Barnet Hospital, Barnet

General Services Information

Hospital Questions

• How many single rooms are available to NHS patients? 76

• Of these how many have an ensuite toilet? 36

• Of these how many have an ensuite toilet and shower or bath? 36

• Does this hospital site operate an accident and emergency unit?

• How many specialist palliative care beds do you have available at this site? 15 Oncology and Haematology Ward bed numbers

• Are staff scheduled to be on site for a rostered session or full shift every saturday to carry out: Imaging - Magnetic Resonance Imaging:

• Are staff scheduled to be on site for a rostered session or full shift every saturday to carry out: Imaging - Computed Tomography:

• Are staff scheduled to be on site for a rostered session or full shift every saturday to carry out: Imaging - Non-obstetric ultrasound:

• Are staff scheduled to be on site for a rostered session or full shift every saturday to carry out: Imaging - DEXA Scan: Barnet Hospital : lists booked when required

• Are staff scheduled to be on site for a rostered session or full shift every sunday to carry out: Imaging - Magnetic Resonance Imaging:

• Are staff scheduled to be on site for a rostered session or full shift every sunday to carry out: Imaging - Computed Tomography:

• Are staff scheduled to be on site for a rostered session or full shift every sunday to carry out: Imaging - Non-obstetric ultrasound:

• Are staff scheduled to be on site for a rostered session or full shift every sunday to carry out: Imaging - DEXA Scan:

• If No, are staff scheduled to be on call at home available to come in and perform this test?

Trust Questions

• Do you have a process/policy for identifying patients for early supported discharge (ESD)?

• Is there currently an ESD programme for Trauma and Orthopaedics?

• Is there currently an ESD programme for Nose & Throat (ENT)?

• Is there currently an ESD programme for Paediatric Surgery?

• Is there currently an ESD programme for Urology?

• Is there currently an ESD programme for Plastic & Resconstructive? NA

• Is there currently an ESD programme for Neurosurgery? NA

• Is there currently an ESD programme for Cardiac surgery? NA

• Is there currently an ESD programme for Throacic surgery? NA

• Is there currently an ESD programme for Oral & Maxillofacial surgery? NA

• Is there currently an ESD programme for Cardiothoracic Surgery? NA

• Is there currently an ESD programme for GI surgery? NA

• Is there currently an ESD programme for Stroke Medicine?

• Is there currently an ESD programme for Care of the Elderly? NA

• Does the trust treat private patients?

Patient Safety

Trust Questions

• Do you have a system for recording operations that resulted in a foreign body being left post surgery:

• What is the reporting system for a foreign body being left post surgery? Incident reporting system- Datix

• Do you have a system for recording operations that were cancelled due to missing notes?

• What is the reporting system for operations that were cancelled due to missing notes? Incident reporting system- Datix

• Do you have a system for recording operations that resulted in wrong site surgery taking place?

• What is the reporting system for operations that resulted in wrong site surgery taking place? Incident reporting system- Datix

• During the period 01 April 2011 - 31 March 2012, how many operations resulted in a foreign body being left post surgery: 0

• During the period 01 April 2011 - 31 March 2012, how many operations were cancelled due to missing notes? 170

• During the period 01 April 2011 - 31 March 2012, how many operations resulted in wrong site surgery taking place? 0

• How many incident investigations using a full Root Cause Analysis were carried out in 2011/12? 159 These were cases declared externally as serious incidents

• What percent of patient safety incidents resulting in severe harm or death had a full RCA initiated/completed? 100%

• What percent of patients are risk assessed for venous thromboembolism on admission? 91-99%

• Is the Trust compliant with all relevant NPSA safety alerts issues in 2011/12? (you can find a full list of alerts issued at http://www.nrls.npsa.nhs.uk/resources/?p=3).:

• Do the trust have a policy for providing educational programmes on using and interpreting clinical indicators? (training): DoN / Asst DoN leads clinical indicators for all matrons weekly on both sites. Fed back to ward staff. PSAG Boards on wards to keep staff updated

• Does the trust have a designated member of staff who supports teams in locating and analysing safety and quality data? (support):

• Is safety and quality data available on a central platform and actively disseminated to users? Nursing informatics dashboard BI Oracle for all users

Trust Board Activity and Patient Safety

Trust Questions

• Over the past year, have board members received formal training in relation to patient safety?

