Our Journal - Winter 2023 - 2024 by communicationsPAHT

Our Journal Edition seven Winter 2023/2024

Contents Welcome

Hosting our Winter Summit

Honorary degree for PAHT surgeon

New elective care hub to cut waiting times across two counties

Committed nurse attends special recognition event at Buckingham Palace

Dedicated nursery nurse receives prestigious award

Community Diagnostic Centre - staff exhibition event

Alex Health: Connecting devices for better data

Alex Health: Timely decision making when it really matters

Teams reach the finals of prestigious awards

Let's Talk Clots: new patient information app is now live

Quality Improvement Accreditation Programme

Emergency department team recognised at local council awards ceremony

Articles and publications - our #PAHTPeople...

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Welcome

Dr Fay Gilder

Sharon McNally

We are pleased to share the seventh edition of Our Journal. Our Journal includes the below, with reference to the articles in this edition: y Focus features on clinical issues/ improvements and the impact on patient care: Let's Talk Clots: new patient information app is now live y Clinical transformation updates: hosting our Winter Summit; new elective care hub to cut waiting times across two counties; Community Diagnostic Centre - staff exhibition event y Awards/clinical recognition: Honorary degree for PAHT surgeon; committed nurse attends special recognition event at Buckingham Palace; dedicated nursery nurse receives prestigious award; team reaches the finals of prestigious awards; emergency department recognised at local council awards ceremony y PAHT 2030: Alex Health: Timely decision making when it really matters; Alex Health: Connecting devices for better data y Quality and safety agenda: Quality Improvement Accreditation Programme y Conference and event reviews/updates y Research updates y Clinical leadership successes y Input from external contributors y Summary of research contributions and papers published by PAHT clinicians Our Journal provides an amazing opportunity for us to showcase the wonderful work we do – please share it widely and let the communications team know which developments we can profile in the next edition of Our Journal at paht.communications@nhs.net. Best wishes Dr Fay Gilder Medical director Sharon McNally Chief nurse and deputy chief executive

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Hosting our Winter Summit Colleagues across the healthcare system met for an engaging workshop on how to improve care for our community on 12 December.

The focus of the Winter Summit (pictured), hosted by our teams at The Princess Alexandra Hospital, was on identifying how we can improve patient flow and ensure patient safety with our system partners. The session featured an update from Lance McCarthy, chief executive, with an overview of system pressures in recent years; our system approach to patient risk; and calling on the more than 60 attendees representing healthcare partners across Hertfordshire and west Essex to focus on actions to make a difference for our community. The group reflected on the impact of delays in care being provided to a patient, with an emotive talk from Naomi Rees-Issitt, whose son Jamie died after suffering a cardiac arrest on New Year’s Day in 2022, with the ambulance service in the West Midlands not reaching him in time. They then discussed how we can improve flow and reduce waiting times in our healthcare system, with enhanced collaboration between partners. Bethan Graf, divisional director for urgent and emergency care, then led a session on feedback from the Getting it Right First Time (GIRFT)

urgent care pathways review. This included key data including that every month, 10 whole time equivalent (WTE) ambulance crew shifts were lost sitting outside our emergency department due to delays. In our area, category 2 ambulance response times are at an average of 45 minutes, compared to the quality standard of 18 minutes. Bethan also discussed topics including the delay related harm to patients and the impact on staff wellbeing, together with system pathways, patient flow and ward round processes, and the Virtual Hospital.

The attendees split into groups to discuss how we could provide improved care for patients in a series of scenarios focusing on care at the hospital and in the community, with actions across the system. The outcomes which will now be taken forward include: y Alternative pathways to the emergency department (ED) and establishing criteria to enable this y Enhanced multidisciplinary team (MDT) and collaborative working, focusing on building relationships across the system. This is to include an improved level of information sharing y A hospital-wide focus on discharging at least two patients before 10am (at least one patient is expected to move to the discharge lounge by 10am)

y Work to strengthen and improve organisational culture, including an acknowledgement that patient flow is a wholesystem issue, rather than for urgent and emergency care colleagues y A review of how the Internal Professional Standards of how to enhance patient flow through urgent and emergency care can be applied y An increased focus on the support of the Virtual Hospital y Work to ensure that the West Essex Care Coordination Centre provides a 20-minute response to patients y Criteria led discharge to trial in acute medicine and general surgery y Increasing the visibility of the frailty service, developing community next day assessments Camelia Melody, deputy chief operating officer, said: “Thank you to all for attending this fantastic event to support our plans to manage winter pressures. There were a great deal of exciting contributions and we are now focused on taking these ideas forward to support patient flow and 4 experience across the system.” 4

