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KIDS Annual Report 2014/15 2

REFERRAL HOTLINE 0300 200 1100

www.kids.bch.nhs.uk

[email protected]

@BCH_KIDS


TABLE OF CONTENTS

Introduction

Highlights of 2014/15

Mission Statement

Service Standards

KIDS Organisational Structure

Personnel

Activity

Geographical Location of Referring Hospitals to KIDS 2014/15

Summary of KIDS KIDS Activity 2014/15

WM Hospital Referrals to KIDS 2014/15

Out of Region Hospital Referrals to KIDS 2014/15

Referring Department Categories 2014/15

PICANet Groups of Referred Patients 2014/15

Mobilisation, Stabilisation and Duration Times 2014/15

Run Chart – Transport Decision Time to Team En Route 2014/15

Run Chart – Stabilisation Time (Time KIDS team spent at Referring Hospital)

Run Chart – Transport Decision time Arrival at Destination 2014/15

Preference and Destination of KIDS Referrals 2014/15

Clinical Governance

Adverse Incident Reporting

Safety and Care Quality Monitoring

Parent and Child Feedback

Education and Training

Simulation Training


Outreach Education

Management and Leadership Developments

Away Days

Regional and National Collaboration

WM Newborn Transport Service

Continuing Professional Developments and External Works

Service Developments

Events and Celebrations

KIDS 5th Birthday Celebration.

Plans for 2015/16


INTRODUCTION

KIDS provides paediatric critical care decision support and transport for the West

Midlands. KIDS is hosted by Birmingham Children’s Hospital NHS Foundation Trust

(BCH) in collaboration with University Hospital of North Staffordshire NHS Trust

(UHNS). The service is based at 1, Printing House Street, Birmingham – adjacent to

the main BCH campus.

KIDS serves the 20 District General Hospitals in Staffordshire, Shropshire, Birmingham

and the West Midlands, Coventry, Warwickshire, Herefordshire and Worcestershire.

Two paediatric intensive care units (PICS) operate within the West Midlands – one at

BCH and one at UHNS in Stoke-On-Trent.


HIGHLIGHTS OF 2014/15

2014/15 saw KIDS move into their 5th year of operations whilst it’s host trust, BCH,

went through a period of restructure of its directorates with KIDS moving into the

Directorate of Urgent and Critical Care.

KIDS Clinical Lead Dr. Mary Montgomery was appointed as the Clinical Service

Director for the new Urgent and Critical Care Directorate, Dr. Sanjay Revanna

became the Deputy clinical lead for KIDS, Dr. Intikhab Zafurallah was appointed

into a substantive 50:50 post between KIDS and BCH PIC and the KIDS full time

consultant pool was further expanded with the appointment of two locum KIDS

consultants.

KIDS Lead Nurse Phil Wilson was appointed as the Deputy Lead Nurse for the

new Urgent and Critical Care Directorate with KIDS Senior Sister Emma Bull

being appointed to the post of KIDS Lead Nurse and Sister Sarah Taylor was

appointed as the Senior Sister for KIDS

KIDS Junior Sister Sarah Webb commenced training to be the 2nd full-time KIDS

ANP.

KIDS successfully undertook their first air transfer of a child receiving High Flow

Nasal Cannula O2 respiratory support.

KIDS presented one poster and one oral presentation at the Paediatric Intensive

Care Society (PICS) conference, in Newcastle.

KIDS trained 6 new transport nurses and 12 new transport team leaders

(doctors/ANP’s).

KIDS and BCH IT won a ‘Highly Commended’ Award at the Building Better

Healthcare Awards in November 2014 for the Openscape Xpert

Telecommunication system used in KIDS operations centre.


KIDS Mission Statement

To provide the right solution, at the right time, and in the right place, for babies,

children, and young people and their families with critical care needs throughout the

region, with timely high quality decision support, PIC bed finding and critical care

transport.


KIDS Service Standards

1. KIDS will comply with the Paediatric Intensive Care Society Standards (2010) –

‘Retrieval and Transfer of the most critically ill children.’

2. KIDS will maintain core infrastructure operational 24 hours per day, 365 days of

the year, including:

i. Operations Centre staffed with trained administrators and dedicated single

referral telephone number;

ii. Trained Transport Team;

iii. Fully maintained transport equipment, drugs and disposables.

