A small group of dedicated nursing staff have seen their pioneering work result in some of the best improvements in patient care to be seen in Scotland.
The team of Critical Care Outreach nurse specialists at Borders General Hospital are being credited with helping the hospital to achieve one of the lowest mortality rates in critical care while also helping to deliver a remarkable reduction in cardiac arrest calls.
The success is another ringing endorsement of the work of the Scottish Patient Safety Programme (SPSP), a ground-breaking initiative lead by Healthcare Improvement Scotland to ensure that every patient in NHSScotland receives the best possible care.
Specialist nurse Ronnie Dornan, who set up the Melrose-based hospital’s Critical Care Outreach Service, is a Fellow of the Scottish Patient Safety Programme. The Fellowship Programme looks to encourage Fellows to strengthen clinical leadership within quality and safety improvements projects in their health boards.
The Critical Care Outreach Team was set up to address the importance of early recognition management techniques when treating patients at risk of deterioration.
RESULTS
Analysis of the results has seen Borders General Hospital Intensive Care Unit record some of the lowest patient figures for out-of-hours admissions, length of stay, need for ventilation and need for renal replacement therapy in the country.
On top of this the number of cardiac arrest calls at the hospital saw a remarkable reduction from 465 in 2000 to 48 in 2013.
Ronnie said: “The Critical Care Outreach Service provides a team of dedicated specialist nurses who focus on the close monitoring of the medical conditions of both ward patients and patients recently discharged from intensive care.
“We believe that visibility and accessibility to a specialised team is of the utmost importance.
“Our motto is simple: ‘early recognition and intervention improves outcome’. To identify the signs of deterioration we use an early warning chart to closely monitor blood pressure, heart rate, temperature, respiratory rate and blood results that highlight the early signs of deterioration
“This way we can act upon any decline in the patients’ condition at an early stage providing us with the optimal chance to prevent further deterioration and expedite treatment.
“This method of managing deterioration in patients has proven to be extremely successful as we now have one of the lowest mortality rates in Scotland.”
INTERNATIONAL RECOGNITION
The work of the Critical Care Outreach Service has been closely followed by two other Scottish hospitals who have now implemented similar models with the hope of recording similar benefits.
The Critical Care Outreach Team have enjoyed international recognition in America and Denmark. The team recently featured on Denmark’s equivalent of BBC Six O’Clock News after a Danish consultant was inspired by the model while working with Ronnie on the SPSP Fellowship.
Dr Stubager, a Consultant at Kolding Hospital in Denmark and one of many leading international medics who are signing up to the SPSP, said: “My study visit to Borders General Hospital has been truly inspirational.
“The methods of dealing with the deterioration of patients that Ronnie and his team have developed are quite ground-breaking and evidently provide outstanding results.
“Since appearing on our national news, the methodology has created huge debate around the whole country and politicians are now looking to take patient safety more seriously.
“We would like to thank the staff at Borders General Hospital for giving us an insight into their work which has now enabled us to begin the process of implementing similar models throughout hospitals in Denmark.”
The Scottish Patient Safety Programme has been running in Scotland’s acute hospitals for more than five years, delivering a range of interventions that have helped to systematically improve the safety and reliability of hospital care. While the starting point has been acute care, there has always been a commitment to extending this approach to other areas. The Scottish Patient Safety Programme, which is part of Healthcare Improvement Scotland, now supports the implementation of safety programmes in Acute Adult, Mental Health, Maternity, Neonatal, Paediatric and Primary Care.
