Finalist

The Maternal Obesity Service at Doncaster

Carolyn Garland, Doncaster and Bassetlaw Hospitals NHS Foundation Trust

This midwifery-led service aims to educate obese, pregnant women on how to minimise associated risks, encouraging them to make positive and sustainable healthy lifestyle changes. The service is based upon a face-to-face consultation with women to gain rapport and trust. Additionally, a ‘Healthy Lifestyle Midwife’ assesses risk for mothers and babies and plans individual care with an immediate dietetic consultation.

Working closely with obstetric and anaesthetic colleagues, a care-planning tool has been developed to ensure that all obesity-related issues have been clearly identified, resolved and documented. Training has been developed for health professionals on dietary and exercise advice in pregnancy and they have presented their learning both in the UK and overseas.

The impact of the service is:

• It is easier for professionals to have frank and informative discussions with women about healthy weight management during pregnancy.
• The service is continually streamlined based on feedback from users.
• Our care planning and communication tools ensure seamless care, with CNST criteria met and clearly documented.
• A 6% reduction in caesarean sections after our intervention equates to a cost saving of approximately £558,000 per annum at the Doncaster site.

Finalist

Standardised procedures for DNACPR decisions

Claire Seymour, NHS Airedale, Bradford and Leeds

In 2010, 53% of deaths in England occurred in hospital, although a survey has found that 63% of people would prefer to die at home.  A National Audit Office study found that 40% of the patients who died in hospital had no medical need to be there. If these patients were discharged, £4.5m per annum per PCT would have been released to invest in community based, end of life services.

In 2009, NHS Bradford and Airedale, on behalf of all Primary Care Trusts across the region, established a common DNACPR form and protocol, transferrable across all care settings. It aims to improve the management of individual end of life cases and reduce the number of inappropriate attempts to resuscitate patients. 

The impact of the standardised procedures are:

• Introducing the form will, on average, make a saving of between £448 and £1,875 per case
• 94% of patients’ notes that were audited were using the new form.
• The education and training package increased staff competence with the form and confidence around DNACPR.
• Staff found the form easy to use, resulting in better cross-service communication and clearer decision-making.

Finalist

Remote monitoring and management of patients with chronic kidney disease

Dr Arif Khwaja, Sheffield Teaching Hospitals NHS Foundation Trust

Key features:

• Identifying suitable patients based on age, clinical history, stability of kidney function and requirement for interventions that can be delivered in the community.
• An individualised CKD-DMP with monitoring of variables and thresholds for re-referral to secondary care, identifying those requiring intervention.
• A CKD nurse-specialist based in secondary care (supported by a consultant nephrologist) to liaise with primary care, plus regular telephone consultations to replace outpatient visits.
• Educating patients in monitoring of blood pressure and allowing online results viewing.
• Providing resources and training to support CKD knowledge and education in primary care.
• The CKD-DMP is currently being piloted with 75 patients in collaboration with the Sheffield Central Consortium of GP practices.

The impacts of the CKD-DMP service are:

• Development of an integrated pathway of care.
• Improved patient experience and increased involvement in disease management.
• Closer collaboration with primary care.
• 58% reduction in cost to commissioners (excluding transport costs) by reducing outpatient attendance.
• Reduced NHS transport costs and carbon footprint.
• Increasing outpatient capacity.
• Likely roll-out across the region.

Finalist

Using IMPAKT CKD tool in kidney disease

Professor Nigel Brunskill, University Hospitals of Leicester NHS Trust

The tool:

• Produces a general practice audit around CKD parameters, including blood pressure management and relevant drug usage.
• Identifies patients who should be on the practice CKD register and those at a high risk of progressing to end stage renal disease.
• Allows comparison of individual practice performance.
• Provides alert, intervention and referral advice for individual patients.
• The development of the tool has been a collaborative process, involving NHS and academic colleagues.

The impact of the tool has been:

• The tool allows practices to easily identify patients with CKD and targets the most effective treatment, reducing referral to secondary care.
• From pilot work, the tool is identifying significant numbers of un-coded CKD patients - on average a further 2.5-5% not currently on disease registers.
• Early identification and effective management of just one new high-risk CKD patient could delay renal replacement therapy by five years, equating to £150k per patient.
• The IMPAKT CKD tool may be used by the National Audit, demonstrating a national impact.