3. On-site dedicated bespoke critical care ambulances and trained drivers

4. The referral line will be answered within 5 rings

5. The referrer will be connected to the KIDS Consultant within 5 minutes

6. KIDS will comply with the appropriate policies and procedures of BCH

7. KIDS will participate in all care quality surveillance and improvement processes

including clinical governance, mandatory training, infection control,

documentation, child protection and patient experience

8. KIDS will use standard operating procedures (SOPs) for informing service

delivery. These will be held on the KIDS Intranet, with indexing & version control

9. The KIDS website will be maintained with service information, clinical guidelines,

drug calculator and feedback mechanisms in place

10. KIDS will maintain close working relationships with PIC at BCH and UHNS;

11. KIDS will relentlessly pursue continual improvements in the delivery of best for

patients and families. This will include care quality, patient experience, capacity

management, medicine, nursing, administration, ambulance provision,

information technology, telecommunication, research, innovation, risk

management, education, leadership and customer service.


KIDS ORGANISATIONAL STRUCTURE

KIDS

(BCH Urgent & Critical Care

Directorate)

KIDS Clinical

Lead

KIDS Senior

Sister

Administration

Team Leader

Sessional

Consultants

KIDS Registrars

& Fellows

KIDS Consultants

KIDS Lead Nurse

KIDS ANP

Rotational

Nurses

KIDS Junior

Sisters/Charge

Nurses

KIDS Volunteer

Call Centre

Administrators

SJA Team Leader

KIDS ANP

Trainee

SJA Technician’s


KIDS Personnel 2014/15

KIDS Consultants

Dr Mary Montgomery(Clinical Lead)

Dr. Sanjay Revanna

Dr. Intikhab Zafurallah

Dr. Aravind Kashyap

BCH Sessional Consultants

Dr. Annemieke Miedema

Dr. Richard Neal

Dr. Barney Scholefield

Dr. Gale Pearson

Dr. Fiona Reynolds

Dr. Dave Ellis

Dr. Steve Cray

Dr. Tina Newton

Dr. Afeda Ali

Dr. Linda Edward

Dr. Reinout Mildner

Dr. Jane Cassidy

Lead Nurse

Phil Wilson

Senior Sister

Emma Bull

KIDS Junior Sisters (B6)

Kelly Robinson

Jackie Somerfield

Joanne Webb

Sarah Taylor

BCH PIC/KIDS Junior Sisters/Charge Nurses (B6)

Sarah Webb (up to Sept 2014)

Rebecca Fry

Sharon Hale

BCH PICU Rotational Staff Nurses

(B5)

Louise Kelly

Kate Evans

UHNS PICU Rotational Junior Sisters

(B5/6)

Sue Dodd

Candi Martin

Rebecca Middleton

Elizabeth Lloyd

Leanne Lovatt


UHNS Sessional Consultants

Dr. Mark Bebbington

Dr. Pavanasam Ramesh

Advanced Nurse Practitioner

Anneke Gyles

Advanced Nurse Practitioner Trainee

Sarah Webb (Sept 2014)

Advanced Nurse Practitioner (PICU)

Steve Cossey

Rachael Morrison

KIDS Fellows / Registrars

Dr. Damien Keene

Dr. Sanjay Swamy

Dr. Neil Crooks

Dr. Claire Bosanko

Dr. Medha Chillal

PICU Registrars / Fellows on rotation

Dr. Rizwan Saxena

Dr. Jarrod Cross

Dr. Shri Alurkar

Dr. Mark Russell

Dr. Manu Sundarum

Dr. Guru Venkatesha

Dr. Edgar Brincat

Dr. Georgina Harlow

Other Fellows / Registrars

Dr. Danni Seddon

Dr. Jeremy Tong

Dr. Balazs Fule

Dr. Ashwath Rao

Dr. Andrea Cooper

Dr. Gan Chin Seng

Dr. Chris Flannigan

Dr. Richard Browne

Dr. Janet McCluskey

Dr. Vishnu Meedimale


KIDS Operations Centre

Call - Centre Team Leader (B4)

Hayley Osmani

KIDS Governance Support Administrator

(B4)

Yasmin Powell

Administrators (B3)

Richard Murphy

Lorraine Rooker

Sarah Casey

Mathew Weir

Christopher Rodgers

Emma Robson

KIDS Volunteer

Pam Kumar

St John Ambulance Services Operations

Manager- West Midlands Region

Samantha Fawcett

Ambulance Technicians

Darren Elgerton

Jayne Wilson

Christiaan May

Paul Colton

Mathew Phillips

Pawel Luczak

Kevin Haggett

Margaret Herbert

Ray Edwards

Dylan Jones

Phil Bone

Alan Jinks

William Byrne

Phil Sprigg


Activity

Geographical Location of Referring Hospitals to KIDS 2014/15

Summary of KIDS Activity 2014/15

Location of referral

No.

West Midlands Hospitals 1211

Out Of Region Hospitals 153

Total Referrals 1364

Outcome

No.