• Have strategic goals and objectives related to patient safety been distributed to staff groups within the last 12 months?

• Allied Health Professionals staff groups have received these goals and objectives:

• Doctors staff groups have received these goals and objectives:

• Management staff groups have received these goals and objectives:

• Nursing staff groups have received these goals and objectives:

• Does the board have formal procedures for reporting inappropriate behaviours in relation to patient safety on a regular basis?

• What are these procedures? Reported from SI panel to Clinical Safet and Risk Committee ( chaired by a non-executive director) reporting to the Trust Board.

• Are there procedures for proactively responding to the reporting of staff concerns (e.g. 'whistle blowing') about patient safety?

• What are these procedures? Formal Trust Policy

• Executive walk-arounds are reported at all board meetings:

• Patient stories are reported at all board meetings:

• Board members shadow clinicians to better understand patient safety issues are reported at all board meetings:

• Board members engaged clinicians to better understand patient safety issues are reported at all board meetings:

• Infection rates are reported at all board meetings:

• Mortality rates are reported at all board meetings:

• Morbidity rates are reported at all board meetings:

• Readmission rates are reported at all board meetings:

• CQC Quality and Risk Profiles (QRPs) are reported at all board meetings:

• How many members of the board have clinical backgrounds? 3

• Does the board have a formal subcommittee that discusses patient safety issues?

Stroke Medicine

Hospital Questions

• Does this hospital have a specialist stroke unit?

• What type of unit does the hospital have? Other Acute Stroke Unit

• The number of beds in the Stroke unit: 24

• Is a trained thrombolysis stroke nurse available 24/7? No

• Is a consultant stroke physician/neurologist available 24/7? via telemedicine available at the local HASU

• Is an ST3 physician with training in thrombolysis available 24/7? No

• Does the hospital have consultant led ward rounds for stroke wards seven days a week?

Trust Questions

• Does the trust have a specialist stroke unit or units?

• Is the Trust part of a stroke care network?

• Details: North Central London

• How many emergency admissions with a primary diagnosis of stroke (ICD10 codes I60 - I64) did the trust receive in the financial year (period 01 April 2011 - 31 March 2012)? Emergency Admissions are taken directly to the HASU

• Does the hospital have a team permanently onsite which is able to provide thrombolysis for stroke patients 24 hours per day and 7 days a week?

• Does the hospital have any formal arrangements with neighbouring hospitals for the emergency transfer of stroke patients who would benefit from thrombolytic treatment?

• The name of the trust with which the hospital has these arrangements: We Transfer to UCH or NWP HASU.

Trauma & Orthopaedics

Trust Questions

• Does the trust offer a trauma service?

• Does the trust have a dedicated trauma list available 24 hours a day for the duration of the week, (Sunday to Sunday)? Half day trauma list M-F + Sat list. Outside of these times, emergency theatre access as required.

• Does the trust offer an orthopaedics service?

• Does the trust run a pre-operative patient education session/class for patients to attend prior to Total Knee Replacement (TKR) and Total Hip Replacement (THR)?

• Percentage of all patients attend the class prior to surgery (estimate): 65

• Does the trust have a standardised anaesthetic protocol for Total Knee Replacement (TKR) and Total Hip Replacement (THR) patients?

• percentage of the trusts total knee replacement (TKR) and total hip replacement (THR) patients walk within 24 hours of surgery (estimate): 95

• Does the trust provide an equivalent physiotherapy service to both elective and trauma patients at the weekend? (i.e. is the service staffed on the weekend with the same skill mix, and numbers of staff):

• How is the staffing model different? 1 or 2 therapists work reduced hours on a volunteer -based roster

• Does the Trust admit patients for total knee replacement (TKR) and total hip replacement (THR) prior to the day of surgery? Only if clinically indicated

• Does the Trust routinely record patient records using a specific multi-disciplinary team THR/TKR pathway document?

• Is this data used to monitor compliance with the agreed pathway? Data is then entered onto the National Enhanced Recovery database

• Is criteria-based discharge used? As part of the enhanced recovery programme

• Are patients routinely phoned in the first 48 hours after discharge to check on their progress?

