Hospital of St Cross

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 rated effective as good. We assessed 6 quality statements. Staff monitored the effectiveness of care and treatment, completed risk assessments for each patient on admission and reviewed them regularly. Assessments were up-to-date and staff understood people’s current needs. Staff supported patients to make informed decisions about their care and treatment. Managers used information from the audits to improve care and treatment and made sure staff understood information from the audits.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's experience

Patients said they were given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally. Patients who had spinal surgery were prescribed patient-controlled analgesia and received 2 hourly observation for 24 hours. Staff assessed patients’ nutrition and hydration needs daily and acted upon the findings. People said staff considered their wellbeing to give the best possible outcomes.

Feedback from staff and leaders

Staff completed risk assessments for each patient on admission and reviewed this regularly. They had standardised patient pathway booklets which prompted staff to update risk assessments daily following surgery. Nursing staff used nationally recognised tools to assess a patient’s risk of developing pressure ulcers, malnutrition, falls, as well as risks associated with moving and handling. Patients identified at risk had specific care plans and were monitored more frequently by staff to reduce the risk of harm. Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and evidence-based guidance. They prescribed pain relief for patients who were discharged on the day of surgery following a hip or knee replacement. They contacted day of surgery patients on day 1 and day 9 to check on their progress. Staff worked with other specially trained professionals to support people with additional needs.

Processes

There were effective processes for staff to follow in order to assess and meet the needs of patients. The service used clinical tools which were relevant to the patients’ needs, for example, WHO checklists, mobility and falls risk assessments. Records were up to date and showed comprehensive assessments undertaken leading to effective ongoing care. The acute team at the University Hospital had recently written a post operative pain guidance which was approved by the Royal College of Physicians. Staff phoned patients discharged on the day of surgery regularly to ask about any pain. They told us 44% of patients who had surgery were discharged on the same day at the time of our assessment.

Outcomes

Patients’ needs were assessed to ensure care and treatment was effective. Assessments considered the person’s health, care, wellbeing and communication needs to ensure outcomes were as good as possible. Assessments were completed to enable the treatment for the patient to be tailored to meet the needs of the patient and deliver the best outcome.

People's experience

Staff gave people clear information about their care and treatment needed to support both their physical and mental health. Staff met people’s nutrition and hydration needs. They told people if they were being assessed for possible surgical procedures and needed to be ‘nil by mouth’ for their safety.

Feedback from staff and leaders

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Staff told us and we observed policies were maintained on an online system which all staff had access to. They followed guidance regarding the records and management of medical implants, such as hip and knee replacements. The service used National Institute for Health and Care Excellence guidelines where appropriate to ensure care was evidence-based.

Processes

The trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. We saw policies contained current national guidelines and were in line with evidence based practice. Care, treatment and support were delivered in line with legislation, standards and evidence-based guidance. The service used policies, care and treatment pathways, clinical protocols and standard operating procedures. National Safety Standards for Invasive Procedures (NatSSIPS) were available in the theatre department. NatSSIPS provide a framework to produce Local Safety Standards for Invasive Procedures (LocSSIPS).

People's experience

Patients told us pre-assessment, ward staff, theatre and therapy staff shared information and worked well together to ensure they received the care and support they needed.

Feedback from staff and leaders

Staff worked across health care disciplines and with other agencies when required to care for patients. Nursing staff had a good relationship with the consultants and anaesthetists and were able to call them for advice when required. Staff held board rounds at 9am and occupational and physiotherapists attended these meetings with other healthcare professionals.

Feedback from Partners

External care providers such as social workers and community occupational therapists could access patient notes as required.

Observation

Staff planned patients’ discharge carefully, particularly for those with complex mental health and social care needs. Staff told us there was a multidisciplinary team approach to complex discharges. Handover details were provided both verbally and in writing and staff accompanied their patient during transfer.

Processes

Managers and staff worked to make sure they started discharge planning as early as possible. Information around patients’ social circumstances which may impact discharge was gathered during their pre-assessment appointment. There were pathways that staff followed to ensure patients received the care they required. Some of these pathways involved transitioning between different services if a patient needed transferring out for example. Staff were aware of how to appropriately hand patients over and refer them to different services.

People's experience

Patients told us they attended pre-operative assessment appointments where their suitability for surgery was checked. This included the completion of a health questionnaire, and an opportunity for the nurse to provide advice or refer patients on to other appropriate services if they required these services. Their procedures were done at the University Hospital if they were deemed to have higher risk during their pre-operative assessment.

Feedback from staff and leaders

Staff gave patients practical support and advice to lead healthier lives. The nature of much of the surgery provided by the hospital meant patients needed to change aspects of their lifestyle either to prepare for or to take advantage of the planned treatment. The service had relevant information promoting healthy lifestyles and support.

Processes

Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle. Where appropriate patients were given pre-operative physiotherapy and exercise programmes to ensure they were fit for surgery and able to carry out their post-operative rehabilitation.

People's Experience

Patients told us staff gave them advice pre-operatively to enable them to improve their outcome.

Feedback from staff and leaders

Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. Managers used information from the audits to improve care and treatment and made sure staff understood information from the audits.

Processes

There was an effective process to enable staff to review cancellations, discuss overbookings and ensure patients had their procedures rebooked. The hospital had been successfully accredited by the national Getting It Right First Time programme as an elective care surgical hub, delivering high standards in clinical and operational practice.

Outcomes

Outcomes for patients were positive, consistent and met expectations, such as national standards. Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. Managers used information from the audits to improve care and treatment and made sure staff understood information from the audits. Theatre and the ward staff audited patient notes. We reviewed 3 theatre notes audits, and these were comprehensive. The hospital submitted Patient Reported Outcome Measures (PROMs) for orthopaedic and neurosurgery elective patients from the Hospital of St Cross to the British Spine Registry and the National Joint Registry. PROMs assess the quality of care delivered to NHS patients from the patient perspective. They tailored PROM questionnaires to individuals, based on their previous responses. PROMs for patients having hip replacements at this hospital from 2023 to 2024 had improved to 95.5% and to 96.7% for knee replacements respectively.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. Outcomes for patients were positive, consistent and met expectations, such as national standards. The service participated in relevant national clinical audits. Managers and staff used the results to improve patients' outcomes. This included those audit and monitoring programmes relevant to the specialised surgery carried out at the hospital. The service participated in the National Joint Registry audits. Data showed the overall consent rate from January to September 2024 was at 98%, which was better than the expected national average of 90%. Staff sent out joints’ questionnaires and carried out X-rays. Patients who scored below a certain number were reviewed in a virtual clinic and discussed monthly during a multidisciplinary team meeting. Learning from audits was presented at the local quality improvement specialty meetings held 8 times each year.

People's experience

A patient told us staff has asked for their consent before delivering care and support. The process was explained to them well. Patients consistently told us that the risks and benefits of surgery were explained well and that they gave their explicit consent for surgery and any emergency procedure that might be needed.

Feedback from staff and leaders

Patients were given information about their proposed treatment both verbally and in writing where required to enable them to make an informed decision about their procedure. Staff understood how and when to assess whether a patient had the mental capacity to make decisions about their care. Staff received and kept up to date with training in the Mental Capacity Act to enable them to understand the rights of patients and legislation around consent.

Processes

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. From December 2023, patients requiring orthopaedic surgery attended dedicated ‘consenting clinics’ at least 4 weeks prior to their surgery. These were delivered virtually for most patients and face to face for those who required it. Patients’ notes showed all patients had a record of their capacity and psychological welfare on admission and where an assessment was needed this had been completed. Staff undertook mental capacity assessments in line with the Mental Capacity Act. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.