COMMUNITY HOSPITALS
EXAMPLES OF PRACTICE
The Scottish Centre for Telehealth believes that the development of the new Community Hospital Model will provide a place where intellectual and capital resource can be brought together to provide enhanced local care close to home for individual communities.
The chance to embed new technologies in communities and engage patients and staff in appropriate developments presents a huge opportunity for Scotland.
The following examples of good practice provide an indication of the potential that is already being realised.
NHS AYRSHIRE AND ARRAN
Davidson Cottage Hospital, Girvan
Davidson Hospital is a 26 bed GP community hospital which serves a rural community. Out of hours services are provided by Ayrshire Doctors On Call (ADOC).
It won the Scottish Health Care Award in 2004 for Palliative Care Services and recently implemented a nurse led palliative care admissions initiative which was so successful that it was rolled out to other community hospitals within Ayrshire and became an accepted practice. The community hospital now provides extended palliative care facilities with designated palliative care beds and overnight accommodation for relatives.
The nurse led admissions policy was extended to 24 hours a day. GPs also agreed to provide continuing home and community medical care for palliative care patients after the surgery closed, overnight and at the weekends, instead of a call being made to ADOC. This facilitated 24 hour care by the local GP, community and hospital nursing services. Medical staff, community and hospital nursing colleagues work together to identify those patients who are in the community, establish their needs and respond to any changes in circumstances at home which may require admission to hospital at any time of the day. Davidson Hospital has a new build scheduled for completion in the summer of 2009 and is working to extend services to the community even further with a purpose built unit.
NHS GRAMPIAN
Aberdeenshire Community Hospitals
Aberdeenshire Community Health Partnership manages 10 Community Hospitals which work in a networked fashion, providing complementary services for a geographical area following their guiding principle that "care should be delivered locally whenever it is safe and feasible to do so".
The following services have been developed:
- Endoscopy (4 centres provide upper and lower GI endoscopy and they intend to offer similar services at another 4 centres)
- Ultrasound Scanning (GPs trained in ultrasound scanning are offering a service complementary to that provided by specialist radiologists)
- Cardiac Assessment (GPs, nurses, technicians and cardiologists provide cardiac assessment services at 4 Community Hospitals-exercise ECG testing, echocardiography and Holter monitoring)
- Chemotherapy (in 2 hospitals nurse led oral chemotherapy clinics for patients with bowel cancer are being piloted)
- Telemedicine (all community hospital casualty departments in central Aberdeenshire are linked to Accident and Emergency at Aberdeen via telemedicine, allowing local staff to obtain specialist advice to assist with patient management e.g. X-Ray interpretation and fracture management and follow up).
The CHP plans to develop further services, including rehabilitation, intravenous chemotherapy, day surgery and more advanced imaging techniques.
Scottish Association of Community Hospitals Ultrasound Courses
Ultrasound Courses for General Practitioners and other professionals involved in providing care in remote and rural Scotland have been developed in conjunction with the University of Portsmouth Institute of Radiographic Education and NHS Education for Scotland.
A number of introductory courses have now been run providing GPs with new competencies. These intensive theoretical and practical courses were designed for clinicians as an extension to their clinical skills. There are lectures and workshops regarding the theory and then a significant period of hand on practical experience with both "normal" models and then with patients with known abnormalities to provide the necessary experience and appropriate awareness of any limitations. These courses have already been used to explore ultrasound and cardiography.
Peterhead Community Hospital
Peterhead Community Hospital has an operational telemedicine link with Accident and Emergency at Aberdeen Royal Infirmary. Acute patients have their picture and any X-rays transmitted electronically and are interviewed by an A&E specialist at Aberdeen Royal Infirmary on the line. The same link is used for remote follow-up of patients with fractures.
Central Aberdeenshire - Healthcare Associated Infection Quality Group
Three community hospitals in Central Aberdeenshire - Inverurie Hospital (in picture), Insch War Memorial Hospital and Jubilee Hospital, Huntly - have recently won a national award for joint working. There were nine award winners from across the UK with Central Aberdeenshire's hospitals being the only Scottish hospitals to receive an award.
The initiative which brought success was focussed around delivering standardised practice in infection control and hygiene and the development of new initiatives, ensuring well-informed and well-trained staff were available and to listen to and action comments from patients across the three hospital sites.
Effective collaborative and multi-agency working have been key to the success of these community hospitals.
Intermediate Care in an Urban Community Hospital
The aim of the Links Unit at the City Hospital Aberdeen is to provide a nurse led, GP supported, comprehensive service and to improve the experiences of older people as users of Health and Social care. They provide a range of services to meet their needs, provided by experienced professionals, working in a multi-disciplinary team, thus preventing unnecessary admission to the acute sector and ensuring that care is tailored to their needs.
The 21 beds provide city GPs with an alternative to admission to the acute sector, especially for the elderly who are medically stable and do not require a greater expertise than is usually provided by a GP and as the Unit has expanded and staffs skills increase, they now target patients in the acute wards whose conditions have stabilised and for whom only further rehabilitation is required thus freeing up acute beds. Once an assessment has taken place by all professionals, an estimated date of discharge is agreed and discharge planning can start at an early stage. Three of the beds have been identified for the provision of terminal care and pain management.
The key to the success of the Unit is leadership, communication, teamwork and professional respect. The older person and their families have input into their care and do not lose the links with their community teams. Nursing staff have become autonomous practitioners through extended learning and development and work in collaboration with all other stakeholders in delivering care tailored to the patients needs.
NHS HIGHLAND
The Royal Northern Infirmary in Inverness was established as an urban GP Community Hospital in 1999 and has quickly become established as a dynamic 30 bedded unit covering a population of over 60 000, managed by the GP's of all 11 Inverness practices. It provides a management option primarily for the frail elderly who would otherwise need a District General Hospital bed.
It has a full complement of nursing and AHP staff skilled in rehabilitation and patients are admitted directly from their own homes or from secondary care to complete their management following initial investigation or surgery. Current bed occupancy is over 91% and the transfer rate from secondary care is continually rising as Consultants recognise the potential of the unit. The in-patient beds are supported by a strong Intermediate Care Team which works to facilitate early discharge from hospital and prevent unnecessary admissions. The success of this team has been recognised with further investment to boost staff numbers to meet increasing demand due to pressures on secondary care, population growth and demographic shift.
NHS LOTHIAN
The Leith Community Treatment Centre in Edinburgh provbides health care for local people in the centre of their community. As well as providing a range of diagnostic services and outpatient clinics, including paediatrics, it also offers rehabilitation assessment for older people and services such as dietics, physiotherapy, midwifery and community dentistry. Co-located services include social work, psychiatric nursing, voluntary services and school nursing. There are no inpatient beds.