Honorary degree awarded to PAHT surgeon A surgeon at PAHT has been awarded an honorary degree from Anglia Ruskin University in recognition of his outstanding contribution to healthcare. Mr Ashraf Patel, associate specialist in breast surgery, received the award of Honorary Doctor of Health Sciences at the graduation ceremony at Chelmsford Cathedral on 22 November. He has worked at St Margaret’s Hospital, Epping, and The Princess Alexandra Hospital, Harlow, since 1993. Prior to this he completed his medical education at Grant Medical College and surgical training at Tata Memorial Hospital, both in Mumbai. At the Breast Unit, with the support of his patients, their families and friends and partner charities, he has helped to raise more than £5.3 million for The Princess Alexandra Hospital’s Charity. This has funded fantastic improvements including breast cancer clinical trials, specialist equipment and health and wellbeing programmes, benefiting patients with breast cancer. Ashraf said: “I am delighted to have received an honorary degree – it means a great deal to be recognised in this way. “Thank you to everyone who continues to support me, from my family, friends and

colleagues to everyone who has donated to The Princess Alexandra Hospital’s Charity.” Lance McCarthy, chief executive, said: “This is a fantastic achievement and is recognition of Ashraf’s amazing contributions to supporting our patients. “Congratulations and thank you to Ashraf on behalf of all at PAHT.” Professor Roderick Watkins, vice chancellor at Anglia Ruskin University, said: “Ashraf’s passion and determination to support patients with breast cancer over many years is inspiring.

His personal commitment to supporting patients whilst still undertaking research and raising considerable funds for clinical trials, specialist equipment and health and wellbeing programmes demonstrates his compassion and integrity. “His approach to his patients and research has made a huge impact on people's lives, and he is a powerful role model for our students.”

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New elective care hub to cut waiting times across two counties Shorter waits for surgery are a step closer in Herts and west Essex now that the green light has been given by planners to build an ‘elective care hub’ in St Albans.

Two new operating theatres at St Albans City Hospital are due to open in late 2024 and will be used to treat patients waiting for hip and knee surgery, spinal injections and ear, nose and throat (ENT) procedures. Following planning permission being granted in November, the next steps are for the design to be finalised and for the business case to be approved by the boards of the four NHS organisations who are working together on this project: East and North Hertfordshire NHS Trust, Hertfordshire and West Essex Integrated Care Board, The Princess Alexandra Hospital NHS Trust and West Hertfordshire Teaching Hospitals NHS Trust. Elective care hubs are being created across the UK to improve access to planned surgery and other procedures. In common with the hub planned for St Albans, they are managed separately, away from emergency care in order to protect planned activity from the surges and pressures that could lead to cancellations. It is expected that more than 4,000 patients will be treated at the St Albans hub

in its first year, with scope to increase capacity by adding an additional procedure suite at a later date. Patients will be carefully assessed to determine whether they are suitable for the hub. Those who need more specialised care will be seen at their ‘home’ hospital, which would be The Lister, The Princess Alexandra or Watford General. There will still be an option for patients who are deemed suitable for the hub to have their treatment at their local hospital. Advances in surgery and anaesthetics, together with the focus on pre and postoperative care (which will be provided at patients’ local hospital) means that nearly half of the patients seen at the hub will be discharged home on the day of their treatment.

Marie Lyons, who is a consultant ENT surgeon at East and North Hertfordshire NHS Trust and also the clinical lead for the elective care hub, said: “Elective care hubs are being developed across the country, concentrating on a defined set of non-complex procedures that can be delivered efficiently. Our hub is a partnership project and will draw on the best clinical practice across three hospital trusts to provide patients with a first-class service in modern buildings.”

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Committed nurse attends special recognition event at Buckingham Palace A committed nurse from PAHT attended a royal reception hosted by His Majesty The King on 14 November. The reception, that took place at Buckingham Palace, was an opportunity to celebrate the contribution of nurses and midwives working in the UK’s health and social care sector. Kristle Bravo, international nurse educator and manager at PAHT, was nominated to attend the reception by her senior nursing management team. Giuseppe Labriola, deputy chief nurse, said: “We were delighted to receive a request to nominate one of our amazing nurses to attend the celebration reception at Buckingham Palace. “The aim of the reception was not only to thank and recognise the contribution of nurses and midwives, but also our international nursing and midwifery colleagues who have joined the NHS to make a real difference. “When we were asked to nominate a nurse to attend the reception, Kristle immediately came to mind because of the amazing work that Kristle and her team does to support our international nurses joining the hospital and settling into working life.

