Preventing thrombosis A Chief Executive’s view

Guy Vautier James Paget University Hospitals NHS Foundation Trust Consultant Physician

Background  Great Yarmouth and Waveney has a population of 240,000, which is ageing faster than national averages, 37% increase in 65 to 75 year age group in next 10 years  Both Great Yarmouth and Lowestoft have significant levels of deprivation (Top 10 in UK)  Of the 27,000 inpatients seen at the James Paget, 80% are acute emergency  Nearest other acute facilities are:  Norfolk and Norwich University Hospital 35 miles west  Ipswich Hospital 50 miles south

History  Successful organisation – second wave NHS Trust 1993  Always achieved financial targets without brokerage, breakeven as NHS, surplus as FT  Only Three Star Trust in Norfolk, Suffolk and Cambridge SHA, 2004/05  Became FT 1st August 2006, the first in Norfolk and Suffolk  University Hospital status 1st August 2006  Health Care Commission rating Excellent / Excellent 2007/08

 Audit Conclusion:  Still need to increase thromboprophylaxis awareness  Prescribers not necessarily dose aware  Opt in verses opt out debate (99% medical patients eligible) Turning point - Audit

Main focus  Opt out is a positive approach  All will be given unless  Unification of documentation  Make the right thing to do, the easiest thing to do (For example pre-printing documentation)  Changing ownership  Nurse intensified (not Haematology)  Pharmacy  Team / Group approach

Exemplar Status - opportunity Opportunity for our health system to be accredited in terms of exemplar status. This is important because: a. It will gives confidence and to reassure our community b. It will consolidate our position of partnership with our PCT c. It will give recognition to the clinical teams that are delivering the service In real terms: a.Improvement in the management of DVT b.Improvement in the management of PE c.Reduction in the number of deaths CHOICE PARTNERSHIPS CLINICAL LEADERSHIP PATIENT SAFETY CLINICAL EFFECTIVENESS PATIENT EXPERIENCE

Ongoing work Where are we now?  Rolling programme of audit (Pharmacy)  Emergency  Elective programme  Spot checking (Anticoagulation Nurse)  Undergraduate projects (UEA partnership)

Impact  VTE – Compliant, Continually reviewing, Growing knowledge  Wider implications  Improvement in patient safety agenda  Improvement in clinical outcome  Improvement in attitude toward change  Improvement in patient experience & information  Improvement in multi-disciplinary working  Improvement in quality

Challenge  To continue learning  To share knowledge  To save lives  HCC / CQC core standards unchanged  SHA have a responsibility to influence commissioners  PCT must include in contract negotiations:  Patient safety  Clinical effectiveness  Patient experience  Quality reports / accounts  Acute hospitals have a “responsibility”