Finalist

A modernised integrated pathway for neck lumps

Dr Kit Chow, Chesterfield Royal Hospital NHS Foundation Trust

The rapid access neck lump clinic has developed a pathway where all patients are triaged by a team of consultants - thyroid, maxillo-facial and ENT - who then allocate the patient to the appropriate Head & Neck (H&N) speciality for detailed clinical examinations.

Patients receive same-day ultrasound examination and, if appropriate, a same-day ultrasound-guided biopsy plus a follow-up appointment. Patients not requiring a biopsy are given a written ultrasound report and reviewed for same-day discharge.

The impact of the new pathway is that:

• The H&N team aims to get the clinical diagnosis right first time, reducing patient uncertainty and making better use of clinician resources.
• Patients with uncertain neck lumps traditionally receive a palpation-guided FNA, which is approximately 30% accurate and uses expensive imaging facilities. With this new service, ultrasound technology is used and a cytologist provides clinical support and a same-day provisional opinion. This practically eliminates the need for diagnostic surgical excision of neck lumps.
• There are also cost-savings associated with the new pathway as an excision biopsy costs up to £1,690, whereas an ultrasound-guided core biopsy costs just £57.  Whereas it would cost £42,250 for only 25 patients to have surgical excisions, it would cost £5,700 for 100 patients to receive ultrasound-guided core biopsy - a saving of £36,550.

Finalist

Point-of-care troponin testing

James Griffiths, Barnsley Hospital NHS Foundation Trust

Current monitoring for suspected low-risk cardiac chest pain is a 12-hour troponin test, often requiring inpatient admission. The results of the Randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial suggested that the use of point-of-care (POC) cardiac marker panels in the ED can reduce hospital admissions.

The diagnostic process is protocol-driven, controlled and plannable, involving collaborative working across the hospital. Turnaround time, from taking blood to availability of results is now only 20 minutes in the case of a POCT in the ED.

As a result of implementing this service, 354 /552 patients were discharged from the ED. 5% re-attended and only three patients (0.5%) were found to have ECG changes or raised cardiac enzymes. The increased throughput of the ED, combined with the decrease in demand for acute beds, may have contributed to a better performance by the Trust in meeting the Department of Health’s ED operational standards. POCT champions maintain quality control and staff training and ED staff from other hospitals have visited to see the POC testing in action.

Julie Hoole is the Lead Macmillan Head and Neck Cancer Project Manager/Nurse Specialist at The Mid Yorkshire Hospitals NHS Trust who has developed and implemted a home alcohol detoxification programme for head and neck cancer patients.

Finalist

Head and neck cancer – home alcohol detoxification

Julie Hoole, The Mid Yorkshire Hospitals NHS Trust

Head and neck cancer patients with an alcohol dependency spend seven days in hospital detoxifying before undergoing surgery and reconstruction. After surgery, they remain in hospital for a further 10 days. As patients can often be the main family carers, being away from home for longer than necessary is problematic.

A pathway has been developed and piloted with the wellbeing team at Spectrum in Wakefield who specialise in alcohol abuse and dependency. Patients requiring detoxification are supported at home, removing the need for hospital admission before surgery. The patient’s family also receive help with their dependency issues, increasing the patient’s chance of successfully maintaining detox following surgery.

The successful pilot has led to a bid to fund a specialist nurse through Macmillan for three years, auditing the effectiveness of the service both as a regional - and possibly national - Gold standard.

The impact of the service has been:

• Financial savings for the Trust by reducing hospital admissions.
• Patients readily comply with a detox programme in their home; less medication is required and patients reduce dependency themselves.
• The pathway has been accepted at the Head and Neck Yorkshire Cancer Network as the Gold standard.

Finalist

To follow-up or not follow-up? That was the question…

Veronica Allinson, The Calderdale and Huddersfield NHS Foundation Trust

The programme consists of four morning sessions over a four week period, covering various health and lifestyle-related topics, including how to re-access the clinician or key worker if needed. Suitable patients are provided with the skills, knowledge and confidence for future self-management, saving unnecessary hospital visits and creating more capacity for new patients.