“Congratulations Kristle and thank you for all that you do for our people and patients. We hope you thoroughly enjoyed the special event at Buckingham Palace.” Kristle said: “I am absolutely thrilled and deeply honoured to have been nominated for such a prestigious invitation to Buckingham Palace. This was an extraordinary opportunity, it's a dream come true, and I can't thank the senior nursing management team enough for this incredible privilege.” 7 7

Dedicated nursery nurse receives prestigious award A nursery nurse at PAHT has received a Chief Midwifery Officer Award for her hard work and dedication in her previous role as a maternity support worker. The Chief Midwifery Officer Awards have been developed to reward the significant and outstanding contribution made by midwives in England and has been extended to recognise the exceptional contributions of maternity support workers. In order to receive the award, maternity support workers have to meet criteria that includes consistently demonstrating the values of the NHS, delivering high quality and compassionate patient care, ensuring patient respect and dignity, building good relationships with patients and championing equality and inclusion. On 6 November, Suela Porja, maternity support worker at PAHT (pictured above) who moved into a new role as a nursery nurse, supporting younger patients and their families, was presented with the award by Matthew Fry, head of the maternity clinical network for NHS England and the wider senior midwifery team at PAHT (pictured with Suela and team, bottom right). The award was presented on behalf of Kate Brintworth, chief midwifery officer for England.

immediately puts people at ease. “Suela is highly-skilled and during her time within maternity she has taken on additional responsibilities and developed her skills further to support the midwives she works alongside.

Linda Machakaire, director of midwifery, gynaecology and assistant chief nurse, said: “Maternity support workers are at the heart of our maternity department and make a real difference every day to the lives of the mothers and birthing people they care for and the midwifery colleagues they support. They are integral to our workforce and I’m thrilled that Suela has received this well-deserved recognition and celebration for all that she does.” An extract from Suela’s citation reads: “Suela consistently goes above and beyond to ensure that she meets the needs of women, birthing people and their families, both physically and emotionally. “Suela plays a vital role in keeping families safe and comforted through one of the most life-changing events they may experience. With a friendly and calming approach to all those she comes into contact with, Suela

“Suela’s adaptability and transferrable skills make her an asset to her team and colleagues. She is a role model to all within the NHS and her contributions deserve to be recognised.” Suela said: “I’m honoured to have received this prestigious accolade. I wasn’t expecting this at all, so it was a fantastic surprise. I feel so privileged that I was able to support women and birthing people as they embark on their new adventure into parenthood and now in my new role providing support to younger patients and their families. “Thank you to my colleagues who I thoroughly enjoy working with and my senior leadership team who continue to support my professional development.”

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Community Diagnostic Centre staff exhibition event Thank you to everyone who attended our Community Diagnostic Centre (CDC) public consultation event at St Margaret's Hospital, Epping, on Wednesday 10 January. We are now also hosting a staff exhibition event at the Alex Lounge at The Princess Alexandra Hospital on Thursday 8 February, 12pm2pm. This will be another opportunity to view our proposals for the facility, which will support quicker and more local access to diagnostic tests close to patients’ homes, share your feedback and ask questions. Planned to be open from summer 2025, there will be extended opening times and additional equipment at the St Margaret’s Hospital CDC, including: y Two additional computerised tomography (CT) scanners; y Extended hours for X-rays; y New ultrasound equipment; y New cardiology equipment; y New respiratory equipment; y Relocated MRI scanner; and y More phlebotomists to be recruited – increasing the number of blood tests that can be carried out This will significantly improve the experience for our patients accessing diagnostic services, enabling our community to be seen more quickly and

closer to their homes, with more options for appointment times that are convenient for them. This aims to have further benefits of contributing to the NHS’s net zero ambitions by providing multiple tests at one visit, reducing the number of patient journeys and helping to cut carbon emissions and air pollution. The public consultation was specifically focused on the CDC development at St Margaret’s Hospital, Epping. Additionally, as part of the CDC programme, the services provided at Herts and Essex Hospital, Bishop’s Stortford, will include extended hours for cardiology, ultrasound and X-ray. Extended hours for non-obstetric (non-pregnancy) ultrasound have begun to be provided, with additional hours to be available early this year (2024). There will also be additional hours for X-ray early this year (2024). Michael Meredith, director of strategy and estates, said: “The Community Diagnostic

Centre at St Margaret’s Hospital will support us to provide modern, integrated and outstanding care to our local community. “We will be able to provide quicker access to diagnostic tests, closer to our patients’ homes. We are focused on having our patients at the heart of our services, with new and enhanced ways of working and providing care. We look forward to hearing your feedback.” You can take a look at the full exhibition boards here > Pictured: An artist's impression of the CDC (above) and the CDC project team (below).

