News

Cutting unnecessary emergencies – Tiziana Ansell

In the latest blog marking World Continence Week, a specialist nurse from South London’s Health Innovation Network describes the work going on across emergency departments:

At South London Health Innovation Network we are working to reduce catheter-associated urinary tract infections by 30 per cent by 2017 and to improve patient wellbeing and recovery.

We carried out several audits across South London to find out how many patients attend Emergency Departments with catheter problems, and what interventions would improve patients’ care experience and their quality of life.

I want to share the story of John, an 80-year-old man patient and our journey to address his care needs.

John lives by himself in his own home. He has a long-term urethral catheter, which he will need for the rest of his life because he has an inoperable enlarged prostate, and a number of co-morbidities and complex care needs. In the last two years John has attended the ED 40 times, travelling to and from the hospital by ambulance.

In the last year at least, ten of John’s ED visits were for urinary catheter problems, including catheter blockage, bypassing urine between the catheter and urethra due to poor drainage, catheter pain and accidental trauma, and recurrent catheter-associated urinary tract infections (CAUTIs). John also suffered from a serious case of uro-sepsis, which was attributed to the presence of the catheter and made him very ill, leading to a long hospital stay.

He depends on community nurses and social care support to continue living independently in his own home, and infections and hospital stays affect his independence and wellbeing. This could mean he has to move to a care home for more support.

John is one of eight patients we audited who were visiting the ED regularly with catheter problems. If these eight patients had individualised and responsive community services, ED attendances would be significantly decreased, and London Ambulance Service would have increased availability to attend emergency cases. This would also improve the quality of life for these patients, and for John, it would allow him to maintain his independence and remain in his own home.

As a result of the HIN’s recent ED audit, we collaborated with local specialist services, including a continence nurse specialist, a urology nurse specialist, community matrons and the rapid response team.

We will now work alongside these eight patients to give them an individual, responsive service that’s tailored to their complex needs. We are also talking to the 111 services and the ambulance service, to design individualised care-planning for this group, to help us manage their care more successfully in the community.

  • NHS England’s Excellence in Continence Care is a practical guide for commissioners, providers, health and social care staff to put into effect the best care for patients. It also provides information for the public.

Image of Tiziana AnsellTiziana Ansell is a registered nurse, independent nurse prescriber and Darzi Fellow.

She specialised in continence care in 1999 and has been working in the field since.

Tiziana works for the Health Innovation Network on a two-year project to reduce catheter-associated urinary-tract infections (CAUTIs) in South London. She has 20 years’ clinical and managerial experience working in the UK across community, acute and private sector.

Prior to moving to the UK she also worked in Italy as a volunteer and paramedic in the ambulance service and underwent work experience in Slovenia in neuro-surgery intensive care unit.

Categories: Guest blogsHomeNews

Tags:

Leave a Reply

Your email address will not be published.

7 comments

  1. I meet many people that have incontinence problems. There are living with depression and even they are not very old suffer in silence. The carers sometimes are embarrassed to speak about it with GP. Many of these problems society could prevent by teaching people about necessity of some exercise for the pelvis area with aiming this specific problem. The elderly are participating in the exercising in chairs, therefore not activate the pelvis and tight, even calves are excluded sometimes from movement during session with exercises.

    • NHS England says:

      Dear Natalia,
      Thank you for your interest in the work of South London Health Innovation Network. The Network is best placed to answer question relating to this specific piece of work and we have passed their contact details on to you via a private email to you.
      Kind regards,
      NHS England

  2. Kassander says:

    ” If these eight patients had individualised and responsive community services, ED attendances would be significantly decreased, and London Ambulance Service would have increased availability to attend emergency cases. This would also improve the quality of life for these patients, and for John, it would allow him to maintain his independence and remain in his own home.”
    =====
    That is the THESIS.
    1)…. It would be interesting to have read how such a set of conclusions was arrived at
    2)…. Whilst the call on the time of the ED (sic) and the Ambulance service might be reduced, will the burden, and the costs, merely be transfered to other parts of the service at par, or will there be an estimated rise or fall in the use of resources?

    • Kassander says:

      Eeerrr, ain’t I going to get a reply to my questions, please?
      Or, :
      “The Moving Finger writes; and, having writ,
      Moves on: nor all thy Piety nor Wit
      Shall lure it back to cancel half a Line,
      Nor all thy Tears wash out a Word of it.”

    • NHS England says:

      Dear Kassander,
      Thank you for your interest in the work of South London Health Innovation Network. The Network is best placed to answer question relating to this specific piece of work and we have passed their contact details on to you via a private email to you.
      Kind regards,
      NHS England

      • Kassander says:

        Thank you for this reply, and the details sent to my private eMail address.
        BUT
        NHS England have chosen to publish this article, and so NHS England should now insist that the Network reply, on this page, to these legitimate questions which people are raising.
        Sloughing off your responsibilities onto readers is not the way to encourage meaningful discussions on this, or future postings by ‘you’.
        You chose to publish – it’s your responsibility to obtain the responses to our – the readers – comments and questions.
        Please do so.
        Thank you.

        • NHS England says:

          Dear Kassander
          I am happy to reply here within the character limit. A one-to-one conversation would enable me to share more information.

          We reviewed these patients in detail, looking at relevant Emergency Department (ED) data from the last two years. We also reviewed interventions coding from the last two years to get a sense of their overall health; and liaised with the local continence nurse and older people nurse practitioner to ensure all patients received an in-depth review of their needs. This enabled us to identify if they were suitable for community care, why they didn’t access community services and what could be done to improve their catheter care pathway.

          This is about streamlining the best possible catheter service for patients within existing resources and at ease of access for patients. It’s more about making the best use of the funds available and/or re-distributing funds in the most appropriate way.

          Please do contact me via NHS England if you would like to talk.
          Tizy