A pilot study, funded by Breast Cancer Care and the Yorkshire Cancer Network, tested patient acceptability of the programme and evaluations are on-going. The project has been rolled out as routine follow-up practice in the Trust and is now being extended to other Trusts in the network.

The impact of the programme has been that:

• An effective and diverse programme allows patients to focus on getting their lives back to normal.
• Reduced hospital visits and better use of PCT clinician resources. The programme is being introduced across all the Trusts in the Yorkshire Cancer Network.
• Patients have a demonstrably better quality of aftercare. Their understanding of the disease is improved and all information needs are met in a friendly and supportive environment.

Finalist

Non-invasive glucose-sensing technology

Dr Gin Jose, University of Leeds

A non-invasive glucose-sensing technology.  Continuous monitoring of glucose levels with reduced ambiguity and minimal distress is vitally important for the efficient management of diabetes. Glucose is currently measured by finger-pricking and squeezing a drop of blood onto a test strip for measurement using a meter. Disadvantages include its high consumable cost, inconvenience and unsuitability for continuous monitoring.

The new glucose-sensing concept that he and his team have developed is a sensor, comprising a nanophotonic device activated by low-power laser, which does not require finger-pricking. They have developed a non-invasive, multi-wavelength fluorescence, lifetime-based measurement concept which has the potential to be a patient-friendly, compact and wearable device valuable in the diagnosis and monitoring of several diseases, including diabetes.  The technology could enable continuous monitoring and generate a patient-specific glucose profile, enabling efficient treatment and self-monitoring and allowing new methodologies in diabetic management and tele-health implementation.

Finalist

Automated diagnostic for Alzheimer dementia from a simple blood test

Dr Nin Bajaj Nottingham, University Hospitals NHS Trust

An Automated diagnostic blood test for Alzheimer dementia. The team have identified proteins and genes that can reliably diagnose AD on a blood test (biomarkers) and by 2013 will have developed a novel instrument for blood biomarker sampling and detection of biomarkers in complex biological fluids (in this case blood and cerebrospinal fluid) from AD patients.  The developed detection system is label-free, making it well-suited for biomarkers without the need for secondary antibody detection. Protein biomarkers attaching to specific monoclonal antibodies are detected by changes in resonance in a targeted laser beam coupled to our own design of CMOS camera.

A biochemical test that is diagnostic and predictive would help achieve the aim of 85% diagnostic accuracy, allowing early detection and timely drug intervention.  The device is highly portable and could detect other neurodegenerative diseases by simply altering the antibody detection panel.

Finalist

Sheffield Clip (novel suction holder clip for endolaryngeal laser surgery)

Matthew Tulley, Single Use Surgical Ltd

A Novel suction holder clip for endolaryngeal laser surgery known as the ‘Sheffield Clip’.

Since the introduction of lasers in laryngeal surgery, a number of technological advances have been made in surgical techniques. Evacuation of the smoke during endolaryngeal surgery improves visualisation of the surgical field. Microlaryngoscopes have been adapted for laser use by the addition of smoke evacuation channels on the side of the laryngoscope. Traditional laryngoscope suctions were reusable and fixed to the scope with an expensive screw mechanism. The reusable suctions are difficult to clean, risking cross-infection. Single-use suctions are now recommended, but have not previously been available to fit to a scope. The clip quickly fixes a disposable suction device to the scope and this has been in use at the Royal Hallamshire Hosptial for several months. Other modifications were made to provide a good tube layout for the surgeon that would not obstruct other operating instruments.

The impact of using the device has been:

• The risk of cross-infection during laser endolaryngeal surgery to over 100 patients per year has been avoided.
• Continuous plume evacuation improves surgical accuracy and lessens the spread of viral particles contained within the laser plume down the respiratory tract of the patient or to operating room personnel.
• Surgical time is reduced.

Finalist

PainKwell: An advanced local anaesthetic infusion catheter and pump to reduce pain after surgery

Mr Martin Stone, Leeds Teaching Hospitals NHS Trust

Previous attempts to develop an infusion catheter for pain relief after joint surgery suffered three problems. First, the functional catheter ends available are too short for the long wounds of hip and knee replacement surgery. Second, many systems require the catheter to be manually topped-up after surgery, taking up nursing time and risking infection, possibly leading to a failed joint replacement. Finally, the catheter has to pass from outside into the interior of the joint, leaving part of the catheter in the new artificial joint and also risking infection.

