Clinical Governance day- 24.Sept.2016

Our First Ever Clinical Governance day:

A massive thanks to everyone at the HM Coastguard Bristows Search and Rescue Base, Inverness for hosting us.   Plus an extra special thank you for all of your help, and enthusiastic participation in the day- you really made it!

Photos of our Major incident practice session:

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Minutes:

13:00- Welcome to the Base- Josh Williams, SAR Paramedic

13: 05- Welcome to the CGD– Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder

13:20- Major Incidents– Peter McPhee, Emergency planning officer for NHS Highland

13:50- Activity Review- Morbidity and Mortality– Stuart Swanson, Advanced Nurse Practitioner, PICT Pilot Co-Lead, Decision Support Team member & PICT responder, with some case discussion from  Dr. Richard Brown, GP, Decision Support Team member & PICT responder & Dr. Brian Fitzsimons, Occupational health & GP, Decision Support Team member & PICT responder.

14:10- Case- Prehospital Thrombolysis, Dr. Duncan Scott, Acute Medicine Consultant, PICT Decision support team member & PICT responder.

14:25- Break

15:10- Case- First time out responding, Dr. James Tullie, GP EP, and PICT responder.

15:20:  Major incident- Medical care & Major incident exercise brief  – Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder

15:30: Major incident exercise.  Including all attendees of the Clinical Governance Day & some Search and Rescue staff.  With Thanks to Josh Shaw- 5th year Medical student who played a major role in the co-ordination of this excercise.

17:00 Round up, feedback forms and close-Dr. Luke Regan, Emergency Consultant, PICT Pilot Lead,  Decision Support Team member & PICT responder & Dr. Alicia Garland – Highland PICT admin & Academic FY1 Doctor

Feedback:

Of the feedback forms returned, 75% rated the day Good or Fantastic, 25% Didn’t complete this element of the feedback form.  0% rated the day as Neutral/Below Par/Poor.screen-shot-2016-10-03-at-20-29-02

Good Points:

  • Major incident exercise, allowed practice with both MI type scenarios, kit
  • Good discussion/debate on a wide range of topics
  • Good feedback from group on cases
  • Morbidity and Mortality Talk

Points to be improved:

  • Unable to cover all topics
  • Clarity on local pre-alerting policy

 

Thanks to the team:

To all attendees: Dr. Luke Regan, Mr. Stephen McNally, Dr. Claire Vincent, Dr. Mike Ashcroft, Dr. Connor Bowbeer, Donna McGregor, Angus Stephen, SAR staff, Dr. Jenny Parsons, Dr. Charles Lee, Jo Findlay, Dr. Graham Bee, Dr. Richard Brown, James Haywards, Leslie Pirie, Eric Pirie, Dr. Ian Craighead, Dr. James Tullie, Dr. Duncan Scott, Peter McPhee, Stuart Swanson, Dr. Dan Baraclough, Josh Shaw, Dr. Brian Fitzsimons & Alicia Garland.

To all speakers: Dr. Luke Regan, Peter McPhee, Stuart Swanson, Dr. Duncan Scott, Dr. James Tullie, Dr. Richard Brown, Dr. Brian Fitzsimons & Alicia Garland

To all organisers: Dr. Luke Regan, All the staff at SAR Inverness, Stuart Swanson & Alicia Garland.

To all facilitators: Dr. Luke Regan, All the staff at SAR Inverness, Stuart Swanson, Josh Shaw & Alicia Garland

Thank you to everyone, for making the day a huge success.

Next CGD due Jan 2016

Date, Venue and Time to be confirmed.

PICT News; June.

This month in numbers:

Tasking to scenes:

Screen Shot 2016-07-06 at 22.28.43

Screen Shot 2016-07-06 at 21.45.49Screen Shot 2016-06-22 at 17.28.31

OHCA= out of hospital cardiac arrest. RTC= Road traffic collision.

At the scene:

Average time spent at scene= 46.5 mins
Screen Shot 2016-07-06 at 22.00.45Screen Shot 2016-07-06 at 21.52.14

 

Thank you to all our Scottish Ambulance Service (SAS) and Helimed colleagues who were with us at the scene.

After the Scene:

Avoiding admission– 22% of patients have been discharged at scene, and thus have avoided travel to and admission to hospital.

