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Emergency department just for older people opens at Swansea’s Morriston Hospital

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A first-in-Wales emergency department exclusively for older people has opened alongside the main ED at Morriston Hospital.

It follows a pilot project within ED that reduced waiting times considerably and saw fewer elderly patients having to be admitted.

The pilot was introduced by OPAS, the Older Person’s Assessment Service, which aims to provide a comprehensive assessment for older people and avoid hospital stays for them if possible.

OPAS was established in 2018 and is a multidisciplinary team comprising healthcare professionals specialising in geriatric care. Since the service began, the team has assessed more than 2,500 patients.

The potential threat to the continuity of traditional community, outpatient and acute medical services the coronavirus pandemic posed was recognised in spring 2020.

There was concern that older people, who were vulnerable to the virus, would be admitted through ED and be exposed to the risk of infection.

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A dedicated area within the Emergency Department was set aside for the OPAS team last May.

The initiative received excellent patient feedback, and achieved excellent results in terms of patient flow, readmissions and mortality.

As a result, a new OPAS pod – with all the facilities needed to carry out a full assessment – has now opened next to the ED ambulance bay.

Previously, elderly patients were only referred to OPAS after they had been seen in the main ED, which referred them on when appropriate.

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OPAS now sees patients directly referred from the ambulance service and from ED triage. This has reduced waiting times for older patients and has helped the flow of patients through the Emergency Department.

Morriston Hospital consultant geriatrician Dr Liz Davies was instrumental in establishing OPAS.

Advanced nurse practitioner Tricia Quinn with consultant geriatrician Dr Liz Davies (Image: Swansea Bay NHS)

Last week she was awarded the British Empire Medal in the Queen’s Birthday Honours for her services to the NHS and older patients during the pandemic.

Dr Davies said: “Traditionally we had elderly patients coming into ED with falls, minor injuries and medical illnesses.

“These were often triaged as low priority and patients often experienced long and uncomfortable waits for assessment and treatment.

“Once the pilot started they were triaged directly to us without delay, which helps the flow through the entire department.

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“Older people came to our specialist area where they could get a full assessment. The waiting time for them reduced by many hours.

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“Within weeks we had achieved 85 percent discharge of all the people we saw. They were signposted to other services that were more suitable for them, which took the pressure off the ED front door.

“It had the additional effect of creating a stream for older people to protect them from Covid. They weren’t going through the respiratory intake, main ED or the general medical intake.

“The rate of inpatient falls in the Emergency Department has fallen dramatically since the unit opened.

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“We’re the only hospital in Wales to have an ED department specifically for older people.

“It’s a solution to a problem that every hospital faces.”

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Led by advanced nurse practitioners Catherine Beynon-Howells and Tricia Quinn, OPAS includes consultant geriatricians, clinical nurse specialists, physiotherapists, occupational therapists and others.

Most patients have had falls, though the team also sees some with other conditions, such as loss of mobility or cognition.

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The new pod features six spaces for patients, with four trolleys and two seated areas, as well as a therapy area.

There, patients can have tests carried out and be seen by a senior clinician.

The OPAS team also undertakes a full geriatric assessment, which considers their history, home environment, what support they may need to stay at home, as well as a medication review.

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Most are able to go home, either with new or existing support, or with physiotherapy, occupational therapy or social services follow-up.

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Those patients who do need admission can be admitted to Morriston, to Gorseinon, Neath Port Talbot or Singleton hospitals or to Bonymaen House in Swansea.

Dr Liz Davies (Image: Swansea Bay NHS)

Dr Davies said the new service had been fully supported by the management team at Morriston Hospital.

“They were very responsive to what we wanted to do as clinicians, particularly during the first wave of Covid when we were all in the position of facing something unknown,” she added.

“They were open to this idea and allowed us to do it, and we are grateful for that.

“We have received a huge amount of support and assistance from the ED team throughout the last year.

“They have welcomed us and made us part of their team. The project has shown what can be achieved by working together.”