KIDS Transfer 627

NTS Transfer 179

CNN Transfer 9

Referring Team Transfer 108

Other Team Transfer 46

Not Transferred 395

Total Referrals 1364


West Midlands Hospital Referrals to KIDS 2014/15


Out of Region Hospital Referrals to KIDS 2014/15


Referring Department Categories 2014/15

PICANet Groups of Referred Patients 2014/15

0 50 100 150 200 250 300 350 400 450

Liver

Body Wall/Cavity

Blood OR lymph

Multisystem

Trauma

Other

Cardiovascular

Respiratory

PICANet Groups of Referred Patient 2014/15


Mobilisation, Stabilisation and Duration Times 2014/15

Run Chart – Transport Decision Time to Team En Route 2014/2015

Times Lower IQR Median Upper IQR

Referral to Acceptance 00:13 00:35 03:51

Acceptance to Mobilisation 00:09 00:15 00:45

Acceptance to Arrive DGH 00:32 00:50 01:31

Stabilisation 01:11 01:41 02:28

Total Episode 03:35 05:02 06:40


Run Chart – Stabilisation Time (Time KIDS team spent at Referring Hospital)

Run Chart – Transport Decision time Arrival at Destination 2014/15

Preference and Destination of all KIDS Referrals 2014/15

BCH = Birmingham Children’s Hospital

UHNS = University Hospital North Staffordshire

UHL = University Hospitals of Leicester

NUH = Nottingham University Hospital

QMC = Queens Medical Centre

OOR = Out of Region

Referrers Preferred Destination

Actual Destination

West Midlands East Midlands

Other Total

BCH UHNS Other West Midlands

UHL QMC Taken OOR

Not Transferred

BCH 444 35 11 8 3 15 17 533

UHNS 3 70 0 0 0 1 3 77

UHL 0 1 0 8 0 0 0 9

NUH 0 0 0 0 2 0 0 2

Other West Midlands

4 1 119 2 0 1 3 130

OOR 1 0 1 0 0 46 5 53

No Preference 49 81 22 2 3 18 385 560

Total 501 188 153 20 8 81 413 1364


Clinical Governance

Adverse Incident Reporting:

KIDS continues to report using the incident reporting system at BCH.

Threshold for incident reporting is low – resulting in high volume of incidents

reported (One of the highest in the Trust, despite small size of KIDS). This

reflects healthy reporting culture, and is encouraged. Incidents are reported as

relating to KIDS team (equipment/communication/clinical and other) or

relating to referrer activities. Management of the non-KIDS incidents – i.e.

those relating to referrer activities – can be difficult to classify due to the

nature of the reporting system and field designation. KIDS works closely with

the BCH Governance department to assist in clarifying designation as ‘KIDS’ or

‘other hospital’ incidents, and continue to work towards developing a system

for managing ‘non-KIDS’ incidents. Most KIDS incidents have caused no harm

to patients. We have also had no SIRI/ DLR/ never events in the year.

All cases referred are reviewed and discussed by the KIDS team in the morning

meeting. Any issues raised are managed in a timely fashion through the

existing channels (depending on nature of issue: equipment, clinical, team

working, communication). Issues relating to ‘non-KIDS’ activities are fed back

directly to the referring centre through the BCH governance system.

Monthly incident reporting is to the Directorate Management Team, with

scrutiny of patterns or significant incidents. KIDS hold monthly M&M meetings

and attend BCH PIC monthly M&M. Any cases requiring higher level scrutiny

are discussed with the BCH Governance department and appropriately

actioned.


Safety and Care Quality Monitoring

In 2014 BCH continued to enshrine the lessons from the Berwick Report, the

Report with the implementation of their new Safety Strategy for 2014-2017.

There was a focus on a pro-active approach to safety with recognition of the

need to engage in human factors training and ensure our systems were robust

and regularly reviewed.

KIDS continues to pursue an open and honest governance structure, with a

high level of reporting of incidents. The high level vigilance of KIDS ensures

physical resources are in a state of readiness and that minor deviations of

standard practice are recognised and addressed swiftly.

KIDS framework for ensuring safety and care quality are maintained includes;

Strong, stable management team focussed on effective and progressive

clinical leadership.

Thorough recruitment process – building a skilled, professional,

motivated and stable team.

Comprehensive training and annual reaccreditation.

KIDS Standard Operating Procedures available on BCH KIDS Intranet Site

Well-resourced and effectively managed equipment store, with on-line

manuals, teaching packages, repair and maintenance plans empowering

all staff to address problems.

Equipment checks, vehicle checks, operations centre checks monitored.

Audit of Critical Incidents, KIDS risk register and serious incidents.

Audit of Mobilisation, stabilisation, transport duration times and ‘blue

light’ usage.

Implementation of all BCH care quality surveillance monitoring; Infection

Control, Child Protection, Documentation, Patient Experience and

Referrer Experience.


Parent and Child Feedback - Child and Family Steering Group

KIDS continued to gain all types of feedback received from patients and

parents, in order to gain a more critical insight of the issues they face when

their family experiences a critical care transport.