The new catheter has a longer working area, a local anaesthetic delivery pump not requiring top-up and alterations to the introduction method. This has now been developed and is available on the open market.

The impact of the device has been:

• Morphine use after surgery has dropped from around 66% of patients to less than 20%, with many requiring only paracetamol to control pain, leading to earlier mobilisation.
• Using PainKwell may reduce length of hospital stay.
• With 170,000 hip and knee replacements in the UK alone per year, the improvement in patient wellbeing and potential cost savings is huge.

Finalist

A computer-based clinical tool for people who stammer

Claire Rowland, Leeds Community Healthcare NHS Trust

Adults who stammer develop frequently report anxiety. The tool was developed to enable exploration of speech-associated anxiety and encourage increased therapeutic autonomy. We collaborated with a patient to understand why he experienced increased anxiety and stammering in different speaking situations and how therapy targets would address this.

The client identifies and rates the variables which come together to construct a speaking situation, such as audience size, familiarity of surroundings, formality etc. An Excel spreadsheet converts the data into a radar chart – a visual representation of the client’s experience. Using the chart, the client and therapist see and understand how the different situations compare, assumptions are prevented and the therapy process develops from the client’s perspective.

The impact of the tool has been:

• Supporting clients in understanding their anxiety can help them to take control.
• Patients understand therapy targets and become increasingly independent in setting these, decreasing reliance on NHS resources.
• The tool has been presented at an international level with specialists interested in using the tool clinically or for research purposes.
• An on-line recording system to increase accessibility for clients is under discussion. The tool could also be developed for client groups in relation to anxiety.

Finalist

OO-Tracker

Dianne Tetley, Lincolnshire Partnership NHS Foundation Trust

This approach incorporates a whole-service model built upon a sound evidence base, using two scales - the Outcome (ORS) and Session (SRS) Rating Scales - to chart therapeutic outcome and the relationship between clinician and service user.

OO-Tracker will interpret ORS and SRS scores automatically and chart progress graphically. Clinicians can then provide ‘real-time’ feedback to service users. Data will be aggregated into reports, enabling therapeutic outcomes to be monitored in different ways. An app will be developed to allow data entry via mobile devices, reducing inputting time.

The impact of using the OO-Tracker is:

• Increased recovery rates
• Identification of those with no signs of improvement
• Reduction in long-term use of services
• Avoidance of early drop-out from treatment
• Improved therapeutic efficiency
• OO-Tracker will accelerate wider take-up of an outcomes-oriented approach to delivery of mental health services and an OO-CAMHS toolkit has been published to support implementation locally and nationally. NICE has recognised our approach as an example of Quality and Productivity in Health and Social Care (QIPP) and the NSPCC is rolling out our approach nationally.

Finalist

Electronic decision support tool for patients undergoing vascular radiological procedures

Dr Christopher Hammond, Leeds Teaching Hospitals NHS Trust

Patient preparation for invasive procedures is informed by multiple guidelines. If patients arrive for treatment inadequately prepared, this leads to risk, cancellations, inconvenience and inefficiency. As pre-assessment is performed by junior staff, this is not surprising. The diversity of referral sources and turnover of junior staff presents a major obstacle to the resolution of these issues.

Audits in our unit have identified same-day cancellation rates of 50 patients per year, with inconvenience for the patient and wasted resources for the Trust. Arrangements made to avoid cancellation are inefficient and can also result in patient harm from inappropriate treatment.

This project will develop a web-based decision support tool founded on evidenced-based best practice to construct individualised workup and care plans. The plan will also be electronically available to aid remote decision-making. The tool will minimise poor patient preparation, resulting in increased safety and efficiency.

The predicted impact of the decision support tool will be:

• Junior staff have clear, patient-specific instructions that will increase patient safety.
• Reduction in cancellation rates will result in cost savings to the Trust and make more time available for procedures.
• The tool could be adapted for any invasive surgical or non-surgical procedure.

Finalist

Making the invisible visible: adherence data for Cystic Fibrosis patients

Dr Martin J Wildman MSc PhD MRCP, Sheffield Teaching Hospitals NHS Foundation Trust