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Alex Health: Connecting devices for better data years and have a background By Jakub in project management and clinical analytics. Whilst Kaczmarek, medical device integration is bedside medical a new area for me, I’ve been to use my background device integrated able to support the steep learning (BMDI) solutions curve. I’m really enjoying the challenge of making sure Alex workstream lead Health is the best fit for PAHT. In my email signature my job title says BMDI\VitalsLink\ infusion pumps\mobile integrated workstream lead. It’s a bit of a mouthful I’ll admit, but simply put, I’m responsible for the integration of medical devices with Alex Health, our new electronic health record system. My workstream is a purely technical one, in contrast to the clinical workstream leads who are looking at the design and integration of specific workflows. But my workstream very much underpins theirs, as my job is to get the technology right to support clinical workstream innovation and integration. I’m one of three technical workstream leads, working closely with Anoop Murala (Alex Health integration and interface lead) and Joynal Abedin (Alex Health infrastructure lead), reporting to Jeff Wood in IT and Kaushik Samanta, Alex Health programme manager.

Connectivity means productivity

I’ve worked in the NHS for 12

Why is integration between Alex Health and medical devices important? It means staff won’t have to spend unnecessary time transcribing information manually from devices into Alex Health. Better data connectivity, shared in real time, will help automate workflows and processes, achieve significant reductions in errors, and release precious staff time to focus on bedside care.

Technology powering the workflows

Alex Health is powered by Oracle Health’s Cerner Millennium electronic health record system. The benefits of integrating BMDI with Alex Health are huge: y Increased patient safety thanks to interoperability between medical devices and Alex Health, improving workflows and communication y Enhanced interface capabilities connecting bedside medical devices to Alex Health, giving access to supported medical devices, barcode

scanning to associate devices for enhanced device association, automatic disassociation of patient monitors from the patient's medical chart, and association of reports and device connectivity through Cerner Millennium’s CareAware platform y Built-in bidirectional device integration to send data from the medical device to Alex Health and vice versa y The ability to connect any validated medical device to Alex Health, regardless of vendor so we can be responsive to emerging industry standards y The ability to collect and store large amounts of data from connected devices, helping caregivers to make more informed decisions at the point of care and biomedical staff understand utilisation trends and needs y Cybersecurity safeguards and the usability of the device will ensure that the security controls 10 are appropriate for the 10 intended use

Start as we mean to go on

Regarding scope, it’s clear we won’t be able to integrate every PAHT medical device in time for go-live. Learning from other Cerner Millennium Trusts, we’re setting out very clear expectations of which devices to go live with. We can’t and shouldn’t do it all by October 2024, as there is too much room for error if we rush. Engagement with all the individual vendors of our medical devices is a complex and lengthy process which is taking time to work through, as many of them have to upgrade their own technology to be fully compatible with Cerner Millennium. And then there’s the cabling and infrastructure to sort out, as well as working through the process of upgrading some of our existing devices, many of which are not tested and validated for Cerner Millennium integration. But to me, this is a good thing. We need to take time to get Alex Health right. We need to embrace it as a journey of continuous optimisation and improvement. If go-live is the birth, then we all have the responsibility to work together to raise Alex Health into the best child possible. Forgive the baby metaphor, but I hope you get my point.

To improve is to change Alex Health is a massive change journey for everyone,

but you will all be supported throughout. System training will be there for you at the level and depth you need, as well as our full support to use new and existing medical devices whilst embedding different ways of working. Alex Health won’t solve every problem from day one, but it will be safe from day one. And as I’ve already mentioned, there will be a continuous programme of new device integration post go-live, so we continue to optimise the system for PAHT. Looking into my crystal ball, I see a moment in the foreseeable future when all medical devices will be integrated with Alex Health, seamlessly synchronising data in real time to our desktop or device. Imagine that level of connectivity in the event of another pandemic, where any patient bed can be instantly converted into a critical care bed. To be able to adapt swiftly in an emergency is vital.

Following FSV, we will be undertaking months of testing followed by a comprehensive programme of training for all users. This is when you’ll really see the difference Alex Health will make to your work. In the meantime, you can stay in touch through our communications channels, inlcuding AlexNet, InTouch briefings, and Our Journal. And please share your thoughts and concerns with your local Alex Health Ambassadors. They are there to make sure your voices are heard.

Alex Health needs you

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Alex Health: Timely decision making when it really matters

By Daisy Philip, critical care workstream lead, Alex Health We care for some of the sickest patients in adult and neonatal critical care. In these challenging environments, every second of care counts.

Currently, if a patient comes through A&E onto a ward, and then from a ward into ICU, their data is inputted into multiple systems - some paper, some digital. This can lead to avoidable delays in clinical decision making.

