Doctors behaving imaginativelyBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1010 (Published 24 February 2010) Cite this as: BMJ 2010;340:c1010
- Tony Delamothe,
The judges for the BMJ Group Award for the secondary care team of the year were looking for UK teams that had produced measureable improvements in outcomes that mattered to patients. Evidence of team work was given high priority; and, with a nod to the current economic climate, we encouraged entries implemented within the organisation’s existing resources.
Altogether we received 26 entries, from which the judges shortlisted four. Many great sounding initiatives didn’t make the cut because they lacked robust data on patient outcomes. Of the shortlisted entries two came from distant edges of the country, while two came from metropolitan London.
The Emergency Medical Retrieval Service (EMRS), which is based at the Glasgow City Heliport, has transformed the care and transfer of seriously ill and injured patients in remote and rural Scotland. Two dozen healthcare facilities in such areas receive emergency patients without onsite emergency physicians or intensive care units.
The initiative began in 2004 with 10 consultants delivering a 24 hour a day advisory service for seven remote hospitals on a voluntary basis. In 2008 the EMRS was established as a government funded pilot to provide training and support to rural clinicians as well as rapid access to a critical care consultant who could assist with onsite assessment, resuscitation, and stabilisation before initiating air transfer to definitive care in an urban hospital.
About two thirds of calls are medical emergencies and a third for major trauma. The mean time from referral call to arrival of patient in a definitive care centre is 3.75 hours. While the predicted mortality among these patients was 25%, as calculated by the acute physiological and chronic health evaluation (APACHE), observed mortality was 17%. The service is saving an estimated 24 lives each year on the west coast of Scotland.
Patients of the diabetic retinopathy team at the Royal Cornwall Hospital, Truro, may be surprised to receive invitations directing them not to the hospital but to a mobile clinic opposite television chef Rick Stein’s café on Padstow quay or by a veterinary practice near Newquay. Thanks to a new, self contained eye screening unit patients no longer have to trek miles for their annual appointment: retinal photography can now be performed in the remotest village. The service sees more than 23 000 patients each year in 70 locations, referring 500 patients to three district general hospitals for treatment. Easier access has increased patients’ take-up of the service by over 30%.
Identifying patients with sight threatening retinopathy has been only the first part of the process. Much attention has also been given to getting timely expert surgical and medical input in what is a team effort, involving ophthalmologists and diabetologists. To accommodate urgent appointments the system of booking and managing clinics has been streamlined. A recent external quality assurance by the English National Screening Committee highly commended the service for its innovation.
The heart attack and stroke team at Royal Free Hospital, London, provides the first fully integrated, direct access heart attack and stroke centre in the United Kingdom. Recognising the clinical synergies between acute “heart attack” and “brain attack,” the hospital’s departments of cardiology and neurology integrated their primary angioplasty and stroke thrombolysis services. Patients are given direct access to the service, bypassing the accident and emergency department. The pathway is triggered by the London Ambulance Service, which alerts the hospital’s switchboard via a dedicated hotline.
A key component in service integration has been a multiskilled “receiving team,” trained to assess and manage both heart attacks and strokes. After treatment, patients are transferred to an integrated heart attack and stroke unit, with guaranteed ringfenced beds.
For stroke, the median door to needle time is 49 minutes, and for heart attack the median door to balloon time is 46 minutes. These times put the Royal Free among the top performing stroke and heart attack services in the country. The team attributes its success to excellent multidisciplinary working between the hospital’s departments of cardiology, neurology, and radiology along with the London Ambulance Service’s close collaboration.
The 56 Dean Street clinic is an outpost of Chelsea and Westminster Hospital NHS Foundation Trust in the heart of Soho, London. It counts 50 gay venues within a 500 m radius and is therefore close to major reservoirs of undiagnosed HIV infection.
Audits of new HIV diagnoses show that a significant number of individuals present late with advanced disease, often with considerable morbidity and mortality. Reducing the proportion of undiagnosed HIV infection has been identified as a priority by England’s national strategy for sexual health and HIV.
In surveys of men attending gay bars, clubs, and saunas in central London, 11% tested positive for HIV, half of whose infection was previously undiagnosed. To address this, 56 Dean Street developed a walk-in, rapid testing service for HIV, which guarantees HIV test results within the hour. The service operates for eight hours a day, six days a week.
In the first six months 200 new cases of HIV infection were diagnosed, a number similar to that for the previous 12 months. Patient approval is high, and the number of patients is rising as awareness of the new service grows.
The five judges—Michael Burke, medical director at the North West London Hospitals NHS Trust; Bernard Crump, chief executive officer of the NHS Institute for Innovation and Improvement; Jonathan Fielden, a member of the BMA council and fellow of the Department of Health’s National Leadership Council; Neil Douglas, professor of respiratory and sleep medicine at the University of Edinburgh; and Andrew Vallance-Owen, group medical director of BUPA—have a tough job ahead of them in choosing the ultimate winner.
Cite this as: BMJ 2010;340:c1010
The award is sponsored by MDDUS, headline sponsor of the BMJ Group Awards. For more about the awards go to http://groupawards.bmj.com/.