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Welcome to the RD&E - Demonstrating Difference

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Learning and improving practice


At the RD&E we consistently strive to provide safe, high quality and excellent care for every individual. Listening to what our patients think about the service they have received forms a vital part of this process. Below are some of the ways in which your feedback through our patient experience and complaints programme has led to direct improvements in care.




Medical Services

Nutrition Support Team
The family of a younger patient found it very difficult to engage with professional support due to previous experiences. A procedure was required which involved several different teams due to the complexity of the patient’s needs. The Nutrition team was involved at an early stage and liaised with the relevant staff to ensure the procedure happened with adequate time for the patient. Since this procedure, the relationship between this family and the Nutrition team has significantly  improved.
The mother of the patient has said “I really appreciated being listened to and felt relieved the procedure was arranged quickly”. She expressed that she felt involved and part of the process and as a consequence felt that she had made a difference to her daughter’s wellbeing.


Surgical Services
Plastic Surgery – Hand Trauma Team
Changes have been made to the Hand Trauma pathway as some patients were waiting longer for treatment than British Society for Surgery of the Hand (BSSH) guidance and there were also patient cancellations on the day of surgery.

Previously patients presenting in the Emergency Department (ED) or directly referred by their GP, Minor Injury Units or EDs in surrounding hospitals were being booked into the next available slot, without taking into account the urgency required in treating the specific injury. This led to some patients waiting for up to 10 days to be seen, or being booked to an inappropriate clinic for their specific need.

The team introduced a process whereby all patients are added to a clinic pending list. The list is reviewed by a Consultant and team the following working day. All images and the ED notes are reviewed and the patients booked to either a Hand Trauma clinic, a Hand Therapy clinic, a Consultant Hand clinic or booked directly to the theatre list within an appropriate time, dependant on the injury.

This service improvement has reduced waiting times for clinics to 5 days or less. Clinics are planned appropriately and liaison with the Hand Therapy team has improved dramatically.

In addition emergency hand surgery has been moved to Heavitree Hospital where there is a protected Hand Trauma theatre list for three days each week thus reducing the time from assessment in clinic to surgery, the number of operations cancelled on the day and time patients are waiting for an operation.


Specialist Services
Lung Cancer Nurse Specialists (CNS)
The Lung CNS met a patient on the ward with a diagnosis of advanced lung cancer who needed an urgent ultrasound biopsy, but also wished to go home due to high level of distress. The following day the CNS made a support call to the patient’s partner and was told they wanted to book their wedding but had been told by the Registry Office this could not happen until the end of the month. The CNS offered to help bring this forward and also facilitated the biopsy within 48 hours. The CNS contacted the Registry Office in Exeter and explained the severity of the patient’s condition and the family were delighted as the wedding was subsequently arranged very quickly.


Community Services
Community Nursing - Exeter
A community nurse identified that a palliative patient had difficulties with pain and soreness with her Saf-T line when receiving medication through her syringe driver which meant that the nurse was visiting sometimes twice daily and the patient was having the line reinserted at least every other day.

The nurse spoke with the Hospice Team and the medication was diluted differently alongside the administration of a drug to prevent inflammation. This enabled the line to stay in for up to five days. This change has improved the patient experience as the line has been able to remain in for longer without causing pain or discomfort for the patient.


September 2016

Area: Medical Services

Patient experience: Relatives of a dementia patient fed back about a lack of interaction available.   

Improvements in care: The day room is being furnished with new furniture, book, games and puzzles etc. There have also been visits to the museum and Morrison café arranged in addition to a school choir, local band, and craft sessions.

July 2016

Area: Surgical Services, PEOC Outpatient Department

Patient experience: Clinics saw increased demand for appointments with more complex cases which meant there was a backlog of patients awaiting routine review for hip replacements. This meant high levels of cancellations and did-not-attends. 

Improvements in care: Virtual Clinics were piloted in September 2014 and subsequently implemented permanently. Further changes have been made to enable patients to have x-rays carried out at their local hospitals at which time they also complete a pain and function assessment. The x-ray and assessments are reviewed by a clinician at a later date and the patient and GP receive a letter with the results. An expansion of this service is now being considered.

April 2016

Area: Cancer Services

Patient experience:  A complaint investigation into End of Life issues raised by a patient’s family, highlighted areas which could have facilitated a better experience for the family during the patient’s last days. 

Improvements in care: Staff worked closely with the family and they are currently helping to produce a DVD, which will be disseminated to other health care professionals. The family have been able to use their experience to help improve patient experience. The DVD will be used as a teaching tool for nurses, doctors and other allied healthcare professionals moving forward.


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