Although not a large teaching hospital, the Trust has its fair share of innovative work. Each year these are listed in the Annual Quality Report which can be found here. Here are a few examples:
Diabetes antenatal care – using technology and reducing face-to-face visits
It is especially important to monitor diabetes during pre-conception and pregnancy as we know that good blood glucose control improves the outcomes for both mother and baby. The Trust was one of the first in the country to have approval to use Flash Glucose monitoring to enable mums-to-be to optimise their glucose control during pregnancy and we can now offer this treatment to all women with type 1 diabetes who become pregnant.
Flash glucose monitoring uses a small device worn on the upper arm, which continuously records interstitial glucose levels. This can be read by scanning with either a reader or the woman’s mobile phone and shows the current glucose reading, the last eight hours of glucose history and a trend arrow showing if glucose is going up, down, or changing slowly. The reader can even scan through clothing, meaning the test can be performed discreetly anywhere and is completely painless. Patients find this easier and less painful that performing multiple blood glucose tests.
Patients can use the data to monitor their day-to-day diabetes control, and they can also choose to share their data with the hospital diabetes antenatal team. The Trust has developed a pioneering weekly virtual antenatal technology clinic, run by a multi-disciplinary team of diabetes consultants, specialist nurses and dietitians to monitor diabetes during pre-conception and pregnancy.
Each woman’s download is discussed every week in a virtual clinic by the expert team. If any changes to diabetes management are recommended, the patients are contacted, either by phone, email or face-to-face, to agree a new management plan. This might involve changing the dose of insulin, offering advice and support about diet and lifestyle, or considering other treatment such as insulin pumps and continuous glucose monitoring devices.
Early results have shown that women are spending more time with their diabetes control within the recommended targets for pregnancy, and need fewer visits to the hospital. Patients report that using the device gives them more support and confidence during this important time.
Support to care home patients
A multi-disciplinary team has been working with care homes across the area to reduce 999 calls and hospital admissions this winter. The Enhanced Care Home Team trains and supports care home staff.
They worked initially with 18 homes across the borough that have the highest number of non-elective admissions. Similar schemes elsewhere led to a reduction in hospital admissions from care homes. This formed part of the Trust’s winter planning.
The team includes a district nurse, community health nurse, mental health nurse, dietitian, occupational therapist and speech and language therapist. They run day-long training in homes and provide support to managers. The aim is to empower staff with their decision making, improve care delivery and safety.
Enhanced Care Home Team lead Edliz Kelly said: “We have identified why residents are going into our Emergency Department and are looking at prevention of those issues in care homes. For instance a common reason is chest infections – this can be linked to poor oral health so the speech and language therapists will be looking at better ways to deliver mouth care.
“Similarly, our occupational therapist will be working with activity coordinators to help them provide activities which improve health and wellbeing and prevent falls.”
Edliz and the team work with the homes on care of residents who are nearing the end of their lives, so more people can spend their final hours in a familiar place of choice surrounded by family, rather than as an emergency patient in hospital. The team have promoted the initiation of advance care planning and granting residents wishes
“We really want to help give residents a better experience in their care homes by working together with, and supporting, the care home staff and residents,” she said.
First specialist operation in the UK
Dr Sauid Ishaq, consultant gastroenterologist, performed the first flexible endoscopic treatment of Zenker’s Diverticulum in the country.
The patient develops a pharyngeal pouch or Zenker’s Diverticulum (when the lining at the back of the throat ruptures through the muscle wall creating a pouch) which results in food entrapment, persistent coughing, difficulty in swallowing and potentially aspiration pneumonia.
Historically it has been treated by the Ear Nose and Throat (ENT) specialty either by open surgery or stapling by using a rigid endoscope under general anaesthetic.
The new technique, used in leading centres in Europe but not in the UK, entails flexible endoscopy treatment performed as a day case.
Dr Ishaq was trained to undertake the procedure in Amsterdam, Milan and Brussels and had gastroenterologist Professor Chris Mulder, from Amsterdam, present during this first case.
App for management of patients with Parkinson’s disease
The Trust has launched a mobile IOS/android phone / tablet app for guidance on the management of patients with Parkinson’s disease that are deemed nil by mouth.
This means the guidelines, for patients with compromised swallowing or those deemed Nil By Mouth, are available for doctors across the world to download to help with the management of patients with Parkinson’s disease. This allows staff to spend more time with patients to deliver the best quality care for each individual. The app offers information about feeding tube administration for patients who can tolerate a feeding tube as well as a Rotigotine Patch Conversion Calculator for the patients who cannot. It can be found by searching ‘Parkinson’s Nil By Mouth’ on the app store.
Reminiscence Interactive Therapy (RITA)
The Trust has introduced new digital reminiscence therapy software to areas across Russells Hall Hospital to offer extra support to patients with dementia. The Reminiscence Interactive Therapy and Activities (RITA) software is a form of cognitive therapy which helps to calm, stimulate and reduce agitation in patients with dementia. The therapy has been proven to positively engage patients, who have a cognitive decline in mental abilities such as memory and thinking. The software, in the form of a tablet device, helps patients to relax, recall memories and encourage interaction between them and their families.
Matron Rachel Tomkins has been involved in training staff on how to use the software across the hospital. “The reminiscence software has already made a massive difference to our patients in such a short space of time,” she said. “I really believe that this fantastic piece of technology is helping to make our patients feel more comfortable during their stay and that it is also contributing to a reduction in falls.”
The Trust has purchased ten tablets which hold a wide range of interactive activities for patients to access, such as a library of music from every generation, old and new films to watch and an app for families to create personalised life albums by uploading photos with their loved ones.
‘Love Your Heart’
An interactive online video programme called ‘Love Your Heart’ developed by consultant rheumatologist, Dr Holly John, in partnership with the National Rheumatoid Arthritis Society (NRAS), has been launched. It has been developed to help those with rheumatoid arthritis (RA) understand why they are at an increased risk of cardiovascular disease (CVD) and the impact RA can have on the most important organ – the heart! It originated following a 4-year research study in how to educate patients with RA of the risks of CVD, which increase due to both their RA as well as established risk factors such as diabetes, high cholesterol or smoking for example. The study was part of a broader and longstanding programme of research projects conducted by the Rheumatology Department in Dudley (with collaborators from multiple universities) into CVD in RA, which has significantly contributed evidence which underpins national and international guidelines.
A recruited participant in the educational programme said, “Doing this programme was life-changing for me – it gave me the knowledge, the confidence and the stimulation I needed to take action to change my life. I cancelled my Sky subscription, joined a gym and started swimming. It’s changed my life in a very positive way.”
The promising results of the programme led to the collaboration with NRAS and the development of the Love Your Heart programme. NRAS is making the Love Your Heart programme widely available to everyone with RA (or inflammatory arthritis) so that they can find out why they are at increased risk of CVD and provide tools to help them lower that risk. The online programme stars some of the team that supported Dr John in her study.
Endoscopic resection of early colon cancer
The Trust was the first centre in the UK to provide minimally invasive endoscopic full thickness resection of early colon cancer with seven other centres now providing this novel procedure. This is a joint initiative between our colorectal surgeons led by Mr Kawesha and Professor Ishaq in the Department of Gastroenterology. Patients benefit from a quicker recovery, fewer complications and a shorter stay in hospital. A patient can be standing, feeling well and pain free the day after major surgery.