• Do 100% of hip and knee replacements follow an enhanced recovery pathway?

• Are there daily goals for hip and knee patients to achieve?

• What day does the Trust aim to have patients ready for home? i.e. what are patients told in their information booklets and at the pre-op class: Post operation day 3

• Apart from hip and knee replacement, what other procedures have enhanced recovery pathways? Colorectal surgery

• For what percentage of hip fracture patients is the time to theatre within 36 hours of arrival to Emergency Department (or time of diagnosis (if an inpatient) to the start of anaesthesia)(%): 70%

• What percentage of hip fracture patients are admitted under the joint care of a Consultant Geriatrician & a Consultant Orthopaedic Surgeon: 100%

• What percentage of hip fracture patients are admitted using an assessment tool agreed by geriatric medicine, orthopaedic surgery and anaesthesia: 100%

• What percentage of hip fracture patients are assessed by a geriatrician in perioperative period (defined as 72hrs from admission) (Geriatrician defined as Consultant; SAS or ST3+): 100%

• What percentage of hip fracture patients receive a postoperative Geriatrician-directed Multi-professional rehabilitation team: 100%

• What percentage of hip fracture patients receive postoperative Geriatrician-directed Fracture prevention assessments (falls and bone health): 100%

• What percentage of hip fracture patients have a Pre and post op abbreviated mental test score (AMTS): 80% 100% post-op AMTS

Paediatrics

Hospital Questions

• Does this hospital offer a paeditrics service?

Trust Questions

• Does the trust provide a paediatrics service?

• Is the trust's elective paediatric surgery carried out only by designated surgeons with at least six months training in a specialist unit?

• Do the trust's anaesthetists with responsibility for paediatric anaesthesia participate in at least one paediatric list per week?

• Paediatrician on site (SpR or higher) available 24 hours per day, 7 days per week:

• At least two registered children's nurses on duty 24hours per day in each children's ward available 24 hours per day, 7 days per week:

• Is there a designated facility on site for parents or guardians to stay overnight?

• What percentage of children who are admitted to a paediatric department with an acute medical problem are seen by a paediatrician on the middle grade or consultant rota within four hours of admission? 91-99%

• What percentage of children who are admitted to a paediatric department with an acute medical problem are seen by a consultant paediatrician (or equivalent staff, speciality and associate specialist grade doctor who is trained and assessed as competent in acute paediatric care), within the first 24 hours? 61-90%

• Do All SSPAUs (Short Stay Paediatric Assessment Units) have access to a paediatric consultant (or equivalent) opinion throughout all the hours they are open?

• Is at least one medical handover in every 24 hour period led by a paediatric consultant (or equivalent)?

• Are specialist paediatricians available for immediate telephone advice for acute problems for all specialties, and for all paediatricians?

• Do all children's social care, police and health teams have access to a paediatrician with child protection experience and skills (of at least Level 3 safeguarding competencies) available to provide immediate advice and subsequent assessment, if necessary , for children under 18 years of age where there are child protection concerns. (The requirement is for advice, clinical assessment and the timely provision of an appropriate medical opinion, supported with a written report)?

Palliative Care

Trust Questions

• Does the trust provide a palliative care service?

• How is specialist palliative care is delivered at this hospital? A multi-disciplinary specialist palliative care team A multi-disciplinary specialist palliative care team with close links to community based palliative care team.

• Does the hospital's specialist palliative team include: A consultant in palliative medicine,A palliative care nurse,Other (please specify) A consultant in palliative medicine, a team of palliative care nurses and social worker

• Is the Trust's specialist palliative care team available 24 hrs a day seven days a week?

• Are facilities provided to support relatives and carers who wish to stay with a patient in hospital? Yes at Barmet Hospital, No at Chase Farm Hospital

• Does the trust routinely survey and evaluate the views of patients and bereaved relatives and carers regarding the delivery of care on the end of life programme?

Care of the Elderly

Trust Questions

• Does the trust have a named senior clinician who takes the lead for quality improvement in dementia in the trust?