When every second counts

A new electronic health record that holds a patient’s data in one place will be hugely beneficial in making timely and informed decisions about each patient’s status and their plan of care, throughout their time in hospital. In my current role as critical care workstream lead for the Trust’s new electronic health record Alex Health, this is what excites me most - the system’s ability to track a critical care patient’s data quickly and safely, leading to faster, real-time decision making, reduced data inputting time and ultimately more time spent on bedside care.

From frontline to back end

I’ve worked in critical care for most of my professional life. Following my graduation as a nurse, I gained two years of experience as a staff nurse in the medical and surgical Intensive Care Unit (ICU) in India. In 2004, I came to the UK to gain a better understanding of the NHS. I have dedicated 19 years of my career to working in critical care at PAHT, where I worked as a senior sister until July 2023. The decision to transition to a new electronic health record has provided me with an opportunity to explore the administrative side of hospital operations and how complex these operations can be. As an Alex Health workstream lead I have a whole new ‘behind the scenes’ perspective, and it is really clear to me that the clinical aspect of healthcare is just a single cog in a more extensive and comprehensive healthcare system. My role in implementing and optimising Alex Health for critical care teams is vital, and I’m working closely with our clinicians and the Oracle Health team to ensure Alex Health aligns with Trust policies and is fit for purpose specific to critical care and NICU requirements.

This includes making formal system ‘change requests’ and then testing these so we can be confident the changes will actually work in practice. It also involves working with third parties to ensure Alex Health integration with, for example, Medicus for the purpose of the Intensive Care National Audit and Research Centre (ICNARC) reporting. Currently, the data for national reporting is manually entered into Medicus by the critical care admin team and we want to avoid clinical data being entered twice, increasing the risk of missing patient information. We are looking into how electronic data in Alex Health can automatically populate the fields for ICNARC.

The benefits speak for themselves

Alex Health is powered by Oracle Health’s Cerner Millennium electronic health 12 record system. The benefits 12

of an EHR for adult critical care and NICU are significant: y all of the complex information critical care and NICU need to give best patient care are in one place, reducing the need to look in different applications y clinical information can be seen from arrival in hospital to arrival in critical care in one application, improving clinical decision making y the infection control solution in Alex Health will support the reduction in infections caused by catheters, central line, catheter and wounds y our ability to prescribe the right antimicrobial medication for patients with infections will be improved y the recognition of patients with sepsis and AKI, reducing demand on critical care beds will be improved y there will be more informed handovers of patients coming in or out of critical care areas, including NICU y clinicians who are less experienced working in these complex areas will have enhanced decision support y integration of bedside monitors will reduce likelihood of transcription error and improves visibility to all clinicians of deteriorating patients y a CCOT dashboard will document and record all CCOT clinical activity, removing the need to manually enter each patient data, saving up to 20 minutes per patient y the dashboard will also provide prompts to support

and improve the clinical management of acutely ill and/or deteriorating patients

One login, one password Alex Health will give us one sign-in for everything we need to use across the Trust to record, monitor and report patient data.

Cosmic, JAC, Nervecentre, ICE will all be replaced by Alex Health. For the systems that will stay, such as BadgerNet (our electronic neonatal notes system) and Chemocare (our specialist chemotherapy prescribing software) we are looking at ways to integrate them with Alex Health so that data is automatically exchanged between systems and visible within the patient’s Alex Health record. Just think how much easier that will be. Patient data inputting on multiple systems takes hours out of our day and with Alex Health this time will be reduced significantly. This will release us to spend more time on direct care for some of our most vulnerable patients.

Change moves us forward

go-live we’ll keep working to optimise the system, so we arrive at the best solution for PAHT. When we get there, we’ll have taken a gigantic step forward in our transformation journey to be modern, integrated and outstanding.

Alex Health needs you

It’s less than 9 months to golive, we’re about to complete our Future State Validation (FSV). This month (January 2024), all the individual workstreams and workflows will come together in a series of live demos of the whole system so we can make sure it is ready to meet the needs of PAHT. Getting to this point has involved a colossal amount of hard work by everyone involved in the programme. Following FSV, we will be undertaking months of testing followed by a comprehensive programme of training for all users. This is when you’ll really see the difference Alex Health will make to your work. In the meantime, you can stay in touch through our communications channels, inlcuding AlexNet, InTouch briefings, and Our Journal.

Alex Health is a massive change journey for everyone, but you will all be supported throughout. System training will be there for you at the level and depth you need, as well as our full support to facilitate and embed different ways of working.

