Brindha DhandapaniRos Swift
Lewisham Healthcare NHS Trust
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
Gastro clinic (Gastro/dietician)
Referral received
Review
AssessmentInvestigationManagement
Joint Gastro clinic(Paed/surg/diet)
Referral/LiaisonHEN
Community Paediatrics
S<
Discharge
Referral
S< Assessment
Comm PaedAssessment
Hosp Paed Dietician HEN Tertiary
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
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
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)
Children resident in Lewisham requiring;
Multidisciplinary input Poor response to initial advice Extreme parental stress Complex ethical issues
3 all day clinics Feb, April and June 2011 12 children 6 children with Cerebral palsy 3 children with Autism 1 child with Chromosomal disorder 1 with Learning difficulties 1 child with congenital infection
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%
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
“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”
“Wanted more practical advice”
“More advice and information instead of going over things we already knew”
“no new information or advice”
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. child’s therapist”
Triage referrals
Referrals received
Multidisciplinary feeding clinicS<Hosp dietician/Home Enteral NutritionistHosp Paediatrician/Comm Paediatrician
Pre-clinic food diary/information gathering
Discharge Review Support wider team
Care Plan
Improved understanding of roles and services offered
Improved links with hospital and community services
Specialist investigations not available in the
trust e.g. videofluoroscopy
Lack of Psychology input
Different processes across hospital and community services
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
◦ 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
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
Negotiate Psychology input for the service
Resources for parents and professionals
Training of wider teams
Video-fluoroscopy service