Project charters

1
Project charters

• Birmingham
• Derbyshire
• Manchester
• Stour
• Torbay

2
Can nurse appointments be shifted using
self-monitoring in hypertension?

• Problem statement
• Patients with hypertension (HT) are invited to
  attend a nurse appointment twice a year.
  However, some patients do not want or need to
  attend appointments this frequently and there is
  a high DNA rate. The stress caused by attending
  for monitoring can result in inaccurate readings.
  
• Patients involved
• Cohort patients diagnosed with HT but no other
  co-morbidity and specifically those newly
  diagnosed or due to be recalled for their review
  during the period of the project (1200 patients
  with HT registered at surgery 50 have no other
  disease)
• Potential benefits
• Reduction in unnecessary nurse appointments
• Reduction in wasted patient time
• Greater empowerment of patients and improved
  patient experience
• Resultant financial benefit

• Levers for shift to be tested
• Substitution
• - Patient held records
• - Self-monitoring
• - Empowering patients through providing improved
  
• patient information
• Proposed measures
• Patients recruited to self-monitoring project
• BP readings received from self-monitoring
  patients
• Reduced number of clinic appointments for
  hypertension
• Improved service users satisfaction with
  services
• Cost analysis
• Project Board and Project team
• Project champion Graham Archard
• Practice lead Alison Nutt
• Patient lead John Reeves
• PCT - TBC

3
Can avoidable hospital attendances be prevented
and/or length of stay reduced through a
practice-based liaison nurse service for
vulnerable patients?

• Problem statement
• A set of patients has been identified who are at
  a high risk of admission to secondary care and
  who are receiving information to signpost
  appropriate care by a liaison nurse based at
  Stour Surgery. There is a need to determine how
  effective this communication and planning has
  been in avoiding readmission and whether there is
  scope for further avoidance through assisted
  discharge from planned and AE hospital
  attendance.
• Patients involved
• Those on vulnerable patients list (115 patients
  over last 12 months 20 patients currently on
  list)
• Potential benefits
• Reduction in admissions to AE
• Reduction in admissions to secondary care beds
• Improved patient, carer/relative experience
• Resultant financial benefit

• Levers for shift to be tested
• Integration
• - shared communication of management plan
• - improving inter-agency working
• Substitution - signposting to the most
  appropriate person to manage care
• Proposed measures
• Reduction in emergency admissions for this
  patient cohort
• Reduction in length of stay in hospital
• Patient and carer/relative satisfaction
• Cost analysis
• Project team
• Project champion Simon Coupe
• Practice lead Heather Amey
• Timetable
• 12 July sign off of project charter
• End July - finalise design and plan for field
  testing