Royal Free Hospital, London

General Services Information

Hospital Questions

• How many single rooms are available to NHS patients at this hospital: 118

• Of these how many have an ensuite toilet: 118

• Of these how many have an ensuite toilet and shower or bath: 118

• Does this hospital operate an accident and emergency unit:

• How many specialist palliative care beds are available at this hospital: 0

• Does this hospital have a named private unit/service:

Trust Questions

• Does the Trust treat private patients:

Patient Safety

Trust Questions

• Is there 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: trust incident reporting system trust incident reporting system (never event reporting), serious investigatuion outcom (si), Outcome discussed at trust board

• Is there 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: Trust incident reporting system and also audits and local performance data Trust incident reporting system and also audits and local performance data, Shadow council of governors

• Is there 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: trust incident reporting system (never event reporting)

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in a foreign body being left post surgery: 0

• During the period 01 April 2010 - 31 March 2011, how many operations were cancelled due to missing notes: 10

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in wrong site surgery taking place: 1 The was no harm to the patient and patient was fully informed of the error.

• How many incident investigations using a full Root Cause Analysis did were carried out in 2010/11: 93

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

• What percentage of acute inpatients have a track and trigger warning system in place for the duration of the admission: 100% is this an early warning system? the trust has system for both adults and paeds

• What percentage of patients are risk assessed for venous thromboembolism on admission: 91-99% last audit results 92 %

• Compliant with all relevant NPSA safety alerts issues in 2010/11 (you can find a full list of alerts issued at http://www.nrls.npsa.nhs.uk/resources/?p=3). :

• Alerts where not expected to be compliant by 1st December 2011 and when expected to be compliant. : The trust currently has four outstanding alerts, NPSA/2010/RRR016 - laparascopic surgery; NPSA/2010/RRR015 Over infusion of intravenous fluid in neonates; NPSA/2011/RRR001 Essential care after an inpatient fall and NPSA/2011/PSA002 Nasogastric feeding tubes. Work is underway in all of the areas and it is anticipated that the trust will be fully compliant by december 11.

• Does the Trust have a policy for providing educational programmes on using and interpreting clinical indicators: trust does not have a policy, however staff training is offered at a number of levels and dependent on role. most senior clincal staff have basis statistical training and all divisions have a information partner specifically to support the design, interpretation and reporting of scorecards

• Does the Trust have a designated member of staff who supports teams in locating and analysing safety and quality data? (support): as well as central corporate support, each clinical division has an information partner and governance partner supporting analysis of safety and quality data and development and reporting on divisional scorecards

• Is safety and quality data available on a central platform and actively disseminated to users:

Infection Control

Trust Questions

• Does the Trust employ an antibiotic pharmacist:

• Does the Trust operate a pre-admission assessment clinic or equivalent system where patients are screened and results returned in advance of the day of admission:

• Elective patient groups screened at the pre-op assessment clinic: All elective surgical

• Are all oncology patients screened at the pre-op assessment clinic: NO

• Are all chemotherapy patients screened at the pre-op assessment clinic: YES

• Are all elective neurosurgery patients screened at the pre-op assessment clinic: YES

• Are all patients with past history of MRSA screened at the pre-op assessment clinic:

• What method of MRSA screening is used when screening at admission: Other (please specify) culture for low risk, pcr for high risk

• On admission, does topical suppression take place immediately:

• Does the Trust have at least one accident and emergency unit:

• Are all patients admitted through A&E screened:

• Is screening done according to individual risk assessment:

• Does the Trust have a dedicated isolation ward:

• How many beds does it contain: 18

• Protocol for isolating patients with infections: all wards have side rooms. complicated tertiary referral does not allow for an isolation ward

• Does the Trust have an isolation policy:

• Where medically appropriate, are patients with C Diff isolated in single rooms as a matter of priority:

• Does the Trust have a policy to guide the use of metronidazole and vancomycin for C.difficile infected patients:

• Does the Trust routinely isolate all patients with diarrhoea:

Stroke Medicine

Hospital Questions

• Does the hsopital have a specialist stroke unit:

• What type of stroke unit does the hospital have: Other Acute Stroke Unit only

• Number of beds in the unit: 24

Trust Questions

• Does the Trust have a specialist stroke unit or units:

• Is the Trust part of a stroke care network:

• Details: We work in collaboration with the North Central London Cardiac and Stroke Network