And please share your thoughts and concerns with your local Alex Health Ambassadors. They are there to make sure your voices are heard.

Alex Health won’t solve every problem from day one, but it will be safe from day one. Post

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Please turn over to continue reading.

Spotlight: Adult and neonatal critical care FAQs How will Alex Health benefit the patient?

The patient record will be accessible to all healthcare providers within the trust, pre-visit, during their stay and post stepdown to the ward. This will enable the exchange of information across different departments and healthcare organisations e.g. NICU babies' records will be accessible if the baby returns to ED post discharge. Adult critical care patients' records can be accessed at all points during their stay at PAHT.

Will Alex Health mean I spend more time on the computer and less with patients?

Once Alex Health is implemented, you will need to spend more time on the computer, however as a critical care nurse this means you will save time looking for notes and finding out information, and therefore you will have more time to spend with your patients. Our aim is for you to either be on the computer or be doing direct patient care. Find more Alex Health frequently asked questions here >

Teams reach the finals of prestigious awards

Six of our teams were shortlisted for the finals of the Academy of Fabulous Stuff Awards that took place on 4 December. We are delighted to share that our multidisciplinary (MDT) team were declared the winners for their work on co-designing our nutrition strategy (pictured below, left). Our frailty lead practitioner, Janice Bernardo, and team were also awarded Highly Commended for their work on our frail cancer pathway (pictured below, right).

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Let's Talk Clots: New patient information app is now live A new app, Let’s Talk Clots, was officially launched at the UK VTE Awards held in The House of Commons on 29 November. The event was attended by Charlotte Walsh from our anticoagulation team (pictured) who has been part of its development. The app, which is free to download, opens the door to a host of information for patients to help raise awareness about clots, including: what is a blood clot?, signs and symptoms, diagnosis and treatment options, pain management, coping with anxiety, recovery, clots and hormones. The Let's Talk Clots app was produced by Thrombosis UK, working in collaboration with Oxford University Hospitals, healthcare and allied professionals from across the UK and venous thromboembolic event (VTE) patients and supporters. All content has been medically reviewed by UK specialists in each topic area and patient reviewed. Some facts and stats (source: www.worldthrombosisday. org) y 60% of all VTE occur during, or within, 90 days of hospitalisation, making it a leading cause of preventable hospital death y 1 in 4 people worldwide die from conditions caused by thrombosis y An estimated 10million

cases of hospital associated clots occur annually across all countries in the world What should you look out for?

Download the app: y You can download in the Google Play store here > y You can download in the App Store here >

Signs and symptoms include: y Pain or prolonged ache in the leg y Swelling in the leg y Sudden or gradual onset of breathlessness y Chest or upper back pain, worse on breathing in Risk is increased through the following: y Major surgery y Trauma y Injury to veins y Cancer y Pregnancy y Hormone replacement therapy y Previous VTE y Family history of blood clot y Blood clotting disorder y Being overweight or obese 15 15

Quality Improvement (QI) Accreditation Programme As part of our journey to become a modern, integrated and outstanding organisation, the PAHT Quality Improvement (QI) Accreditation Programme was launched in April 2023. Over the last seven months, 11 Quality Improvement Practitioners have been working extremely hard in leading their own quality improvement project, applying the skills they have learnt throughout the programme to their project and leadership practice. The final masterclass was held on 21 November, where during part of the session the participants shared their projects and learning journeys with their project sponsors, line managers and members of the executive team. This allowed those on the programme to share how they had applied their learning and development to both their project but also to their wider roles as Quality Improvement Practitioners. Well done all – a fantastic achievement. Here is a summary of some of the amazing projects that were shared on the day: y Fabiana Carrico: Kidzmeds project in paediatrics y Hannah Evans: Lengths of stay for total primary hip and knee replacements y Joy Castres: Enhancing medical equipment availability in the emergency department

y Antonia Moynihan: Referral to treatment (RTT) 12-week validation improvement y Fran Humphries: Cardiac digital transformation y Jackie North: Safe discharges from paediatric emergency department y Jade Pattison-Blane: Improving musculoskeletal (MSK) shoulder management at PAHT y Jo Burge: Addressing cardiology’s appointment slot issue and backlog y Seval Gurtunc: Reducing did not attend (DNA) rates in dermatology y Victoria Andrews: Improving pain assessment for patients with cognitive impairment

y where they will graduate and become quality improvement practitioners y Quality improvement practitioners will have ongoing support from the Quality First team to help them continue to build on the skills they learnt during the programme

Next steps: y Participants submitted their final portfolio for assessment at the end of December. There will be an evaluation and celebration event on 7 February,

