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Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust.

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Presentation on theme: "Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust."— Presentation transcript:

1 Brindha Dhandapani Ros Swift Lewisham Healthcare NHS Trust

2 Innovative proposals for service redesign across community and acute services following integration of University Hospital Lewisham and Community Health Services in April 2010 To deliver excellent service building on the strengths in both organisations Lack of coordination of hospital and community services, duplication of services and lack of continuity of care

3 Gastro clinic (Gastro/dietician) Referral received Review Assessment Investigation Management Joint Gastro clinic (Paed/surg/diet) Referral/Liaison HEN Community Paediatrics S< Discharge

4 Referral S< Assessment Comm Paed Assessment Hosp Paed DieticianHENTertiary

5 8year old with Cerebral palsy, gastrostomy fed, vomiting, poor weight gain, Multiple hospital & community appointments Multiple DNAs Community staff not able to attend appointments in the hospital No response to change in treatment plan Unable to co-ordinate services to implement plan

6 To provide a co-ordinated approach, through collaborative working between community and hospital services Improved parent/carer satisfaction Reduce referrals to tertiary feeding service Reduce number of hospital appointments Providing detailed care plans with clarity of input

7 A multi-disciplinary feeding service for children with neuro- disability, ASD, learning difficulties with complex feeding difficulties To complement existing hospital based Joint Gastro- enterology clinic and improve collaborative working Core team - Dietician, Speech and Language Therapist, Paediatrician (Community /Acute) Extended team - Specialist Nurse, Occupational Therapist, Physiotherapist, Care- coordinator, (Clinical Psychologist)

8 Children resident in Lewisham requiring; Multidisciplinary input Poor response to initial advice Extreme parental stress Complex ethical issues

9 3 all day clinics Feb, April and June children 6 children with Cerebral palsy 3 children with Autism 1 child with Chromosomal disorder 1 with Learning difficulties 1 child with congenital infection

10 All the children had detailed care plans Six (50%) children had fewer appointments in the hospital Six (50%) children were discharged from the hospital clinic to avoid duplication of services Reduced referral to tertiary feeding services by(7/12) 60%

11 Ten parents/carers (83%) completed satisfaction questionnaires Administration of clinic was thought to be Excellent-Good by majority of the parents 70% thought the appointment length was just right, 30% thought it was too long All 10 (100%) said their questions and concerns were addressed 90% said it was useful having health professionals together for the appointment 60% thought the advice given was useful and practical but 40% said it was not

12 So nice to have all professionals in one room, bringing information together and leaving as a parent with a plan great having the discussion and plan written and given to me to take away Would welcome more multi team appts Good to review matters and to be able to monitor changes

13 Wanted more practical advice More advice and information instead of going over things we already knew no new information or advice

14 Seven professionals completed questionnaires All 7 felt the length of appointment was just right Co-ordinated approach – most useful Saved time liaising with other professionals Works best when the right people are present- i.e. childs therapist

15 Triage referrals Referrals received Multidisciplinary feeding clinic S< Hosp dietician/ Home Enteral Nutritionist Hosp Paediatrician/ Comm Paediatrician Pre-clinic food diary/information gathering DischargeReviewSupport wider team Care Plan

16 Improved understanding of roles and services offered Improved links with hospital and community services

17 Specialist investigations not available in the trust e.g. videofluoroscopy Lack of Psychology input Different processes across hospital and community services

18 To develop the knowledge base and expertise of the feeding team To improve the overall management of feeding issues in the community/hospital Potential to expand the service

19 Increased referrals might result in increased waiting times and less efficient service Extra funding and resources Duplication of assessments if services are not sufficiently well co-ordinated- Admin support

20 8year old with Cerebral palsy, gastrostomy fed, vomiting, poor weight gain Care plan with clear responsibilities Medication administered at school, new feed regime, equipment sorted Reduced hospital appointments Key worker to liaise with parents and professionals with guidance from the service Parents and professionals satisfied with outcome

21 Negotiate Psychology input for the service Resources for parents and professionals Training of wider teams Video-fluoroscopy service

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