• 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 2010 - 31 March 2011): 55 The London Stroke pathway means that the majority of our patients come from HASUs (some 250 patients in 2010/11). 55 patients came straight to our A&E at RFH, 48 of which were CT scanned within 24hrs. All other stroke patients were CT scanned at HASU and then repatriated to the RFH

• Of these, what was the number of patients given a Computerised Tomography (CT) scan within 24 hrs of admission: 48

• Is thrombolysis for stroke patients provided 24 hours per day and 7 days a week :

• Are there any formal arrangements with neighbouring hospitals for the emergency transfer of stroke patients who would benefit from thrombolytic treatment:

• These arrangements are with: University College London Hospitals Trust

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):

• Does the Trust offer an orthopaedics service:

• Do all the Trust's orthopaedic ward/team have a linked geriatric team with whom they have regular meetings at least once a week:

• 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)? : We do offer pre-op OT assessment including information and equipment provision. We also have patient information accessible via the website including leaflets and DVD.

• What is the estimated percentage of all patients that attend the class prior to surgery: 95

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

• Estimated percentage compliance to this protocol: 90

• Estimated percentage of the Trusts total knee replacement (TKR) and total hip replacement (THR) patients walk within 24 hours of surgery: 90

• Does the Trust have a specialist orthopaedic physiotherapy service which is available 7 days a week: 6 days only

• How many patients' discharge's delayed due to lack of physiotherapy services at weekends - estimated figure: 0 We estimate no delays due to lack of physiotherapy at the weekend. Most delays due to other reasons such as lack of access to social services etc

• Are patients for total knee replacement (TKR) and total hip replacement (THR) admitted prior to the day of surgery:

• What is the principle reason for patients not being admitted on the day of surgery: This only occurs when certain patients' medical history requires admission the evening prior.

• Are patient records routinely recorded using a specific multi-disciplinary team THR/TKR pathway document:

• Is this data used to monitor compliance with the agreed pathway:

• Is criteria-based discharge used:

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

Paediatrics

Hospital Questions

• Does the hospital have a paediatrics service:

Trust Questions

• 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:

• Is a paediatrician on site (SpR or higher) 24 hours per day, 7 days per week:

• Are at least two registered children's nurses on duty 24hours per day in each children's ward: We do not provide out of hours paediatric service

• Is there a designated facility on site for parents or guardians to stay overnight: We do not provide out of hours paediatric service

Palliative Care

Trust Questions

• Does the Trust provide a palliative care service:

• How is specialist palliative care delivered at the hospital: A multi-disciplinary specialist palliative care team we also provide a community palliative care team for the local community

• Does the hospital's specialist palliative team includes: A consultant in palliative medicine,A palliative care nurse,Other (please specify) Team administrator, community OT, Physio and social work. The hospital team works with speciality based counsellors & psychologists throughout the hospital

• 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: Wherever possible facilities are provided for relatives and carers to stay by the bedside

• 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: We are expecting to undertake the new VOICES survey of relatives and carers in bereavement in 2012. The Palliative care Team regularly evaluates patient experience of their services

Maternity Care

Maternity Sites

• Royal Free Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 346 The Royal Free Birth Centre is a co located birth centre

• How many babies were born in the unit during the year? (not including home births): 346

• How many women were booked for a home birth: 43

• How many women had a home birth? (not including births at home by accident): 30

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 0

• Total assessment area beds: 0

• Number of delivery rooms: 3 The Birth Centre has 3 birthing suites, all have en suite facilities and one room has a birthing pool

• Total delivery beds: 3

• Number of postnatal rooms: 0

• Total postnatal beds: 0

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0 If women are having an early discharge home - anything from 2 hours following the birth of their baby they will usually stay in the birthing suite where they had their baby. If women are going to stay in hospital they will be transfered to the postnatal area on 5 South Ward

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 0 Not Applicable

• Does the maternity unit have a neonatal intensive care unit: We work with other units in the North Central London Perinatal Network to provide babies with the right level of care for their needs.

• Does the maternity unit have a neonatal high dependency unit: We work with other units in the North Central London Perinatal Network to provide babies with the right level of care for their needs.

