North West London Critical Care Network
Confirmed notes for JCFB meeting 6 March 2014
North West London Critical Care Network
Network Joint Clinical Forum Board
Action notes of the Network Joint Clinical Forum Board meeting held on
11th December 2013 from 5.30 –7.15 pm at the Royal Overseas League (Wrench Room)
Action Note
Present
Jeremy Cordingley
Jonathan Handy
Eve Corner
Andrea Blay
John Vogel
Sohan Bissoonauth
Ruth Griffin
Wendy Willingham
Debs Adley
Nigel West
Dr Mo Ali
Roseanne Meacher
Steve Brett
Liz Staveacre
Linsey Christie
Andy Dimech
Catherine Forsythe
Tessa Longney
Veronica Marsh
Angela Walsh
Gezz Van Zwanenberg
(Chair) RBH - Royal Brompton and Harefield Hospitals NHS Foundation Trust
Chelsea and Westminster NHS Foundation Trust
Chelsea and Westminster NHS Foundation Trust
Chelsea and Westminster NHS Foundation Trust
Ealing Hospital NHS Trust
Hillingdon Hospital NHS Foundation Trust
Hillingdon Hospital NHS Foundation Trust
Hillingdon Hospital NHS Foundation Trust
Hillingdon Hospital NHS Foundation Trust
Hillingdon Hospital NHS Foundation Trust
Inner NWL Integrated Care Pilot
Imperial College Healthcare Trust – Charing Cross site
Imperial College Healthcare Trust – Hammersmith Hospital site
North West London Hospitals Trust – Northwick Park Hospital site
Trainee - Royal Brompton and Harefield Hospitals NHS Foundation Trust
The Royal Marsden NHS Foundation NHS Trust
The Royal Marsden NHS Foundation NHS Trust
West Middlesex University Hospital NHS Trust
Trainee – The Lister Hospital
Critical Care Network
Critical Care Network
Apologies for absence
Ganesh Suntharalingam – NWLHT NPH, Tim Wigmore – RMH, Rohit Juneja – RMH, Jacek Borkowski – CMH, Doris Doberenz
–ICHT CXH, Elaine Manderson –C&W Heather Spurgeon – RMH, Chris Woollard-THH, Anthony Bastin – RBHT, , Katie ScalesICHT CXH, Julie Oxton - ICHT St M, Fionna Moore LAS, Gary Wares – RMH, Barbara Thomas – WMUH, Craig Brown – RBHT,
Joan Milton – NWLHT NPH, Barbara Walczynska – WMUH,
1.
Welcome
Who
When
Who
When
Who
When
Who
When
Jeremy Cordingley welcomed all members to the Network’s Joint Clinical Forum Board. Apologies for
absence were noted (See above). Jeremy also welcomed Dr Mo Ali, a GP from primary care in North West
London who was joining the meeting as joint lead for the Network’s work programme on rehabilitation
after critical care.
2.
Agree the notes of the last meeting held on 25th September 2013
th
The notes of the Network Joint Clinical Forum Board meeting held on 25 September 2013 were agreed.
3.
Matters arising not on the agenda
There were no matters arising that were not included as substantive items on the agenda
4. Update from each site/member
General/ patient pathways/winter issues
Charing Cross – working at capacity at the moment
Chelwest – staffing remained difficult with the added complication of refurbishment of the Burns
unit. JMH reported that he was looking to re-instigate the TCCDG and was liaising across all acute
specialities to determine membership. AW agreed to send out the Network guidance on TCCDG
and would be available to support JMH with set up if required
Hillingdon – RG reported that capacity discussions were on-going. Executive membership of the
Page 1 of 5
North West London Critical Care Network
Confirmed notes for JCFB meeting 6 March 2014
local TCCDG was again in place.
Ealing – JV reported that the unit was often over capacity – there had been some recent discharge
delays. Daily meetings about beds had started to happen and the effect of these on delayed
discharges from ICU was being monitored.
Royal Marsden– remains busy – Some movement of nursing seniors to support outreach
(maternity cover). Variable agency rates and whether other units were finding it harder to fill
agency shifts was raised.
Royal Brompton – busy with lots of transfers. ECMO is running at approx. 1 patient admission per
week. Recently the units had 2 children and 3 adults at same time which had started to affect
supplies –now resolved.
West Middlesex – nothing extraordinary to report, busy but steady. Grateful to network for
support in making appointments
Actions
1. AW to send JMH Network TCCDG guidance
2. Vacancy rates to be tabulated and sent to all Nurse leads for sense check once received. All units to
provide a return to Gezz.
5.
NICE CG 83 Rehabilitation after Critical illness
AW
GVZ
Who
Steve Brett and Mo Ali (GP)
5.1 Network wide survey
The Network wide summary survey of provision on communication with primary care, patient
engagement and provision of rehabilitation had been circulated to all members for the second
time. The likely standards for provision of rehabilitation after critical illness expected in the
standards due in 2014-15 w. (National Critical Care Service Specification, London Standards, ICS
and FICM standards) were discussed. It is anticipated that these metrics will be reflected in the
commissioning intentions and built into Trust contracting discussions April 2014 onwards. It was
agreed that all unit leads would use the Network wide summary to support work by the
respective Trust CCDGs locally.
