You said

Patients with acute hand injuries used to be seen in various locations at Queen Elizabeth Hospital Birmingham (QEHB). Clinics were held in the fast-paced Fracture Clinic within main Outpatients, and patients needing surgery were admitted to the very busy Surgical Assessment Unit on Level 6, along with lots of other specialty patients.

Staff from the hands team had go between these areas so clinical experts were always spread out across the hospital and there was no central point for staff or patients.

Feedback from patients suggested that waiting times were quite lengthy and that their experience could be better.

Staff realised that patients weren’t being seen efficiently and started to look into changing the pathway for hand injury patients.

We did

At first, there were many challenges as in order to streamline the pathway and create a central ‘hub’, equipment needed to be sourced and admin support brought in.

Ambulatory Care staff were instrumental in providing assistance to the hands team with setting up and continuing to maintain the clinics and facilitating the flow and care of extra patients through the department, as well as ensuring electronic processes were fit for purpose. Developments within the team are ongoing to further streamline the process.

Mr Mark Foster, Consultant Hand and Plastic Surgeon said: “In collaboration with Division A, a lot of work went into designing the new pathway and putting patients at the heart of our plans.

“We now have a consultant-led and fit-for-purpose ‘one stop shop’ for acute hand injury patients. Patients arrive to a proper reception desk, can sit in the comfortable waiting area and are then seen in the Ambulatory Care unit for both their consultation and procedure, rather than having to visit various pockets of the hospital.”

“Not only is the single location a great improvement, but patients can now have their consultation and surgery on the same day, whether that’s repair to a nail bed or a tip amputation. This is much more convenient for patients, has reduced waiting times and has streamlined decision-making as the team are now working together in one place.”

Mary McCarthy, Lead Nurse for Hand Surgery, continued: “Patients have benefitted from the changes – they become familiar with the area and have even made their way back to thank us days after their surgery.

“We are also able to see more patients as the consultation rooms are available for longer periods and time is being saved as the team no longer have to go between the different areas of the hospital.”

Ambulatory Care staff and theatre practitioners, all of whom could see the benefits for the patients and other departments, have worked extremely hard to make environmental and staffing changes to actively support the hands pathway, freeing capacity in other areas.

There have also been some unexpected benefits. The hands team are now based in Ambulatory Care so can review patients who come via this pathway more quickly. In addition, the hospital’s Emergency Department can send patients who’ve walked in with hand injuries across to them, knowing that the clinical experts are on hand in one place.

Mark continued: “The changes have been supported by the implementation of the NORSE system. This has helped reduce our admin time, as the patient booking process is now more streamlined and helps us plan and prepare our patient lists.

“In terms of making further improvements, I can see the hands service operating seven days a week so we can see patients quickly and at a time to suit them.

“Implementing the changes has been a real team effort across Ambulatory Care, Theatres and the hands team. The hands team includes junior doctors, consultants, nurse practitioners and both operational and admin support, and all departments involved have put patients at the centre of their thinking and contributed to the success of the new pathway.”