Optimised Care Limited

On this page

• 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

Effective - 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. This is the first assessment for this service. We rated this key question good, which meant people's outcomes were consistently good, and people's feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Staff took a person-centred approach to any unexpected physical symptoms before surgery. For example, where patients’ blood pressure was raised, staff followed a series of checks to try and identify the cause and reduce the need for delayed treatment. For example, anxiety or worry ahead of treatment could raise blood pressure. If staff could not lower it, they referred the patient to their GP and rescheduled surgery once a GP had completed an assessment.

Care pathways often included several providers, like the NHS hospital that made the referral and a separate company that handled diagnostic imaging. These providers worked together, sharing knowledge and training, to make sure the service looked at each patient’s needs as a whole.

Staff used recognised tools and assessments to deliver care and treatment. These were based on each patient’s individual needs and conditions.

Staff used effective tools to monitor and address pain. Monthly pain audits on the ward demonstrated consistently good practice, with 100% compliance in the previous 6 months. The team maintained continuous pain assessment in theatres and worked with patients with chronic pain and complex prescriptions to manage their needs.

All staff completed Mental Capacity Act and dementia awareness training. Such training enabled them to meaningful communicate with patients.

Staff carried out multidisciplinary reviews of patients with complex needs and comorbidities. They made sure planned treatment was safe by liaising with referring services and the patent’s GP.

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

Staff delivered surgery in line with Association for Perioperative Practice(AfPP) guidance with regards to evidence-based practice and risk management. Healthcare professionals held appropriate registration, such as the Health and Care Professions Council for physiotherapists and the Society of Radiographers for diagnostic imaging staff.

Staff used the Association of Anaesthetist’s Quick Reference Handbook to manage uncommon or unexpected reactions to anaesthesia. This was the industry standard, and the provider had the most up to date version available.

Managers used a ‘policy of the week’ system to make sure staff maintained up to date awareness of key policies and practices, particularly those they might not need to use often. The team discussed the policy during daily team huddles.

The most recent radiation protection audit highlighted good standards of evidence-based practice amongst radiographers, including a 2% image rejection rate, which was better than the national standard.

The provider implemented more consistent pre-operative assessment documentation following an audit that found 84% compliance. This was due for reaudit to check new processes were effective.

Staff had access to policies and demonstrated good knowledge of local procedures. The senior team had improved how bank staff accessed and used key policies as learning from a recent incident. However, the quality of some policies needed improvement. For example, a policy to reduce the risk of hospital-acquired infections gave staff generic good practice guidance rather than specific instructions for the hospital. The policy that guided staff on handling suspected female genital mutilation was missing contact details for regional safeguarding services. While staff knew how to contact these services, polices should include up to date information.

The provider 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.

Multidisciplinary working was embedded in the service and reflected the short period of time patients spent in the hospital. Staff proactively looked for opportunities to improve care and made sure patients had access to specialist input when they needed it.

Nurses and physiotherapists worked closely together to deliver multidisciplinary rehabilitation and recovery care to patients.

During our observation of surgery, we saw the surgeon taught and educated staff opportunistically, which reflected a culture of development and learning.

Diagnostic imaging services had improved integration with the surgical team in recent months, reflecting a drive for more consistent standards of practice. A radiation protection advisor, radiation protection supervisor, consultant radiologist, the director clinical services and the head of governance and compliance managed national safety compliance in relation to X-ray. They worked with the wider team to make sure diagnostic imaging was integrated in the orthopaedic care pathway.

Team meetings took place fortnightly and included temporary staff. While those who attended meetings said they were useful and meant they stayed up to date, staff who could not attend said they did not always receive a copy of the minutes or actions.

Staff supported people to manage their health and wellbeing to maximise their independence. The team supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff understood most patients sought treatment to regain their independence and enable them to do activities important to them. The team worked together to support patients with post-operative care planning, such as exercise regimes to support good rehabilitation.

Nurses discussed smoking cessation and alcohol reduction with patients during pre-assessment and physiotherapists arranged support for exercise and weight loss post-operatively.

During a pre-operative assessment, we saw the nurse proactively give health promotion advice to a patient about lifestyle influences on their health. This reflected a culture of engagement and honesty with each patient, which promoted better long-term health outcomes.

The provider monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive, consistent, and met clinical expectations as well as people’s desired goals.

Staff were committed to supporting patients to achieve outcomes important to them. For example, a physiotherapist worked with a patient to develop a post-operative exercise plan that would help them safely resume their favourite daily activities.

The service participated in the ‘Getting It Right First Time’ (GIRFT) national benchmarking programme to assess outcomes, including patient-reported outcome measures (PROMS), for hip and knee surgery. The service met or exceeded national GIRFT averages in all measures, including for hip score improvements and knee score improvements. The return the theatre rate was less than 1%, which was better than the GIRFT benchmark of 1.5% - 2%. The service had a readmission rate of 2.3%, which was better than the GIRFT target of 5%. PROMS results showed a 95% patient satisfaction rate.

The service submitted data to the National Joint Registry (NJT), a safety and quality data monitoring tool, to support monitoring and benchmarking of national patient outcomes. In the previous 12 months the service met or exceeded the national benchmarks in all 6 key measures.

The service reported 16 readmissions after surgery in the previous 12 months. In each case staff reviewed the patient’s clinical needs and liaised with the NHS trust to make sure treatment remained safe and appropriate. Staff reviewed treatment documentation to make sure surgery had been carried out as planned. The readmission rate was within the expected range for the type of surgery and level of activity.

The radiology service audited the quality of X-ray images to make sure needs assessments were consistent. In the previous 6 months the service reported image quality of over 90% as measured against the national benchmark. The team had updated auditing tools to reflect new X-ray equipment recently installed.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment.

All care and treatment was elective. Patients referred from an NHS trust had consented to their details being passed to this provider. Patients gave consent at each stage of treatment, including at their pre-operative assessment and on the day of surgery when they met the anaesthetist. The NHS trust carried out a capacity assessment to make sure the patient was able to consent to care. This provider reviewed the capacity assessment and made sure the patient’s understanding and needs had stayed the same.

The process ensured patients were aware of the planned treatment outcomes as well as potential risks and action staff would take if things went wrong. Patients we spoke with said they felt well informed and clear on the potential benefits and risks of their planned procedure.

The consent process included a discussion of each patient’s medical history so that staff could identify risks or barriers to treatment. For example, some scans could not be carried out if a patient had certain kinds of implant and staff needed to know if they were fitted with a pacemaker.

Consent forms were personalised and included details of discussions between staff and the patient. Surgeons documented specific risks relating to the patient’s presenting condition and comorbidities.

The service submitted consent data to the NJR. In the previous 12 months the service performed better than the national average.

We observed staff carry out consent processes with patients who did not speak English using a telephone translation service. Staff were thorough and methodical and asked the translator to ask the patient several questions about what they understood about their planned treatment, recovery plan, and associated risks.

The service offered a 14-day cooling off period for surgery in line with national standards.

Staff worked within exclusion criteria to make sure care and treatment plans were in the patient's best interest and did not create unacceptable risk.