St Anthony's Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes
and promoted a good quality of life, based on best available evidence.
At our last assessment we rated effective as Good. At this assessment the rating has remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients records were on paper and safely stored. Staff told us that a nurse was in charge of uploading some information on their electronic folder to facilitate information sharing during patient transfer as some entries could be difficult to read. However, they said that they would prefer patients’ records keeping to be fully electronically accessible to avoid duplication and facilitate sharing. We reviewed 10 patient records, and they were properly completed. They contained information such as patients’ condition, complexity of the surgery and any other medical condition.

Staff completed a comprehensive health assessment of patients in a timely manner soon after admission, and developed a holistic care plan, tailored and personalised to meet the needs of the patients identified during assessment. The risk assessment audit showed 100% compliance against the hospital 90% target.

Patients’ observation charts were kept by their bedside, and all nursing documentation were appropriately completed. These included risk assessment information such as nutritional screening (MUST), sedation assessment (RASS). To identify any signs of deterioration they used the National Early Warning Sign (NEWS2), to assess confusion they used (Confusion Assessment Method (CAM), the delirium screening tool to evaluate and manage any sign of delirium. Staff escalated concerns appropriately and they informed patients or relatives of any change in the care plan or treatment. Staff also used sepsis screening tools to identify and manage patients with suspected sepsis. The assessment audits showed that staff achieved 100% compliance for risk assessment and 98% for venous thromboembolism (VTE).

Medical staff were trained in advanced life support and European advance life support to ensure that they had the appropriate skills and expertise to manage cardiac arrest and deteriorating patients.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The critical care unit had access to the multidisciplinary professionals (MDT) required to meet patients’ needs, including pharmacists and physiotherapists and specialist services such as dietician and speech and language therapy. MDT support was available daily, with on-call cover overnight.

The service followed relevant national guidance, including the Guidelines for the Provision of Intensive Care Services (GPICS), Faculty of Intensive Care Medicine (FICM), Intensive Care Society (ICS) and National Institute for Health and Care Excellence (NICE) guidance. Staff used this guidance to plan and deliver care and treatment.

Staff assessed and met patients’ needs for food and drink, including specialist nutrition and hydration. Patients told us that the food was catered considering their dietary needs and requirements, including food allergies.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

During the assessment, we spoke with more than 14 members of staff, including nurses, consultants, anaesthetists, physiotherapist, pharmacists, and healthcare assistants. Staff told us that they had regular multidisciplinary (MDT) meetings and discussed patients. We attended the morning handover meeting, and staff shared patients’ important information following the situation, background, assessment and recommendation (SBAR) format. MDT reviews and ward rounds were held daily to discuss patients progress and review clinical and care plans.

We observed staff preparing for a patient’s admission from theatre. There was an effective communication between different teams, including non-clinical staff, information about the patient and instructions was efficiently shared by the senior consultant and actions, including setting all the required equipment were evaluated. Upon the arrival of the patient with the anaesthetist, the medical team immediately took over and promptly attended to the patient.

The transfer of severely deteriorating patients to local NHS hospital was decided by the lead consultant. The MDT reviewed any transfer incidents using PSIRF methodology to determine the type of investigation required. The Key Safety Indicator (KSI) is an investigation process that was used to triage, review and learn from. Patients’ information showed input from consultants and resident doctors (RMO) and shared to ensure a consistent approach to care and treatment.

Patients were not discharged from the critical care unit. Rather, they were transferred to the ward before discharge. Staff planned for patients’ discharge, which included liaison with care managers/co-ordinators, including outreach services and discharge information were sent to the GP.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The critical care unit did not directly discharge patients. Staff transferred patients to wards for them to continue to receive the right support in their recovery journey and to ensure a good flow. The service made provisions of services such as physiotherapy and social workers to ensure safe and smooth transfer of patients to the ward and reduce their needs for care and support. Once transferred to the ward, staff supported and provided information to patients to help them better manage their post-surgery recovery, health and wellbeing, and they were signposted to community services to live a healthier lifestyle and to minimise and reduce their need for care and support in the future.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service participated in the National Audit programme and mortality and morbidity review programmes to ensure that patients outcomes were positive, consistent and to improve learning. The service participated in the National Institute for Cardiovascular Outcomes Research (NICOR) to monitor and benchmark against similar services. There had been 0 unplanned readmission in the critical care unit and transfer to NHS hospitals was low at less than 1%.

Concerns and incidents were recorded on DCIQ to identify themes and monitor outcomes. Audit findings were monitored, reviewed and discussed during governance meetings and the Medical Advisory Committee (MAC) to identify and drive learning.

Staff took all practical steps to enable patients to make their own decisions and took a person-centred care approach to treatment.

We observed staff discussing treatment and care plans with patients and taking time to answer questions and ensuring they understood before obtaining consent.

Staff assessed and documented patients’ capacity to consent where appropriate. Where patients lacked capacity, decisions were made in their best interests, reflecting their wishes, feelings, culture and personal history, involving family members, carers or next of kin where appropriate. The service made provision of mental health first aiders services, to help people who may experience mental health issues or emotional distress. We reviewed mental capacity assessment records, and they supported and evidenced this decision-making process.

The Mental Health Capacity Act (MHCA) and the Deprivation of Liberty (DoLS) training data showed 100% completion, above the 90% provider target. This provided the assurance that staff complied with their training.

Patients told us staff took the time to understand their needs and expectations and were aware of their rights. They were also able to raise concerns and understood how to escalate issues where necessary.