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit

• Pain relief available - birth ball: Provided by women

• Pain relief available - Massage: Provided by unit Some midwives have attended massage courses

• Pain relief available - Aromatherapy: Provided by unit We have aromatheraphy diffusers available

• Pain relief available - TENS: Provided by women

• Pain relief available - Epidural: Not available Women who would like an epidural will be transfered to the labour ward

• Pain relief available - Mobile epidural: Not available Women who would like an epidural will be transfered to the labour ward

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Other pain relief: 0

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 0 See below for total establishement of midwives

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 0 See below for total number of midwives in post

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call The community midwives provide midwifery care for women having home births. Outside of normal working hours the community midwives are on call for home births

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On site

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On site

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week: On site

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week: On site

• Royal Free Hospital - Consultant Led

• How many women gave birth in the unit during the year? (not including home births): 2835

• How many babies were born in the unit during the year? (not including home births): 2853

• How many women were booked for a home birth: 0

• How many women had a home birth? (not including births at home by accident): 0

• Number of antenatal rooms: 0 The antenatal beds are located on 5 South Ward and these are located both in bays and in single rooms depending on dependency needs of the woman

• Total antenatal beds: 8 As above

• Number of assessment area rooms (for monitoring and / or induction): 0 There are 6 beds in the Day Assessment Area and 2 beds in Triage

• Total assessment area beds: 8 There are 6 beds in the Day Assessment Area and 2 beds in Triage

• Number of delivery rooms: 5 There are 5 birthing suites on the labour ward all with en suite facilities

• Total delivery beds: 5

• Number of postnatal rooms: 23 There are 23 postnatal beds on 5 South Ward these are located both in 4 bedded bays and as 4 single rooms

• Total postnatal beds: 23

• Number of rooms in obstetric high dependency unit: 0 The RFH has a bespoke High Dependency Unit called CLOMA. This provides a dedicated area for women needing high dependency care

• Total obstetric high dependency beds: 3

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0 If women are having an early discharge home - anything from 2 hours following the birth of their baby they will usually stay in the birthing suite where they had their baby. If women are going to stay in hospital they will be transfered to the postnatal area on 5 South Ward

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 0 Not Applicable

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit: We have a special care baby unit and we can carry out short term high dependency care. We aim to transfer out pre-birth, pregnancies where delivery before 34 weeks is likely. When babies from our area who have received high dependency or intensive care elsewhere are stable, they are transferred to us for special care before going home. We work with other units in the North Central London Perinatal Network to provide babies with the right level of care for their needs.

• Security measures - ankle bands for the baby: All babies have 2 identity lables secured following birth

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit Women who are on the labour ward can go to the Birth Centre to use the Birthing Pool

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by unit Some midwives have attended massage courses

• Pain relief available - Aromatherapy: Provided by unit We have aromatherapy diffusers available

• Pain relief available - TENS: Provided by women

• Pain relief available - Epidural: Provided by unit

• Pain relief available - Mobile epidural: Provided by unit

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Other pain relief: 0

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 99

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 97.71

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call The community midwives provide midwifery care for women having home births. Outside of normal working hours the community midwives are on call for home births

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On site

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On site

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week: On site

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week: On site

Trust Questions

• Do all women have a choice about where they receive their antenatal appointments (i.e. at hospital or local health centre): antenatal care is provided within community locations and within the antenatal clinic. Some women may need to see an obstetrician during their pregnancy and these appointments will occur in the hospital antenatal clinic

• Are NHS antenatal classes available (e.g. Parentcraft):

• Available during the daytime (until 5pm):

• Available in the evenings (after 5pm):

• Available at weekends (Saturday and/or Sunday): The infant feeding workshop and Maternity Unit Tour occur at the weekend

• Available for women only groups:

• Available for other groups:

• Also available for: The RFH NHS Trust have a comprehensive education package available. This includes * Midwife Antenatal Classes * Breastfeeding Class * Labour Ward Tour * Hoem birth Support Workshops * Waterbirth Workshop * Physiotherapy Antenatal Classes * Pain relief in labour Workshop *Active birth workshop

• Are all women routinely offered ultrasound scans: Ultrasound scans are offered in line with National Screening Committe recommendations

• Scan 1 available between: Usually between 11 - 14+1 weeks of pregnancy

• Scan 2 available between: Between 18- 20+6 weeks of pregnancy

Trust Statistics

Trust Questions

• You can view various measures relating to the Trust's performance by clicking the following link: Royal Free Hampstead NHS Trust