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Lead Image: (l-r): Dr David Burberry, consultant geriatrician; Catherine Beynon-Howells, advanced nurse practitioner; Amanda Mdhlongwa, staff nurse; Maria Cridland, clinical nurse specialist; Dr Liz Davies, consultant geriatrician; Danielle Davies, health care support worker; and Tricia Quinn, advanced nurse practitioner. (Image: Swansea Bay NHS)


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Swansea Bay NHS

Plans for Vascular Hybrid Theatre at Morriston Hospital get a major boost

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Plans for a state-of-the-art new operating theatre at Morriston Hospital which combines a traditional operating room with advanced medical imagery, have taken a huge step forward.

Health and Social Services Minister Eluned Morgan has endorsed the high level multi million pound proposal. This means Swansea Bay University Health Board can now develop the next-stage detailed business case for the Vascular Hybrid Theatre for South West Wales.

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Vascular surgery treats patients with diseased arteries and veins. Blocked arteries can result in limb loss (amputation) and swollen blood vessels (aneurysms) which can burst, resulting in sudden death.

The Vascular Hybrid Theatre, the first in South West Wales, will combine operating theatre functionality and state of the art X-ray imaging equipment. It will treat around 500 patients a year, and some patients who currently need to go to England for treatment will be able to have their care in Swansea instead. The theatre could open early in 2025.

The new theatre will be used by Morrison Hospital’s vascular surgeons and radiologists to carry out minimally invasive techniques, often known as ‘keyhole surgery.

Compared with traditional surgery, hybrid operating theatre surgery is less invasive and less traumatic for patients. The hybrid approach will give patients quicker access to surgery and in some cases could mean the difference between limbs, and lives, being saved.

Currently, a significant number of South West Wales’ patients undergo staged procedures during their care, which can lead to multiple or prolonged stays in hospital.

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Swansea bay University Health Board say that access to these new advanced surgical technologies will allow Morriston’s vascular surgeons to perform both minimally-invasive image guided procedures, as well as traditional open surgery. This will not only improve the overall patient experience, but reduce the risk of amputation, reduce the length of stay in hospital and cut waiting times. 

The hybrid theatre will treat patients from the Swansea Bay, Hywel Dda and Powys health board areas.

Investment in the new theatre will also save a significant amount of money for the health service because the surgical techniques the hybrid model supports not only improve patient outcomes, they are also much more efficient.

The hybrid theatre will also support the clinical staff teaching.

Huma Stone, Swansea Bay UHB’s Associate Service Director, Clinical Support Services for Morriston Hospital, said: “We welcome this long awaited development and are excited that we will be able to treat patients using a combination of traditional surgery and the latest minimally invasive (keyhole) treatments at the same time, saving lives and limbs. This also reduces the number of times a patient is admitted, and shortens the patient stay in hospital.”

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Senior Consultant Vascular Surgeon Louis Fligelstone said: “This brings state of the art facilities to west Wales that will enable optimal treatment of patients with swollen blood vessels (aneurysms) and blocked blood vessels and will save lives and limbs, whilst reducing the time patients spend in hospital.” 

(Lead image: Swansea Bay NHS)

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Charity

Mayor of Llandovery raises over £2k for air ambulance after surviving freak cycling accident

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The Mayor of Llandovery in Carmarthenshire has raised over £2,000 for Wales Air Ambulance after surviving a freak cycling accident that left him unconscious at the side of the road and saw TWO air ambulances sent to his aid.

Mayor Handel Davies and his wife Margaret raised £2,280 during the annual Mayors Charity Ball.

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The successful ball, which included an auction of rugby related paraphernalia and a raffle, also raised funds for Llandovery Hospital League of Friends.

Over 110 guests enjoyed an evening of entertainment, which included ‘an excellent address’ from Wales Air Ambulance chair of trustees David Gilbert. Over £4,500 was raised during the evening for the two good causes.

The Mayor and Mayoress presented the cheque to David Gilbert at a recent base visit at the Wales Air Ambulance’s headquarters in Llanelli.

The mayor has had personal experience of the essential service the Wales Air Ambulance provides after the Charity’s medics were called out to him during the pandemic.

Handel was involved in a freak accident when a dog ran out in front of him whilst out cycling. He was knocked unconscious for 15 minutes and despite two air ambulances being called out to him, luckily for Handel he didn’t need to be airlifted to hospital.

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Mr Davies said: “A sheepdog literally appeared from nowhere at full speed in the blink of an eye hitting the front wheel of my bike at right angles causing me to fall immediately. It happened so quickly I do not remember hitting the road, but the eyewitness commented that had I not been wearing a helmet I would not have survived. The shattered interior of the helmet is evidence of this.

