Safer Clinical Systems: Southmead Hospital, North Bristol NHS Trust

A team at Southmead Hospital, North Bristol NHS Trust, set out to test the Safer Clinical Systems approach to improve systems of care for patients with end-stage renal failure. In particular, the project concentrated on how clinicians share and hand over care when these patients need surgery.

The renal unit at Southmead Hospital serves a population of 1.4 million patients. In 2010, 788 operations were performed on patients cared for by the unit. Of these, 176 were emergencies.

Patients with end-stage renal failure have diverse clinical needs, relating to dialysis, electrolyte and fluid management and appropriate prescribing. As a result they have a complex care pathway.

The existing system at Southmead Hospital required multiple handovers at various stages of patient care and there were numerous human factors that could compromise a patient’s safety. This renal care microsystem provided an excellent opportunity for teams to develop robust pathways and improve the experience of care for patients with end-stage renal failure.

This project aimed to generate a positive working environment, in which health care teams could proactively identify and eliminate potential safety breaches and build a better system of care.

The project aimed to understand and improve the complex care pathway for patients with end-stage renal failure. The team hoped to improve communication and handover processes between all members of the multi-professional team but particularly between senior surgical, medical and anaesthetic doctors. The project team also set out to improve patient experience, team working and organisational efficiency.