5.2 Digital work-up
SB, AW,MA GVZ had met with the Network’s digital partner to discuss mini film outlines to
support patient rehabilitation after critical illness. These will aim to bridge the flow of education,
information and understanding between hospital and community /primary care teams. Work was
on-going to develop understanding of the ICP and how we might support education and video
material. Filming is planned for 2014 with some content to be filmed at a hospital ICU and some
in the community and primary care setting .
5.3 Admission and discharge to and from critical care - notifications to GPs
The progress on ensuring GPs were informed that a patient has been admitted or discharged
from critical care was discussed. The aim being to ensure the critical care patient’s GP was well
informed with advance notification. This would help support primary care needs where there
were impacts on patient family – e.g. partners and or young children. Also to flag up that their
patient was likely to be coming out of hospital in the future and would have follow up and review
needs.
MA confirmed that, currently, faxing information to GP surgeries in NWL was the best and most
efficient method. Using NHS mail, it was possible to email to a fax number. Each ICU would need
to engage their IT department about NHSnet requirements to use attachments generated on local
IT such as admission or discharge summaries. RM had been working on this locally.
MA reported that, as a GP, he was unable to see emails sent via acubase, hence the need for Fax.
There was discussion about being consistent in labelling the fax notification sent to GPs such as
Critical Care – Admission to ICU and Critical Care Survivor – Discharge from ICU
MA agreed to research and supply fax numbers for all surgeries and GPs in NWL. Units would
then be able to test clinical information flow with primary care colleagues locally.
5.4 Care planning in primary care for critical care survivors - design of GP clinical template in NWL
Dr Mo Ali provided an introduction to primary care provision, background and some challenges for NWL
412 GP practices in NWL
Page 2 of 5
Dec
2013
March
2014
When
North West London Critical Care Network
Confirmed notes for JCFB meeting 6 March 2014
1800 GPs , each GP usually dealing with minimum of 3 trusts
ICP for NWL – aims to get rid of complexity across social and health divide
Post discharge medication ( need for a repeat Prescription )is the most frequent contact and
often first contact for GP after discharge
Scope of MDG meetings - 50,000 patients supported locally via the MDGs across west London
(local and specialist)
selection process used for entering this type of care planning
need to determine process for critical care survivors with aim being to tap into MDGs and ICP
infrastructure
Ministerial approval had been given to the configuration programme SaHF. Building up
programmes in primary care had already started and CC survivors to be included in this work
MA outlined the current GP care planning pathway leading to the patient taking hand held
records away with them. Also being built into 111 and “coordinate my care”. Opportunity to
build in critical care survivors into existing plans over the next 2 /3 years
MA would provide an existing template outline which the Network Rehab group will then look to
amend/populate to form the core of the ICP care plan requirements for critical care survivors
SB thanked MA for his presentation
Discussion points raised by members
Timescale: April 2014 onwards – need to have pilot of CC survivors in the ICP system
Would need to select the pilot cohort of patient. How do we do this? How many? Could 3 days
ventilated in ICU be a proxy? What volume of patients would this trigger?
Modelling – risk with 3 day LOS – half of RBHT patients would fit criteria for example
Setting goals – patient centric – what goals – top 5% of the high risk groups, ? 10,000 patients in
that group?
Patients in the ICP pathways already? Can we cross match existing data to find post critical care
patients?
Most discharged patients, discharged to own home not requiring complex on-going chronic
disease management. Patients preferred seeing local primary care services and linked to GP(
patient feedback data) .
SB: Some patients picked up with specific CC issues such as sub glottis stenosis/contractures and
get a rapid referral back into hospital. This could be better supported by education and
management out in primary care with support from secondary care clinicians and shared learning
through the MDGs
NW raised IT systems as Hillingdon had good communication with GPs via email systems. These
varied across the sector. Clinicians noted the “virtual” ward concept for cohorting patients.
MA confirmed that IT systems in primary care were not yet robust across acute/primary care
boundaries ; the most robust communication was via FAX
UCC centres already contact GPs via secure fax on NHS net.
Actions
3. All units agreed that they would supply their TCCDG with copies of the core standards and the
Network wide survey of rehabilitation after critical illness
4. MA agreed to supply fax numbers for all GP practices in NWL
5. Working in principle : Subject line for fax will be “critical care survivor
6. Each unit agreed to explore NHS mail options locally for sending email to fax
7. MA to produce a sample template for the Network rehab group to work with ICP on care planning
and pathways for GPs and referral to MDGs
8. Network rehab core group to continue to work with primary care on educational films that would be
carried on Network website, Trust and GP intranets.
6.