“It took 6-9 months to really recover and get over the impact, which following another serious cycling accident when I was 18, has led me to decide to ‘hang up’ my bicycle and instead attend ‘spin classes’ at the local leisure centre.”

A cheque for £2,280 was presented to Wales Air Ambulance by Mayor of Llandovery, Cllr Handel Davies

The Wales Air Ambulance Charity needs to raise £8 million every year to keep its emergency helicopters in the air and its rapid response vehicles on the road.

The 24/7 emergency service offers advanced critical care and is often described as a ‘Flying ED’. The on-board consultants and critical care practitioners are highly skilled and carry some of the most pioneering medical equipment in the world. They can deliver blood transfusions, administer anaesthesia, and undertake emergency operations at the scene of the incident, before flying the patient directly to specialist care. 

Reflecting on why the 24/7 Charity was chosen to benefit from the Mayor’s charity Ball, he added: “I have the utmost respect for the incredible and invaluable work the Wales Air Ambulance undertake and as we live in a beautiful part of north Carmarthenshire next to road which is very popular with both cyclists and motor bikers, over the last 25 years we have seen many accidents along this stretch of the A4069 particularly at weekends.

“It seems that almost every weekend during the summer months a Wales Air Ambulance flies overhead to attend to an incident.”

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Jane Griffiths Wales Air Ambulance’s Community Fundraising Manager said: “It was lovely to meet the Mayor and Mayoress of Llandovery during their recent base visit. They’ve raised a fantastic amount for two important causes and we’re extremely grateful for them choosing the Wales Air Ambulance as one of the charities to benefit from the Mayors Charity Ball.

“It’s lovely to hear that the mayor has recovered from his freak accident, and we wish him well for the future. Your support of our lifesaving Charity is much appreciated and will help us to continue to be there for the people of Wales when they need us most.”

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Swansea Bay NHS

£2.5m investment aims to help tackle hospital waiting lists in Swansea Bay by expanding care after surgery

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photo of woman lying in hospital bed

Swansea Bay University Health Board say a £2.5million investment in a new service that provides enhanced recovery support for patients following some types of complex surgery, will open the way for Singleton and Neath Port Talbot hospitals to do even more to tackle waiting lists.

In the wake of the two-year+ pandemic, pressure on waiting lists is higher than ever. Changes to how Swansea Bay University Health Board delivers services; and investment in staff and equipment, are aimed at bringing those waits down the health board says.

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One of the key investments is focused on expanding enhanced post-operative care facilities, which offer a step up from general ward care for patients who need extra support immediately after their operation.

This includes offering patients advanced pain relief, blood pressure monitoring and oxygen support in the immediate 24-48 hour post-operative period.

These facilities and services are not as intensive as high dependency or intensive care units. However, this additional layer of care will offer Swansea Bay hospitals greater flexibility over where that surgery can be carried out.

Opening these services in Singleton and Neath Port Talbot hospitals mean they will soon be able to offer a wider range of certain surgeries which are currently only carried out in Morriston Hospital.

Pankaj Kumar, Deputy Group Medical Director, Morriston Hospital and the project lead said: “In providing these enhanced post-operative care facilities, the health board is providing right-sized, fit for purpose, post-operative care that is responsive to every patients’ needs and is efficient in its delivery of care.

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“It will lead to improved patient care and better clinical outcomes for patients, and will also reduce the time they spend in hospital.”

The health board says that expanding these services will also ease the pressure on critical care units located on the Morriston site, and reduce the risk of a scheduled operation being cancelled at the last minute because an emergency patient needed the bed.

Singleton Hospital, which already carries out some complex surgery, will benefit from four enhanced post-operative recovery beds to begin with (eventual plan is for six beds) offering the enhanced post-operative recovery facilities particularly for colorectal and gynaecology patients.

Neath Port Talbot’s plan to become the Orthopaedic Centre of Excellence will be supported by enhanced recovery unit beds being introduced in phase two, with the commissioning of three beds. This development will also help urology surgical patients.

Morriston Hospital already has advanced post-operative care beds as part of post-anaesthetic care unit services to complement its higher level of critical care beds.

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