Some examples of feedback received from parents;

“In the ambulance with the phone charger I was able to reply to the hundreds of texts I

was getting from everyone about what was going on! Really glad you let us both travel &

we hadn't eaten for hours. So thanks for the Ribena & Chocolate.”

“They were totally amazing! They spoke to us lovely & so kind! They seemed really

bothered about our comfort. They were so reassuring, that they knew what they were

doing! The drink and snack was so needed. Dairy Milk just perfect! For a stressed mum!”

“The offer of the Sat Nav was good. The team helped us in this stressful time for us.”

Themes within feedback received during the year 2014/15 were, by far the

most frequent, about the parent snack packs (that were introduce in the year

2013/14 on the back of parent feedback), the phone charges in the

ambulances (again introduced in 2013/14 as a result of parent feedback), the

professional manner of the KIDS team and their calm and caring natures.


Education and Training

KIDS trained and signed-off 12 new clinical team leaders (12 registrars/clinical

fellows and 1 PIC ANP) and 6 nurses in transport during 2014/15. This was

achieved through in –house study days and 1:1 training from KIDS consultants

and senior nurses.

KIDS continues to provide placements for other healthcare students and other

healthcare professionals (doctors, nurses and paramedics) to observe the KIDS

team at work. Feedback remains positive about KIDS as a learning

environment for paediatric transport, service coordination and team-working.

Demand for places continues to rise.

Simulation Training

Dr Zafurallah leads on delivery of the simulation programme. The high fidelity

SimBaby owned by KIDS is used for training of staff at KIDS and throughout the

region. It is an effective tool for delivery of real time scenarios. Dr Zafurallah

and a team of KIDS nurses trained in simulation use SIM frequently to delivery

training around human factors and crew resource management, improving

team working in complex and stressful environments. This training is not only

provided for KIDS team members but also for those in the region.

Outreach Education

KIDS has, within its available resources, delivered outreach education to many

of the district general hospitals (DGH) across the region. Requests for outreach

education are regularly received and are commonly cited on the ‘feedback

questionnaires’ received from hospitals after each transport.

The ‘Stabilisation of the Sick Child’ study day was led by the KIDS team at at

BCH upon 2 occasions during 2014/15 to a multidisciplinary audience of

doctors and nurses from WM region.


Simulation training in progress


Management and Leadership Development

2014/15 saw quite a change in the management structure of KIDS as BCH

restructured.

In October 2014 KIDS Lead Nurse Phil Wilson was appointed to the position of

Deputy Head of Nursing for the new Urgent and Critical Care Directorate

following the restructuring of its directorates.

In January 2015 KIDS Senior Sister Emma Bull was appointed to the post of

KIDS Lead Nurse

KIDS Consultant, Dr. Intikhab Zafurallah was appointed into a substantive post

50:50 with BCH PIC.

Away Days

The KIDS Team had a multi-disciplinary away day in November 2014 at the

Thistle Hotel. The theme for the day was the implementation of the Trust

values – with emphasis upon the value of ‘Respect’.


Research and Audit

Poster Publications – Paediatric Intensive Care Society Conference (2014) -

Newcastle

KIDS presented one poster publication and delivered one oral presentation at

the Paediatric Intensive Care Society conference which took place in

Newcastle, during September 2014.

KIDS Lead Nurse Phil Wilson delivered the oral presentation, titled, “Customer

Service Theory Improves Patient and Staff Experience in a Paediatric Transport

Service” and won the prize for the best free paper presentation.


Regional and National Collaboration

WM Newborn Transport Service

The merger project of KIDS and the WMNTS continues.

Continuing Professional Development and External Work

KIDS ANP Anneke Gyles had the opportunity to sit on the working group for

the new ALSG transport course NAPSTaR. Anneke, with input for the KIDS band

6 team contributed 2 new chapters to the course manual.

Service Developments

New switch board and training of the relevant staff

Training of ambulance staff to perform additional roles- arterial flush

system, help with monitoring etc

RCPCH approval for CPD points of our stabilisation day programme

Discussion and set up of the new database system which went on air

from 1 April 2015.

Events and Celebrations

KIDS celebrated their 5th year of service with a ‘Childrens Party’. It was a a fairly

informal affair, held in the conservatory at BCH with party food, children’s

entertainment, face painting and music. Families who KIDS had maintained

links with, including those who have kindly donated money to the KIDS Charity

Fund were all invited, even BCH CEO Sarah-Jane Marsh attended!


KIDS 5th Birthday Celebration

Plans for 2015/16

Full merger of KIDS and WMNTS.

Further development of the KIDS ANP team.

Develop outreach teaching to involve ‘in-situ’ simulation.

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