• Name and job title: Sarah Fowler Care of the Elderley/Stroke Physician

• Does the trust have an explicit care pathway for the management and care of people with dementia in hospital?

• Are all appropriate nurses trained to recognise the signs of dementia and identify patients for this care pathway? Dementia Awareness Training

• Is there a process for identifying patients who are at risk of dehydration an malnutrition?

• Does the trust currently audit the number of "slips, trips and falls" using a risk management system?

• Is this information submitted to the NPSA's National Reporting and Learning System (NRLS) via the local risk management systems or e-forms?

• The total number of incidents during the period 01 April 2011 - 31 March 2012 for the category: No harm: 909

• The total number of incidents during the period 01 April 2011 - 31 March 2012 for the category: Low harm - harm requiring first-aid level treatment, or extra observation only (e.g. bruises, grazes): 757

• The total number of incidents during the period 01 April 2011 - 31 March 2012 for the category: Moderate harm - harm requiring hospital treatment or a prolonged length of stay but from which a full recovery is expected (e.g. fractured clavicle, laceration requiring suturing): 53

• The total number of incidents during the period 01 April 2011 - 31 March 2012 for the category: Severe harm - harm causing permanent disability (e.g. brain injury, hip fractures where the patient is unlikely to regain their former level of independence): 8

• The total number of incidents during the period 01 April 2011 - 31 March 2012 for the category: Death - where death is directly attributable to the fall: 3

Staffing

Hospital Questions

• Foundation Doctors, Year 1 & 2 Scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 7

• Foundation Doctors, Year 1 & 2 On call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 7

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 7

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 7

• ST3 or higher (specialist training) scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 6

• ST3 or higher (specialist training) on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 6

• Staff grade post equivalent to ST3 or higher scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 4

• Staff grade post equivalent to ST3 or higher on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 4

• Consultants scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 4

• Consultants on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 4

• Consultants on call from home on Sunday June 17th at 11:00am: 3

• Foundation Doctors, Year 1 & 2 responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 1

• Foundation Doctors, Year 1 & 2 responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round, on Sunday June 17th at 11:00am: 1

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 2

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice: 2

• ST3 or higher (specialist training) responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 2

• ST3 or higher (specialist training) responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 2

• Staff grade post equivalent to ST3 or higher responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 1

• Staff grade post equivalent to ST3 or higher responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 1: 1

• Consultants responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00am: 2

• Consultants responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00am: 2

• Foundation Doctors, Year 1 & 2 scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 6

• Foundation Doctors, Year 1 & 2 on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 6

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 4

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 4

• ST3 or higher (specialist training) scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 4

• ST3 or higher (specialist training) on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 4

• ST3 or higher (specialist training) on call from home on Sunday June 17th at 11:00pm: 2

• Staff grade post equivalent to ST3 or higher scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 4

• Staff grade post equivalent to ST3 or higher on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 4

• Consultants on call from home on Sunday June 17th at 11:00am: 6

• Foundation Doctors, Year 1 & 2 responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 1

• Foundation Doctors, Year 1 & 2 responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 1

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post responsible for current medical inpatients and new medical admissions scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 0

• ST1/ST2 or CT1/CT2 (core training/specialist training ) or equivalent non-deanery post responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice: 0

• ST3 or higher (specialist training) responsible for current medical inpatients and new medical admissions Scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 1

• ST3 or higher (specialist training) responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 11:00pm: 1

• Staff grade post equivalent to ST3 or higher responsible for current medical inpatients and new medical admissions Scheduled to be on site for rostered session or full shift on Sunday June 17th at 11:00pm: 1

• Staff grade post equivalent to ST3 or higher responsible for current medical inpatients and new medical admissions on call, but physically on site either as a requirement of terms of on call or as routine practice, e.g. Ward round on Sunday June 17th at 1: 1

• Consultants responsible for current medical inpatients and new medical admissions on call from home on Sunday June 17th at 11:00pm: 1

• Does the hospital have a formal "hospital at night" system?

• Night Nurse Practitioners in the "hospital at night" team: 1 Not Nurses but SHO

• Other nursing staff in the "hospital at night" team: 2

• ST3 or higher (specialist training) in the "hospital at night" team: 1