DAWN DVT MODULE Victoria Frimpong, Jo Eggleston DVT specialist nurses
DAWN DVT MODULE • Why – the history • When… the time is right….. • Where – the DVT move • How – the 2 perspectives: UHL, DAWN
Moving from the old…… to the new – AMBULATORY CARE CENTRE – sandwiched between ED and radiology
Our new home – February 2013 ‘Fit for purpose’ - The right space - Efficient patient flow for current numbers and projected increases
Drowning in paperwork A drama in the NHS SUI – The paper trail petered out Missing documentation
Secure funding for a paperless system Seamless referral • DAWN DVT and GP module communication Improved clinical • governance and audit trail A WIN-WIN-WIN •
Defining process • ‘The devil is in the detail’ • Conferred with the people who did the job • Questioned why things were as they are and how they could be improved • ‘Dream the dream, have the vision’ • Communication • Meaningful meetings • Ownership
The pathway - “Primary Care & Secondary Care” /Specialist-generalist – not site specific DVT Service – One Service – One Team Where …. Best Place Low Blood Test Unlikely High Wells -ve Score 2 weeks To 3 Likely Months Prescribe Scan Assess +ve Inject Level 1 Level 2 Level 3 City – 1000/pa 80% 20% County – 2000/pa Consultant 3PAs NICE CG144/TA261 Band 6 3.61 Band 3 1.8
DAWN = 80% reduction in workload Triage: This includes gaining information, demographics, GP details, next of kin and clinical details. Questionnaire: WELLS score and blood test + / - D.Dimer. Algorithm: The route through is illuminated by the information input, producing an outcome.
Where we are up to • DVT unlikely + normal D.Dimers = The patient can be discharged. • No further information collecting is required. A letter is automatically produced and sent electronically to the GP. • DVT unlikely + raised D.Dimer = Proceed with scan. • DVT likely, D.Dimer not done = Proceed with scan or treat accordingly until scan available.
Scan outcomes • Whole leg scan + no DVT = discharged • Whole leg scan + DVT confirmed = Proceed on paper • Proximal scan only + DVT confirmed = Proceed on paper • Proximal scan performed + DVT inconclusive = Return one week later for re scan, no treatment.
Benefits • Information is electronically stored therefore, easy to access for future episodes. • Provides an audit trail. • Saves time and resources as only collecting relevant information. • Fluent methodical way of working. • Simplified algorithms easy to use. • Message box to highlight information for other users.
Benefits • Able to add messages for letters to GPs. For example, abnormal blood results. • No more writing endless discharge letters and blood results. • Easy referral to anti coagulation clinic. • 80% of those patients who are scanned are negative and discharged. This allows us to spend more time with those who require treatment.
Approach and principles moving forward DVT/PE/Anticoagulation Service – One Service – One Team • Stakeholder •Goals Service Vision • Public • Patient •No Serious Incidents •Correct Diagnosis and Treatment first time •Prevention •Best Patient Experience Best Improving Possible Health Care Step opportunity for improvement Joy and Value for Pride in Money Work • Commissioning Group • Team •Reduce Cost •Clear Understanding of Process, Role and •No Waste Responsibilities
The Future Over to DAWN….
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