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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 the 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


Over the last 12 months the Exeter Renal Unit has been growing and developing the service to increase the volume of people dialysing at home. A home haemodialysis nurse specialist post was created to work with the renal community team to improve education, promote home haemodialysis and put in place the infrastructure for the training and support of patients and staff.

A home haemodialysis roadshow was organised to raise awareness with patients and staff and several satellite units in Devon were visited. Centre stage was an experienced home haemodialysis patient dialysing themselves in a camper van, giving visitors and staff an opportunity to hear their experience.


This is what difference home dialysis makes to patients:

“I walked to church last weekend, haven’t been able to do that for a long time, even stopped for a chat and joke with a few people on way”
“It used to take it out of me, had to rest for the remainder of the day, now there is little or no recovery time afterwards”

“Dialysing overnight means I can work and have a social life, home dialysis has given me my freedom and choice back”

“I feel amazing since starting home haemodialysis, wish I did it sooner”
“I feel much better with home haemodialysis, dialysing every other night has helped me get back to full time work”.


Surgical Services

Surgical Admissions Unit (SAU)

Patients who experienced a short stay on SAU were being discharged from the waiting room which had hard backed chairs, sometimes waiting a number of hours for relatives to collect them. The team decided that they should purchase a comfortable semi reclining chair so that patients could wait in comfort. This has improved patient experience following treatment when waiting to return home.


Specalist Services


In order to make the paediatric X-ray room more friendly and welcoming for younger patients it has been given a submarine style makeover, complete with a deep sea diver mural, make-believe periscope, control panels and portholes looking out to sea from which tropical fish, turtles and even a whale can be spotted swimming by.

Due to the campaign’s success Agfa HealthCare, who supplied the room’s new high-performance DR 600 X-ray machine, pledged to match the team’s fundraising total of £5,000 and fund the total refurbishment of a second themed X-ray room which is currently underway.

One of the first patients to see the completed room was an eleven year-old patient from Tiverton who had raised £1,270 for the campaign by riding 28 miles on the Tarka Trail in May after recovering following spinal surgery. He said: “In February I was allowed to ride my bike so I have been training to get fit enough to do the bike ride - it has been my goal since coming out of hospital. I wanted to do this because I’ve had a lot of x-rays here and they’ve always been really good with me so I thought I could get fit and help some of the people who helped me. I think the room looks a lot better now – it makes you think that you really are inside a submarine. It’s a lot friendlier and less scary in here now so it was well worth the effort!”.


Following patient feedback about the Centre’s telephone line being either engaged or going to voicemail, the phone system has been changed from an options menu to a queue system managed by the reception team. This has resulted in a dramatic drop in both unanswered calls and negative responses from patients.




Surgical Services


The Urology team have adopted a new procedure for patients with a BPH (benign prostatic hyperplasia) enlarged prostate as an alternative to a TURP (transurethral resection of the prostate). This new process, Urolift, is available to a small group of patients and offers a number of benefits. The Urologists performed their first list of six patients in July; the list was performed at Tiverton hospital and all patients were treated under local anaesthetic or with sedation, whereas if they had needed a TURP this would have been carried out under general anaesthetic at our Wonford site. All six patients were discharged home on the same day without the need for a catheter and performed under local anaesthetic.


Specalist Services

Neonatal Service
Following feedback from parents the department has purchased a second microwave through Trust funds enabling families to eat together.


Cancer Services
Feedback was received from younger patients (TYA Teenagers and Young adults) that they were anxious about having their treatment in a bay with other patients who may have varying ages, complex needs and stages of their disease. Depending on the individual this could sometimes increase anxiety levels and ability to cope with the hospital stay.

The ward worked closely with the TYA clinical nurse specialist and the Teenage Cancer Trust to look at providing a side room for TYA patients that puts them at ease, gives room for family members to stay with them if necessary and provide an environment that is more homely and less clinical. The ward has been supported by the Teenage Cancer Trust to redecorate one of the larger side rooms to build on the work that has already been put in place to produce a family room for patients who stay on the ward for end of life care. Feedback from teenagers and a bereaved relative assisted with the design of this space. This room will now have a dual purpose – to be a family room or TYA room depending on the need. The room has a beautiful mural of a countryside landscape, fridge, sofa bed, tea and coffee making facilities and an outside courtyard.






Medical Services
A patient requested a ‘Pet’ at Mardon Unit. As a result the senior nurse has arranged with the charity ‘Pets as Therapy’ to start visits at the Mardon Unit. They will do this as soon as a volunteer is available to begin.


Specialist Services
Paediatric Diabetes Team
The Diasend download system was introduced 2 years ago which enables all patients to download their Diabetes monitoring equipment at home, for the Diabetes Team to review in clinic.

This provides accurate, current data for review by the Paediatric Diabetes team via telephone consultations in addition to face to face clinic contact.

As a result we have been able to see significant improvements in patient clinical outcomes and in some young people a reduction in the risk of long term complications reflected by significantly improved Hba1c outcomes.

The resource has been embraced by a variety of patients and their carers whom previously we would have had limited data to review between face to face interactions. It has also provided evidence where required to support the need for other agency involvement especially with regard to safeguarding children and young people.

