Innovations in a small hospital

Have you heard of Goole Hospital? If you have not heard of it, that is not surprising. We generally don’t want you to hear about it/us.  It is a small hospital with about 30 beds and we do not do brain transplant.

We have a minor injuries unit, some medical in-patients, elective services in ophthalmology, orthopaedics, general surgery. There are outpatients and other services – you can check out the website http://www.nlg.nhs.uk/hospitals/goole/

What fascinates me is the number of innovations that have happened in Goole. Why it happens could be the subject of another blog post.

I am defining innovation as, ‘use of a better and, as a result, novel idea or method’ (Wikipedia).

Goole Innovations

Here I write about a dozen innovations that I have seen or been involved in at Goole.

1)      No clinic letter Clinic notes faxed to GPs as is

This when the general surgery clinic’s doctors’ handwritten notes are faxed to the general practitioner (mostly within 24 hours) instead of a letter first dictated then typed and then cross checked before signing and sending. Saves a load of secretarial time and money.

2)      Tests before OPD (USS OGD Flex Sig)

When we know by reading a general practitioner’s letter that the patient would undoubtedly need a particular test, such as an ultrasound scan, gastroscopy or a flexible sigmoidoscopy the doctor who vets the letter orders the test so that the result of the test is available for discussion at the patient’s first out-patient clinic consultation. Allows sensible discussion, often gives answers.

3)      Same day pre-assessment for general surgery and endoscopy patients

When the doctor tells the patient ‘you need a surgical procedure’, the patient if they have the time are pre-assessed at the same first surgical clinic visit. A kind of a one-stop service. Saves a lot of time for patients. We try to do this as often and as many patients as we practically can.

4)      Single Visit General Surgery

For general surgery patients who are suitable for day case surgery the Goole Single Visit pathway offers for suitable patients the option of visiting the hospital just once. Consultation and operative surgical procedure (occasionally some smaller additional investigations) all done in the same visit. Lumps and bumps right up to gall bladders.

See this link http://successinhealthcare.blogspot.co.uk/2011/12/single-visit-surgical-service.html that blogs about the single visit service

5)      Laser Haemorrhoidectomy

Formal surgical operation for piles done with local anaesthesia and laser with patients discharged in two hours. We have been doing this for a few years now. Brief blog about that can be found at http://successinhealthcare.blogspot.co.uk/2011/11/laser-surgery-for-piles.html

6)      Entonox for colonoscopy

Entonox, also known as gas & air can be used instead of sedation for colonoscopy. That is neither special nor surprising. In Goole, at the last look, we found approximately 35% of our colonoscopy patients opted for Entonox when the general published number is 17%. All I can say is our patients and staff are very special.

7)      Straight to test two week wait colo-rectal cancer referrals

Overwhelming majority of patients referred as two week wait cancer referrals end up having a colonoscopy. We have a system where suitable patients have their first consultation and colonoscopy at the same visit. http://www.nlg.nhs.uk/news/one-stop-service/

8)      Own reporting software for endoscopy

External software involves purchase cost, maintenance cost and annual licensing costs. We have created our own reporting software with Microsoft Infopath which was already available in trust computers. We have been using this for a few years. Spending your money responsibly, eh?

9)      Single length endoscopic accessories (0 error)

We use the colonoscopy length accessories for colonoscopy and gastroscopy. This has resulted in zero error hence zero waste (since there is no possibility of opening a gastroscope length accessory for a colonoscopy procedure)

10)  Home enemas

Patients who are for flexible sigmoidoscopy need an enema. To have someone unknown administer an enema in an unfamiliar environment and then have to use the unfamiliar toilet can be bothersome. We ask patients if they want to administer the enemas themselves in the comfort of their own homes.

11)   In-situ simulation training

First in-situ simulation training with two scenarios, two trainers, one volunteer ‘patient’ and a professional actor, in our organisation with three hospitals. Even before our nearest tertiary hospital could do it (they have since done it)

12)  Local Anaesthesia option for most inguinal and umbilical hernia repairs

Once the patient is considered suitable the patient has the choice to go for local anaesthesia (with or without sedation) or a general anaesthetic. A large number go for local anaesthetic repairs.

13)  Synchronised test-opd

When routine follow up ultra-sound scans are needed to monitor a situation, we used to get them done a couple of hours earlier than the clinic appointment time. Latest information available. One visit instead of two for the patient. We used to do this typically for patients who were being monitored for abdominal aortic aneurysms.

I said a dozen things done differently at Goole but have listed 13; that would be typical of Goole, we try and often tend to over deliver.

There are a number of innovations from our colleagues in orthopaedics, ophthalmology and other departments.

You will not hear too much from Goole, the people there are a bit shy of fame, a bit skeptical about awards, a shade reluctant to talk about themselves; it is a unique micro-culture - more on that later. There are very specific reasons why innovation happens at Goole (though I do not have too high a regard for CQC ratings you may be interested to know that Goole Hospital scores all greens ‘good’ www.cqc.org.uk/sites/default/files/new_reports/AAAA1778.pdf  for its services, we at Goole are neither bothered nor surprised about this).

At this point I have to say that I am one of the very few variant ones for Goole, talking and blogging about these things, I suspect my team often wonders why I am so vain.

Many hospitals in the country could be doing one or more of the above, but I do wonder if all these things happen in a small hospital.

©M HEMADRI 

Follow me on twitter @HemadriTweets

PS: We follow Noble prize winner's Kahneman's methods to improve our patients' experience, I have already blogged about this http://successinhealthcare.blogspot.co.uk/2014/02/kahneman-colonoscopy-and-goole.html

Laser surgery for piles

Many of you will be aware that piles is a very common problem presenting usually as bleeding and/or swelling from the anus. If the piles involves an external swelling at the anus along with the bleeding then a surgical operation may be indicated.
Currently the standard method of doing a piles operation involves a general anaesthetic, cutting out the piles (called open haemorrhoidectomy or Milligan-Morgan technique) and possibly an overnight hospital stay though more centres are doing piles operations as day cases.

We (Peter Moore, Consultant Surgeon, now retired and I) have been performing a technique called Laser Seal Haemorrhoidectomy for a few years where we use a local anaesthetic with mild sedation and use a laser to seal the cut edges of the piles. Patients are able to go home about 2 hours after the operation (they may be able to go home earlier but sedation guidelines kick in I suppose), we believe that this procedure gives better pain relief in the early days http://www.nlg.nhs.uk/services/laserhaemorrhoidectomy/default.asp  

We learnt this procedure a few years ago from Peter Thomas from Arizona  http://laserhemorrhoids.com/; of course we don't do it exactly like him and he has been doing it for 25 years.  A public thanks to Peter.

I think to change an operation that involves a general anaesthetic and often one or two nights of stay in the hospital to a local anaesthetic (with mild sedation) with a two hour stay is our local technical example of Success in Healthcare. Surely not an earth shattering example, only a small one but hopefully relevant for some. The point is to try and pursue every activity that improves quality and decreases cost at the same time.

 © HEMADRI 
Follow me on twitter @HemadriTweets

Warning & Disclaimer
1) There are many causes of bleeding from the anus and many causes of swelling in the anus, some of those may be more serious conditions than piles - please consult your doctor whose advise will be the only thing relevant to you personally. This blog does not give you medical advise.
2) We do not claim scientifically superior results. We describe only our process and some of our beliefs.We use the laser seal haemorrhoidectomy as a clinical process improvement example not as scientific proof of any treatment.

Amended on 30 August 2014