Nottingham University Hospitals NHS Trust

“Aortic Dissection Improvement project. This work will be undertaken by an Acute Aortic Dissection Improvement Group led by the Cardiac Surgery team, with support from colleagues in the Emergency Department, Acute Medicine, Stroke, Radiology, Patient Safety team and the Medical Director's Office, and involves other teams such as Stroke and Radiology etc as required.”

“All patients who are planned to be transferred from an NUH in patient bed into Linden Lodge are now required to be physically assessed and reviewed by a Consultant from Linden Lodge, prior to transfer. This is to ensure that the patient is medically stable and suitable for transfer and for care within the Neuro-Rehabilitation Unit. The team are developing induction guidelines for junior doctors working in Linden Lodge, supported by an escalation process where a patient may be at risk of clinical”

“- The referral pathway has been completely re-designed and will move away from the old 'NOTis' based information system to Medway orders (the current information system in use in the Trust) from 14 February 2022. The Medway order will incorporate: information on the indication, latest blood tests, date and findings of relevant imaging, capacity for consent, awareness of LPA, highlighting potential factors for "higher risk" procedures, and seek history or symptoms of dysphagia for any procedure”

“Broadening understanding of the Medical Examiner process through more widely engaging maternity and paediatric staff through training and awareness seminars. There will be sharing of expectations of information needed by the Medical Examiner for early and robust collection of relevant details from Neonatologists, Paediatricians, Midwives, Obstetricians and parents/carers/family.”

“Provision of record keeping training to staff on Turner Ward to ensure that staff are reminded about the Trust's expectations in respect of the record keeping”

“Development and implementation of a discharge checklist to ensure that the discharge procedure safeguards patients' clinical needs more robustly and supports healthcare staff”

“Audits to monitor implementation of the discharge checklist”

“Update of the HTT Service Operational procedure to ensure that the patients are not discharged without HTT or ACAT assessment, in the cases where there is a suggestion that the patients may benefit from HTT service input”

“Update to Trust's Clinical Handover of Care and Discharge Policy to ensure that the discharges take place more safely and effectively, and the referrals have been effectively completed to address the clinical needs of the patient as required”

“The NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 - 2023/24, commits to new and integrated models of care between crisis, acute, primary and community services.”

“taken. A new protocol has been written after consultation with the following groups: - NUH Critical Care Consultants - NUH Theatres and Anaesthetic teams - NUH Surgical Divisional and specialty teams (including Neurosurgery and Gastroenterology) - NUH Interventional Radiology - NUH Medical Division and specialty teams (including Stroke team) - Mid Trent Critical Care Network and Clinical Leads. - Medical Directors and Critical care service leads at NUH, Lincoln, Derby and Kings Mill Hospitals. - Sheffield”

“A Root Cause Analysis is routinely employed in all cases of incorrect referrals for medical imaging. The RCA will generate an action plan which is managed by the responsible Directorate. The RCA for this patient is attached (appendix 1). It is difficult to be certain of the cause of the patient identification error. The experienced (Consultant) investigator concludes that the most likely cause to be a mistake whilst using the electronic requesting system (Notis). It is possible to open multiple”

“The new guideline to assist with the prompt and appropriate treatment of patients who are on warfarin presenting with Intra Cranial Haemorrhage has now been agreed by all parties involved and accompanies this letter.”

“A new guideline has been prepared which I am confident will provide more rapid intervention in the management of anticoagulation and will clarify which specialty is responsible for this element of care.”