It enables patients and their carers to be empowered to review their own data and make more timely changes to treatment between clinic appointments. This has further helped optimise control, giving ownership to patients for managing their long term condition, every day. This is especially important when moving towards adulthood.

Gynaecology Oncology
In March 2017, FORCE kindly donated funds to the Gynaecology Oncology dept. for the purchase of a new laparoscopic stack system called Pinpoint.

The system and process makes staging of cervical and endometrial cancer much more accurate and with fewer side effects. It also subsequently saves many patients requiring radiotherapy unnecessarily. This system will improve patient care (in some patients) by reducing harm from treatment side effects, while identifying those requiring extra treatment, thereby optimising their cancer prognosis.

The system was first used in April and has already been used to successfully identify sentinel nodes in a patient, in an area that would not normally be sampled.

Musculoskeletal out-patients (Heavitree)
Following a complaint from a patient it was identified that some patients who undergo a second operation which has put their out-patient course of treatment on hold can be delayed in restarting the treatment immediately following the operation, because appointment slots may not be available.

A new process has been introduced whereby patients that are known to have a planned second operation date are now pre-booked a post-operative outpatient appointment to ensure they are seen in an appropriate timeframe following the operation and by the same therapist to provide continuity of care. This was implemented as a direct result week of a complaint being received.

Rheumatology Physiotherapy O/P
Following patient feedback it was highlighted that patients with long term conditions such as rheumatology out-patients were being given ‘routine’ follow up appointments for 6 or 12 months or their cases being ‘left open’ just in case they needed to come back. This did not address the needs of the patient and from feedback received as a routine appointment was not always required at the time.

The Specialist Nurses have now set up a self- referral system for known rheumatology patients ensuring that patients can access treatment or advice in a timely manner; this has reduced the overall patient appointments.


Community Urgent Response - Exeter
A 90 year old lady in the community was appropriately admitted to the acute RD&E. The GP had also sent her 94 year old husband with severe dementia into the acute RD&E as a social admission. Following discussions with the patient the Discharge Lead rang the Urgent Community Response Team in Exeter to arrange support for the husband within the community environment rather than him being in the hospital. The Physiotherapist and Social Care Assessor worked together and arranged a residential care home to provide respite care.


The residential home accepted the gentleman within the hour based on the information provided to them. The community team visited him on the Saturday to ensure he had settled in and continued to liaise with acute hospital staff to plan both the support for the couple to return to their home (the wife from hospital and the husband from the residential home) 7 days later.

This demonstrates:

  • The value of trusted relationships between health and social care, acute and community teams and other care providers
  • The importance of staff feeling empowered to do the right thing first time
  • The need for 7 day working (with extended hours) to be across all Eastern localities for an MDT urgent community response

What changed as a result of this?
Shared at core groups highlighting the result of good communication and exploring all options before assuming what care may be available.
Existing staff will be supported through a consultation to achieve consistent 7 day cover across the Eastern localities. Colleagues have been encouraged to continue to use their initiative and do the right thing, in order to ensure we always remained focused on what the individual needs.




Surgical Services

The World Health Organisation estimates that less than 50% of patients with chronic diseases take their medications as prescribed. A local audit showed that for biologic treatment 38% of our patients missed at least one treatment in a six month period. Missing treatment is suboptimal andalso associated with wastage. The Rheumatology team has implemented a project employing a drug coordinator and a specialist nurse and as a result have helped to save approximately £330K across a 12 month period on a share arrangement with the CCG.


Specialist Services

Infection Control/Microbiology
Traditionally over the winter period, flu testing increases from two runs a day to three runs. Each run takes four hours for results to be available which impacts on patient flow and decision making around the placement of flu positive patients.


To help improve the patient flow and patient experience, a three month trial of point of care testing (POCT) for flu in the Acute Medical Unit (AMU) and the Emergency Department (ED) has been undertaken from January to March 2017. The Microbiology laboratory are still required to process the request, initial test, provision of results and any further tests that are required to provide more comprehensive testing. Through this trial, the results of the initial test are available in these areas within 30 minutes.


Based on the positive outcomes of the trial, funding has been approved to implement POCT across AMU and ED as part of winter planning for 2018/19 and thereafter.


Cancer Services
Feedback has been received from a patient and their family regarding the new Chevithorne family room on Yarty for End of Life patients requiring haematology and end of life care. The patient was able to have their family and friends spend a significant amount of time with them. They reported how important it was for them to remain together as a unit as the patient neared the end of life, and how this positively impacted the support they were able to provide to the patient and to each other. The family also knew that they had access to nursing support as required but were able to provide the care they wanted to give due to the family room facility.


Community Nursing- Silverton
The Community Nursing team has taken preventative measures to try and reduce patients being admitted to the caseload with significant pressure damage and subsequently requiring a hospital admission. With the support of the GP surgery the “Think Pink” and “Your Turn” leaflets have been put on the surgery website, and these will also be attached to repeat prescriptions during the year. This learning has been shared with other community teams to consider.


Honiton Community Hospital
Open visiting has commenced not only for dementia patients (John’s Campaign) but for all of the patients on the ward. A key principle was to enable family/carer’s to provide the more familiar support and company to their loved ones, which not only is beneficial for patients but also releases nursing time. This resulted in patients being more settled and the ward being more productive. Open visiting for all patients will continue.






Call 111 when its less than urgent