The Royal Bournemouth Hospital

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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This is the first assessment for this service. This key question has been rated good.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care and wellbeing. Patient safety initiatives, including consistent and accurate needs assessments were observed, reflecting the surgical division's priority of effective care. For example, we saw accurate completion of surgical safety checklists with documented allergy checks, and pro-active falls prevention strategies like educational boards.

Patient needs were checked carefully with detailed care plans. This involved regularly monitoring their weight and blood pressure, checking if they were eating enough, and keeping track of what they ate and drank. Patients who were fed through a tube in their nose or received all their nutrition through a drip were closely watched by dietitians. We looked at the records of 5 patients who were at high risk or malnourished and saw that they were consistently monitored.

Care plans for patients with elevated National Early Warning Scores (NEWS2) reflected up-to-date medical reviews and clear plans known to the nursing team. Pre-operative assessments involved detailed patient reviews, which included past medical history, surgical site mark verifications, and ‘fit to proceed’ forms. This helped to ensure a clear understanding of the procedure and identification of any additional needs.

All surgical wards we visited had a visual monitoring system which helped to provide real time insight into patient status, facilitating timely interventions and referral tracking. Wound assessments were consistently completed by nursing teams, and pain management was addressed through medicine rounds and handheld electronic device prompts.

The service planned and delivered people’s care and treatment with them. Staff did this in line with legislation and current evidence-based good practice and standards.

Our observations highlighted an emphasis on patient safety and adherence to best practices. For instance, during surgical procedures, we observed staff counting all disposable items, including gauze, needles, and other instruments, as a critical safety measure to prevent retained surgical items, aligning with guidelines from the Canadian Association of Perioperative Registered Nurses (CAFPP, 2022). These counts were performed with visual and verbal confirmation of numbers, immediately documented on a pre-printed count board. Adherence to infection control protocols was also evident through proper sharps disposal and consistent hand decontamination, following the standards set by the Association for Perioperative Practice (AFPP, 2022).

Readily accessible guidelines and algorithms for managing difficult intubation and malignant hyperthermia, alongside the consistent use of the WHO Surgical Safety Checklist, further supported clinical safety.

Ventilation compliance and the management of cold chain breaches were addressed through clearly displayed notices and flowcharts. A cold chain breach refers to an event where temperature-sensitive medical products are exposed to temperatures outside their recommended storage range. Process reviews demonstrated thorough patient assessments utilising the NEWS2 and ABCDE protocols and included specific guidelines for sepsis management and wound care assessments.

The Derwent Orthopaedic department's involvement with the GIRFT initiative for pathway improvement ensured a commitment to national quality standards.

The hospital's participation in national reviews highlighted some strong points in their care. For instance, when the kidney cancer team at the Trust met to discuss patient cases, they had more thorough information available compared to 95% of teams nationally (82%). This completeness could help to better-inform treatment decisions for patients. The service performed major kidney cancer surgery (radical nephrectomy) more quickly, with 82% of patients receiving it within 31 days compared to the national average of 69%. This faster access to surgery could help to improve patient outcomes, reducing waiting times, and ultimately lead to better and more timely care for individuals with kidney cancer at this hospital.

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

We identified a collaborative environment within the surgical division. Staff highlighted the pivotal role of the discharge co-ordinator in streamlining patient transitions, the valuable presence of the learning disability and dementia teams, and good communication with bed managers. All staff we spoke with consistently emphasised management support and internal teamwork.

In orthopaedic theatres, a strong collaborative culture was noted, with surgeons and staff working effectively as a team. For example, we observed a ‘time out’ within theatre, with all team members (scrub practitioner, surgeon, anaesthetist, ODP) actively participating in verbal verifications. A time-out in this context refers to the surgical team pausing prior to surgery to ensure safety measures are in place, such as the patient's name and date of birth, name of the procedure, correct surgical site, allergies, and availability of necessary equipment.

The surgical divisions therapy team, comprising of physiotherapists and occupational therapists, actively supported multidisciplinary care. They provided patient rehabilitation across surgical wards, co-ordinated discharges, made referrals for external rehabilitation placements, and worked to reduce inpatient deconditioning. For example, we saw a co-ordinator checklist on a surgical ward which highlighted the sharing of critical ward information, such as patients under Deprivation of Liberty Safeguards (DoLS), those experiencing acute illness, and those prepared for discharge. Furthermore, the Carer Support Service demonstrated collaboration by liaising with surgical staff to provide personalised support for an individual undergoing surgery, ensuring adjustments were made to help alleviate their concerns. This demonstrated effective information sharing and how staff, teams and services were working together.

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, reduce their future needs for care and support.

Prior to any surgical intervention, specialists ensured thorough discussions with patients about potential risks and strategies for optimising their overall health. A positive example of this is the vascular service. This service worked to improve the lives of individuals experiencing claudication, characterised by exercise-induced leg pain or cramping. Their approach involved specialist-led clinics offering comprehensive health assessments and crucial advice on smoking cessation, cholesterol management, and safe exercise practices. Furthermore, patients had the opportunity to participate in a structured 12-week exercise program, incorporating gym sessions and educational classes on self-management techniques.

To enhance patient engagement and progress monitoring, the team utilised video resources and had plans to implement a dedicated mobile application. Looking ahead, the service was also developing pre-operative fitness programs. This multifaceted approach, emphasising good teamwork and pro-active future planning, aimed to empower patients to actively manage their condition and ultimately achieve a better quality of life.

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

Surgical teams across the hospital used a multi-layered system to monitor and enhance clinical outcomes. Initially, individual specialty teams and directorates tracked their specific outcomes, escalating any concerns to the care group level as necessary.

To check how well they were treating cancer, the hospital used information from national studies as a benchmark. This was overseen by the cancer information team and clinical leads, who reviewed survival rates for bowel, stomach, and prostate cancer. They then shared this information in their regular team meetings.

Similarly, for patients with blood vessel problems, the hospital used a national database to keep track of their care. They talked about this data in meetings with other hospitals in the area, specifically looking at how patients with aneurysms were doing.

While using national information like this was a helpful way for hospitals to see how they compared to others and find areas to improve, it is important for them to also look at their own local information and listen to their patients to get the full picture and make the best possible improvements.

To strengthen oversight and focus on improvements, the hospital initiated new kinds of meetings called Service Deployment Reviews. These regular meetings focused on monitoring key metrics across all directorates, commencing with the Head and Neck Department. The hospital also used a system called Patient Reported Outcome Measures (PROMs). This is where patients who had hip or knee replacements were asked how they felt after their surgery. This information was analysed and published by NHS England. NHS England is the national body that leads the NHS in England.

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

The Trust's consent policy stated consent must be informed, voluntary, and provided by an individual with the capacity to do so, aligning with legal and ethical principles outlined in the Mental Capacity Act 2005. The policy reinforced the importance of assessing patient capacity and acting in their best interests, especially when capacity was lacking.

Documentation reviews and positive patient feedback confirmed an emphasis on informed consent at the hospital. Multiple consent checks were evident throughout the surgical pathway, including clear surgical site markings and pre-operative communications, ensuring adherence to safety protocols. For instance, conversations with 2 patients awaiting eye surgery revealed their surgical sites were clearly marked and consent checks had been conducted at numerous points during their hospital stay.

Before any surgery, patients consistently received detailed explanations, and our review included multiple appropriately signed consent forms. On the wards, we observed staff asking for patients verbal agreement before any treatment and/or intervention, like checking their vital signs or helping them move. We also saw staff checking patient wristbands before giving medication, which correctly followed the procedure for identifying the right patient and confirming their consent at the same time.