect on anesthetic cover......(Colorectal surgeon) Out of Hours Emergency Cover 2011

  28. September 2011- Trial up and running However……………………….. Despite all the grumbling…………. September 8th Trial change in OOH cover started. So far so good. Anaesthetic Emergency Cover 2011

  29. The Way Forward • The trial continues • Ongoing work to reduce emergency OOH operating • Planned weekend Trauma lists • Careful detailed audit • Revert back to the original scheme from Mon 31st October • Review trial data • Discussion/decisions • Full implementation • Partial implementation • Yearly 3 monthimplementation • Non implementation – employ locums 3 months each year Anaesthetic Emergency Cover 2011

  30. Thank you ? Questions ? ? ?

More Related