All
March
2014
All
Ongoing
All
April
2014
Core
work
2014-15
Who
National Early Warning Score – Network roll out
6.1 Progress
AB reported on the progress of the Network NEWS group and the anticipated output and work
for 2014. To recap, it had been agreed that all Trusts in NWL would implement NEWS and the
Page 3 of 5
When
North West London Critical Care Network
Confirmed notes for JCFB meeting 6 March 2014
Network had produced an organisational checklist to support local implementation.
The NEWS group were supporting
- standardised approach to roll out and education
- local variation for escalation response
AB reported that the group were now collaborating on two education slide packs being drawn
from all of the existing education materials being used by teams across every site in NWL
currently delivering the training. The two packs were split for
- “observers”
- and “responders”.
These would complement the RCP online NEWS training package and also would be the
forerunner to the Network planned film about NEWS with the working title “why bother about
the News”?
It was planned to pilot the slide pack Network education materials first , to then refine and bring
to the Network JCFB prior to making the two packs available to all those delivering NEWS
education in Trusts across NWL. All sites and professions were represented in the development.
Other discussion points included:
- research on NEWS and response across NWL
- feeding back about NEWS model findings in NWL to the RCP.
It was agreed that the Network group would submit abstracts representing the Network
members’ implementation of NEWS across a geography not just a Trust.
Discussion points
The potential for digital and technological support to the implementation of NEWS.
Anyone considering piloting solutions was invited to liaise with the Network.
JC suggested that any electronic method needed proper testing in NWL
There remained the issue of overall validation of the NEWS for some patient groups
On-going implementation, research and network wide common audit would make a significant
contribution to patient safety escalation and the validation of scoring systems.
Actions
9. Work up and refine the Education slide packs and test at pilot site
10. Work up script and story board for the NEWS film
11. Consider abstract submission
12. Technological considerations – anyone looking at implementing or piloting new technology
around early warning scores to notify network and NEWs group
9.
National Critical Care CRG update
Specification : JC reported that the critical care service specification would be put out to
consultation for 12 weeks in 2014. Network feedback had been submitted in august. The
specification would be signed off after wider consultation and then implemented. Trusts would
have until September for derogation.
ICNARC . DH/NHS England were setting up national dashboard and expected all dashboards to be
formatted the same way. DH/NHS England/ICNARC had been in discussion about meeting the
specification requirements and providing full access to NHS ICNARC data submitted by Trusts.
The NHS England expectation was for a national database but had not specifically commissioned
ICNARC.
Trusts would need to be part of the National case mix database but it might not necessarily be
ICNARC - e.g. another provider may be sourced.
JC reported that costs of ICNARC collection were currently calculated at £300 per L3 bed per year
– not known what the cost of the L2 beds would be. JC would report the Network views back at
the next CRG
JC reported that the CRG had been informed that NHS England was writing a 5 year strategy for
all specialities including critical care.
Discussion points
Benchmarking exercise of the current standards ICS /London/ specification/FICM etc. for critical
care . AW noted that such a request for benchmarking with the ICS standards had been received
Page 4 of 5
News
Group
March
2014
News
Group
June
2014
Who
When
North West London Critical Care Network
Confirmed notes for JCFB meeting 6 March 2014
from St Mary’s.
Action
13. Await final draft service specification and then run a benchmarking exercise across the Network
14. JC to report back network views and to report to Network members any intelligence received from
CRG about national database providers
10.
AOB and date of next meeting
JC
AW
June
2014
Who
When
RM
June
2014
Network Fellow
JMH introduced VM as the Network Fellow. VM would be working with AB on specific projects
linked with NEWS and Burns at Chelwest
Medical staff
RM wanted to set up a training rotational post for fellows and middle grades. Both JC and RG
stated they would like to be involved and that a 3 site rotation would be an attractive
proposition. The proposal would then go to the College although for non EU trainees , may have
to stay in one trust/hospital.
Action
15. MH, RM, RG, JC to discuss options for arranging this and presenting to the College
JC thanked everyone for attending and wished everyone a Merry Christmas. All were invited to drinks in
the bar (self-pay).
--------------------------------------------------------------------------------------------------------------------------------------------Joint Clinical Forum Board – next meeting
th
Network Joint Clinical Forum Board 6 March 2014 (6 -8pm ) Royal Marsden Hospital Board Room
Other dates currently being confirmed for 2014
Transfer Training Dates ( supported by Network wide faculty)
st
31 March 2014
Network wide ICU/HDU Royal Marsden Hospital Education Centre
th
7 April 2014
ED Transfer Course
St Mary’s Hospital
nd
22 April 2014
Local
ICU/HDU
RBHT Clinical Skills Centre
nd
2 June 2014
Network wide ICU/HDU Hillingdon Hospital Education Centre
th
5 August 2014
Network wide ICU/HDU Royal Marsden Hospital
th
4 September 2014
Local ICU/HDU
RBHT Clinical Skills Centre
th
4 November 2014
Network wide ICU/HDU Royal Marsden Hospital
Page 5 of 5