St Mark s: the IF & HPN service. Dr Simon Gabe Consultant Gastroenterologist St Mark s Hospital
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1 St Mark s: the IF & HPN service Dr Simon Gabe Consultant Gastroenterologist St Mark s Hospital
2 IF Service 1 IF coordinator 2 consultant GI surgeons 2 consultant GI physicians 3 medical juniors 1 psychiatrist 2 psychologists 5 dietitians 24 severe IF inpatients & 323 HPN patients 1 nurse consultant 3 specialist nutrition nurses 2 surgical juniors 1 staff grade surgeon Microbiology service Interventional radiology 3 specialist pharmacists 1 pharmacy manager 2 IF nurse practitioners Pharmacy aseptics manager 2 pharmacy technicians
3 The IF Service IF Unit 20 beds Frederick Salmon ward (colorectal surgery) Additional beds for perioperative patients and emergency admissions Staff IF Unit 1 modern matron 1 nurse manager 3 sisters 17 trained nurses 5 healthcare assistants 1 physiotherapy assistant (shared) 1 occupational therapist (shared) 1 ward clerk Nutrition team 2 consultant physicians, 2 consultant surgeons 1 consultant nurse 3 CNS (1 seconded from homecare company) 2 IF nurse practitioners 5 dietitians 4 pharmacists 3 junior medical doctors, 2 junior surgical doctors 1 IF coordinator
4 A dedicated IF unit For intestinal rehabilitation!
5 Extended services Psychological medicine unit Dr Yoram Inspector (IF & eating disorders specialist) 2 Psychologists (Esther Serranos-Ikkos and Megan Virtue) Further plans to develop this unit Interventional radiology Drainage of abdominal sepsis Venoplasty, stenting & recannalisation Microbiology Close working relationship Plastic surgery Visiting plastic surgeons from St Thomas hospital (David Ross & Joannis Constantinitis)
6 Integration with transplant services Joint transplant clinics Simon Gabe & Steve Middleton (Cambridge) Jeremy Nightingale & Peter Friend (Oxford) Senior clinical IF & transplant fellow St Mark s Addenbrooke s Shared aftercare for transplanted patients NASIT (National Adult Small Intestinal) Forum Meetings every 2 months St Mark s, Hope, Addenbrooke s, Oxford
7 HIFNET Aim to improve quality & access to services Core list of 30 services which Trusts needed to demonstrate they met 30 Trusts submitted June 2012 Peer reviews completed Jan 2014 Current tender process (34 Trusts applied) Next stage commissioner & clinician allocation Approved Trusts will be reimbursed from NHS England BUT currency still not been established! Launch April 2016 (but no tariff) DoH (2008)
8 Specialised IF services: referral criteria
9 Unit specifications
10 : new IF referrals
11 2014/15: new patient referrals Patient numbers Crohn's disease Mesenteric vascular disease Surgical complication s Motility disorders Radiation enteritis Scleroderma Familial polyposis Malignancy Salford St Mark's Other
12 2014/15: all admitted patients Patient numbers Crohn's disease Mesenteric vascular disease Surgical complication s Motility disorders Radiation enteritis Scleroderma Familial polyposis Malignancy Salford St Mark's Other
13 2014/15: IF inpatient activity IF Activity St Mark s Occupied bed days 8455 ICU days 79 HDU 98 Total 8632
14 2014/15: surgery on IF patients Hospital Surgery type No Operation type No St Mark s IF surgery 58 Fistula repair 12 Restoration of continuity 36 Other 10
15 CVC infection rates 9 CVC Infection rate/1000 days Inpatients Outpatients
16 2014/15: new patient outcomes New patients St Mark s HPN 81 (76%) Discharged home S/c fluids 1 (1%) Enteral (incl distal) feeding 2 (2%) Oral alone 8 (7%) Died 5 (5%) Hospital Transfer 10 (9%) Total 108 (100%)
17 HPN patient numbers No. Patients No. Patients
18 2014/15: IF activity Admissions New patient admissions 109 Known patient admissions 193 Inpatients Occupied bed days 8455 ICU & HDU days 177 Outpatients Total new patients 26 Total follow-ups 893
19 Training & teaching In house training All disciplines Advanced surgical training and medical IF training in place Refresher course for HPN patients Observers National & international Doctors, nurses, dietitians, pharmacists National teaching courses 15 th National IF & Rehabilitation course Standard & advanced training for homecare nurses Baxter National Intestinal Failure Forum CVC & EN tube masterclasses EC fistula masterclass Members of IF team regularly invited speakers nationally & internationally
20 Research & audit Research themes Mesenteric infarction HPN & transplant prognostic risk factors Development of a novel ORS Growth factors: GLP-2 Tissue engineering Immunological profiling PROM development Audit themes CVC complications Fractures, infection Occlusion, thrombosis Management of PN Refeeding Lipids Reducing dependency Nutritional status Micronutrient status HPN training PN CVC pressures
21 Intranet & database
22 Patient information
23 Holiday locations of HPN patients
24 Future plans & service developments Improving the patient experience Patient-controlled electronic medical records (PKB) Development of a PROM (St Marks & Salford) HPN contracts with healthcare provider Pharmacy & nursing staff monitoring contracts IF nurse practitioner post Plan to expand posts and develop PICC service Shared & devolved care Awaiting the start of HIFNET Many established patients will be wary of being transferred Collaboration with industry Development of enteral and parenteral tubes and devices
25 5 year plan
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