Average time for Decision support team feedback on submission of PRF = <27hrs

Other numbers:

Number of responders active = 26% of all live responders.

 

 

 

 

PICT NEWS, Apr & May.

The NHS Highland (NHSH) Prehospital Immediate Care & Trauma pilot (PICT) is a scheme to co-ordinate and support a group os BASICS responders, distributed around the Moray Firth basin.  Dornoch to Aviemore, Nairn to Beauly.  Members of this group currently include, Intensivists, GPs, Anaesthetists, Advanced Nurse Practitioners and Emergency Physicians.

The first wave of 15 responders went live on 23.04.2016.

First month cases:  Cases in the first month of operations have seen multiple road traffic collisions (RTCs),  including a seven casualty three car incident; and an out out of hospital cardiac arrest (OHCA) with the attending physician securing a definitive airway, gained intra-osseous (IO) access and guided peri-arrest thrombolysis, amongst others.

So far we have achieved:

  •   The Introduction of the Decision Support Team (DST), made up of senior and experienced clinicians.
  • Standardised kit, drugs bags, standard operating procedures, and currencies for all responders.
  • An increase in responders available to be tasked by the Scottish Ambulance Service (SAS).

The role of the DST:

  • Supporting PICT responders, in the capacity of providing decision support at scene, via a dedicated and robust phone system- available to responders 24’7.
  • With the information the DST receive from responders, they can pre-alert receiving hospitals, and relaying information to Ambulance Control.
  • De-brief and Feedback.  The DST have been providing rapid feedback on all submitted patient report forms, providing governance and follow up of patients seen by PICT responders.

Recruitment:

AIM: Recruitment of responders and promotion of the role across wide disciplinary and seniority range

PROGRESS:

Screen Shot 2016-08-03 at 19.15.03Screen Shot 2016-08-03 at 19.14.52Virtual learning:

AIM: Additional training to current responders

PROGRESS: e-induction available to all responders; modules include: who are we; kit walkthrough;  good jobs/bad jobs;  training currencies, ride alongs, ACC, dual tasking….and more.

Case based learning: Available to all responders- Currently 2 cases available.

Interagency working:

AIM: Promote inter-disciplinary and inter-agency training and operations &  provide up to date responder information to ambulance control

PROGRESS:  During the initiation of this project we have had several useful and productive meetings with Ambulance control.  Thank you very much to all that attended.  Ambulance control has up to date information on all live responders.

Forecast: Document 2.0 in progress, ambulance control should  receive this shortly.

  • Proportion of total recruits who have attended Ambulance control, and or ambulance ride alongs = 40%.
  • Input from Police, SAR/Coastguard, Fire and Rescue in e-induction material

Appeal for more ideas/opportunities for interagency working. Please e-mail Alicia with any suggestions.

Decision Support:

AIM: To implement Decision support, case review and adverse event reporting.
PROGRESS:  The current average response time for DST feedback after PRF submission is <24hrs.  Thank you to all DST members who have been providing feedback.

Adverse event reporting is to be done via the EMRS developed SPHERE  pre-hospital reporting system http://www.sphere.scot.nhs.uk

A massive thank you to Luke Regan who has been on call for the decision support team until the implementation of the dedicated line.

Standardising our Service:

AIM: More formalised standard operating procedures for management of serious conditions & alignment with best practice in other Scottish pre-hospital teams currently operational

PROGRESS: We currently have a list of 18 SOPs available at  https://highlandpict.wordpress.com/resources/s-o-p/   Many of which are standard BASICS Scotland SOPs or are adapted from the Emergency medical retrieval service (EMRS).

Out of hospital cardiac arrest -OHCA:

AIM: Review tasking criteria, particularly in light of recent Scottish Government initiatives in delivering care to Out of Hospital Cardiac Arrest (OHCA) patients.

PROGRESS: We are collating data on the types of cases we’re being sent to including, special groups such as:

  • OHCA, RTAs, Entrapped and Paediatric patients.

Forecast: With data from cases,  we hope to demonstrate current PICT utilisation in OHCA cases.

Highland PICT is now LIVE

Screen Shot 2016-05-29 at 01.12.04.png

As of the 23.04.16, the Highland PICT pilot has gone live.  The first wave of BASICS trained prehospital responders are live, with more being recruited and kitted to follow in their footsteps.  A massive thank you to all our partners who have supported us up to this point.