Always open, always ready

Dr Juliane Kause – lead consultant, out of hours care and seven day services blogs on the journey University Hospital Southampton NHS Foundation Trust (UHS) is on as it progresses at pace towards delivering quality services, seven days a week, 24 hours a day.

University Hospital Southampton NHS Foundation Trust is an urban university hospital which provides local hospital services to 1.9m people in and around Southampton and Hampshire, a full range of specialist services to a regional population of more than three million and employs over 10,000 staff.

We started to develop our five year strategy for consistent quality care across the week in 2012, initially focussed on strengthening out of hours care. This required strong commitment from the executive leadership team and a clinical lead was appointed to progress the agenda.

As a result of significant investment and focus, we are becoming a national leader in providing 24/7 care and will continue to improve on this. Last year, the trust also became part of the national vanguard programme as a partner in the ‘multi-specialty community provider (MCP) @BetterLocalCare and in 2016 we were selected as a Phase I delivery site for seven day services.

So what is our approach?

To deliver the improvements, we identified the services provided in each directorate at the start of the project and identified areas requiring investment in order to deliver inpatient clinical care twenty four hours per day. The trust has invested in a range of clinical and support posts – consultants, nursing, administration and pharmacy. We committed significant investment to consultant-delivered care which has led to improvements in outcomes, productivity, flow, support and education and training opportunities for junior staff.

Additionally, new roles have been developed, tested and introduced. For example, our new doctors’ administrators attend ward rounds and support junior doctors with tasks including discharge summaries, chasing results, organising equipment and data collection. These tasks would previously have been performed by junior medical staff who now have significantly more time to spend on clinical duties.

The drive to improve out of hours and broader seven day service provision has required change in culture and it’s now described as becoming ‘what we do around here’. This culture change has supported and enabled increased flexibility in the workforce, for example, creative job planning, shift rotas and also innovative solutions to systems and processes such as electronic prioritised doctors’ work lists and planned improvements to ward rounding approaches.

What’s the impact?

The trust has recorded reduced length of stay of non-elective (NEL) admissions in some areas (medicine, elderly care and surgery), and also improved weekend discharge rates. We experience fewer internal delays based on operational standards which demonstrates improvements in pathway flows.

Although it is impossible to relate improved outcomes directly to just improved out of hours and seven-day services, the trust has seen improvements to Hospital Standardised Mortality Ratio (HSMR), which is now below 100. Weekend and weekday HSMR are both now reviewed at Trust Board and all safety metrics (Serious Incidents Requiring Investigation (SIRIS) and never events are split between in and out of hours.

What next?

While we have made good progress, there are still some areas where we want to make improvements. We have just undertaken a detailed stocktake of all our inpatient services and, supported by the findings of our 7DS survey, we are discussing action plans with each directorate to ensure that we build these into our business planning. As a Phase I site we are aiming to deliver seven day services against the four priority standards by spring 2017 – a tough challenge but we are optimistic that we can deliver.

Dr Juliane Kause

Dr Juliane Kause is the care group lead emergency care, lead consultant out of hours care and seven day services University Hospital Southampton NHS Foundation Trust.

Visiting fellow at the University of Southampton

Intensivist and General Physician with interest in service improvement, multi-professional working and recognition & treatment of acute illness.

First full time Out of Hours and Seven Day Services consulant in NHS (to date as far as we know).

Passionate Leader for Seven Day Services and Out of Hours Hospital Care.

Proactive teacher, leader, contributor and learner to the patient safety collaborative.

Research interests include rapid response systems in hospitals, Out of Hours Care Systems and Human Factors.