Jim McLeish, director of quality improvement, said: “It was a great privilege to be invited to attend the feedback session from our participants on the QI practitioner programme 16 at BMAT STEM Academy 16

Feedback from the masterclass last month was extremely positive as follows: Fay Gilder, medical director, said: “It was so exciting to see our dedicated colleagues empowered to use improvement tools to understand the problem, listen to their teams and deliver meaningful improvement.”

in Harlow. I was able to see first-hand the amazing amount of improvement work the team have underway, and it was equally great to see the teams in action. Their level of enthusiasm and engagement in improving pathways of care for our patients and our staff was palpable; and I have no doubt these individuals will go on to be improvement ambassadors across our Trust, supporting and developing our

improvement plans for PAHT 2030 and beyond. Thank you so much to all our QI practitioners, really impressive work.” Jo Burge, business change manager for medicine, who is also taking part in the QI accreditation course said: “I qualified as an APMG change management practitioner over 10 years ago and learnt an enormous amount of theory

around change. This course has been different. It has required the ability to look at, and reflect on, my own leadership capability and what it takes to work with people to affect change in the messiness of organisational life. The action learning groups were powerhouses of support and reflection. I’m eager now to ensure this is shared with others who want to grow their own skills and confidence.”

Emergency department team recognised at local council awards ceremony The emergency department team (pictured) has received the Gems of Harlow Award for their hard work and dedication. The event, hosted by Harlow Council on 6 November, celebrated the achievements of local organisations, services, charities and people who make a real difference in the community. Polly Read, associate director of nursing for urgent and emergency care, said: “We are delighted to have been recognised by Harlow Council for the urgent and emergency care services we provide. “Our amazing team work around the clock, 24 hours a day, seven days a week, 365 days a year, to assess, treat and admit patients to ensure that they receive the right care, in the right place at the right time.

“Our sincere thanks also to our colleagues across the hospital, partner organisations, and the local community for their support.” Stephanie Lawton, chief operating officer, said: “I am incredibly proud of the team for receiving this award, which demonstrates their commitment to putting our patients at the heart of everything they do. “Along with emergency departments across the

country, we continue to respond to a high demand for our urgent and emergency care services; the team go above and beyond to ensure that our patients receive high quality care and experiences. “This award has helped to give the team a real morale boost and bring a smile to their faces.”

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Articles and publications - our #PAHTPeople...

Take a look at some examples of the range of articles published and publications contributed to by our people since the last edition of Our Journal - a fantastic achievement. Full information of authors and articles are available from the library team: paht.lib.desk@nhs.net. y Agbedare, O., Lingam, G. and Kirmani, N., 2023. "320 Surgical Site Infections (SSIs)-Are you doing your part to prevent them?." British Journal of Surgery, 110(Supplement_6), pp.znad241-480. y Ahmed, H.E., Baldock, T., Wei, N., Walshaw, T., Walker, R., Trompeter, A., Scott, S., Eardley, W.G., Stevenson, I., Yoong, A. and Rankin, I., 2023. "Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes– Patient Operative Delays (ORTHOPOD) study." Injury, 54(12), p.111007. y Anwar, M,. 2023. (2023). "DASH score for recurrent VTE-Retrospective study." Irish Journal of Medical Science, 192(S2), pp.41– 120. Available at: https://doi. org/10.1007/s11845-02303534-z y Boraey, N.F., Bebars, M.A., Wahba, A.A. et al., 2024. "Association of ACE1 I/D polymorphism and susceptibility to COVID-19 in Egyptian children and adolescents." Pediatric Research y Boyce, L. and Kaldas, F., 2023. "HPB P22 Improving Time to ERCP for Acute Gallstone Cholangitis Admissions at a District General Hospital: A

Closed Loop Audit." British Journal of Surgery, 110(Supplement_8), pp.znad348-161 y Crane E, Wimsey S. "Posttraumatic Hand Stiffness." 2023 (Stat Pearls, Epub Ahead of Print) y Dragonas, C.G., Mamarelis, G., Shahid, S. and Tsekes, D., 2023. "A Systematic Review of Heterotopic Ossification Following Shoulder Arthroplasty: Is There a Clinical Value?." Cureus, 15(10). y Dragonas, C.G., Kottaridou, E., Vampertzis, T., Abbakr, L., Taha, N. and Manoukian, D., 2023. "Length of treatment and ultrasound timing in infants with developmental dysplasia of the hip." European Journal of Orthopaedic Surgery & Traumatology, pp.1-8. y Edwards, C., Reid, L., McCrossan, J., Parrot, R. and Austin-Davies, H., 2023. "Developing a National Policy for Library Learning Space for the NHS in England: Its Development, Impact and Continued Relevance." Journal of Hospital Librarianship, pp.110. y Falcone, M., Preto, M., Morgado, A.R., Sokolakis, I., Sarıkaya, S., Capece, M., Capogrosso, P., Manfredi, C., Tsampoukas, G. and Russo, G., 2024. "Risk and

benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group." Therapeutic Advances in Urology, 16, p.17562872231215177. y Fowler, T., Pullen, S. and Birkett, L., 2023. "Performance of ChatGPT and Bard on the official part 1 FRCOphth practice questions." British Journal of Ophthalmology. y Hudson, H., 2023. "Dying in a terminal society: a response to Maung." Journal of Medical Ethics. (ahead of print) y Hurst, J.R., McMillan, V. and Roberts, C.M., 2019. "The National COPD Audit – what you need to know." Clinical Medicine, 19(6), p.499. y Light, A., Peters, M., Reddy, D., Kanthabalan, A., Otieno, M., Pavlou, M., Omar, R., Adeleke, S., Giganti, F., Brew-Graves, C. and Williams, N.R., 2023. "External validation of a risk model predicting failure of salvage focal ablation for prostate cancer." BJU international, 132(5), pp.520-530. y Liu, Y., Tan, T., Ngwayi, J.R.M., Zhuang, X., Ding, 18 Z., Chen, Y., Zhou, Y. and 18

Porter, D.E., 2023. "Work Patterns and Intensity of Chinese Surgical Residents-A Multicenter Time-and-Motion Study." Journal of Surgical Education. y Mosea, A., Bella, M.H. and Thamer, M., 2023. "Awareness and attitude of ENT surgeons towards various dental implants or oral surgery procedures: a cross-sectional survey in the UK." The Journal of Laryngology & Otology, 137(11), pp.1261-1263. y Mylrea-Foley, B., Napolitano, R., Gordijn, S., Wolf, H., Lees, C.C., Stampalija, T., Arabin, B., Berger, A., Bergman, E., Bhide, A. and Bilardo, C.M., 2023. "Do differences in diagnostic criteria for late fetal growth restriction matter?" American Journal of Obstetrics & Gynecology MFM, 5(11), p.101117. y Nevill, B., Collier, W., Lingam, G. and Sivarajah, V., 2023. WTP7. "13 Simultaneous pneumoperitoneum and pneumomediastinumwould you guess sigmoid diverticular perforation?" A Case Report. British Journal of Surgery,

110(Supplement_6), pp.znad241-229. y Pairo-Castineira, E., Rawlik, K., Bretherick, A.D., Qi, T., Wu, Y., Nassiri, I., McConkey, G.A., Zechner, M., Klaric, L., Griffiths, F. and Oosthuyzen, W., 2023. "GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19." Nature, 617(7962), pp.764-768. y Phillips, W. and Somner, J., 2023. "A Case of Idiopathic Intracranial Hypertension/ Pseudotumor Cerebri Syndrome Cured by Myomectomy." Journal of Neuro-Ophthalmology, 43(4), pp.e156-e158. y Plagens-Rotman, K., Jarząbek-Bielecka, G., Lorkiewicz-Muszyńska, D., Przystańska, A., Obrębowska, A., Pawlaczyk, M., Jakubek, E., Małgorzata, M., Pisarska-Krawczyk, M., Pawlaczyk, M. and Opydo-Szmaczek, J., 2023. "Outline of the Problem of Sexual Violence against Children Including STD." Clinical and Experimental Obstetrics & Gynecology, 50(6), p.117 y Sewpaul, Y., Huynh, R., Hartland, A.W., Leung, B.,

Teoh, K.H. and Rashid, M.S., 2023. "NSAIDs and COX-2 Inhibitors Do Not Affect Healing After Rotator Cuff Repair-A Systematic Review and Meta Analysis." Arthroscopy: The Journal of Arthroscopic & Related Surgery. y Walters, G., Dring, K.J., Nevill, B.A., Cooper, S.B., Nevill, A.M., Nevill, M.E. and Morris, J.G., 2023. "ShortTerm High-Intensity Rowing Ergometry Training Improves Rowing Performance Equally in Healthy Weight and Obese Adolescents." Medicine and Science in Sports and Exercise. (In press)

Showcase your work in the next edition of Our Journal Thank you to everyone who has taken part in the first seven editions of Our Journal. It has been excellent to showcase your work, with a broad range of articles. Please contact us at paht.communications@nhs.net to feature in the next edition - publishing in April 2024. 19 19

The Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX 01279 44 44 55 NHSHarlow @NHSHarlow @PrincessAlexandraNHS The Princess Alexandra Hospital NHS Trust

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