Networks: South West Critical Care
Location: Junction 24, Bridgwater
Date: 26th June 2019
Information: For more details please contact us Find out more
NHS England South – Adult Critical Care Improving Value (QIPP)
During the pregnancy at around 28 weeks, Finn’s mum had, threatened preterm labour, which was stopped with medication, the pregnancy then progressed normally and Finn was born at 38 weeks an uncomplicated water birth, Finn was born with normal apgars and breastfed like a dream.
At around 9 months, Finn was seen by his health visitor for his 9 month-1 year check, where is became apparent that he wasn’t meeting his physical mile stones, he had never pulled himself up, wasn’t cruising furniture and also had a dominant right hand. A referral was made to a children’s physiotherapist and Finn was seen a few weeks later, this coincided with the family relocating to Hampshire but thank to the initial physio’s making contact with local services in Hampshire, Finn was seen by a physio and consultant, where an official diagnosis of Cerebral Palsy (Bilateral Diplegia of the Lower limbs with some upper limb involvement) was made. This was a complete an utter shock to us as a family.
With endless hospital, physiotherapy, OT appointments, Finn has come on leaps and bounds since his diagnosis. He has gone from not walking, to using a walking frame, to now at the age of 5 completely walking independently and attending mainstream school. He wears orthotic splints and uses his wheelchair out and about, as gets tired easily and falls over a lot. He also suffers with regular night cramps, which are heart-breaking, we tried medication but unfortunately for Finn he suffered a lot from the side effects.
Last year we made the decision that we would consider SDR for Finn and we were referred to Bristol Children’s Hospital. At the beginning of this year (2019), we were given the exciting news that Finn fulfilled the NHS SDR criteria as he was GMFC level 2 and could have the surgery. Finn had his surgery on 09th August, we hope it will reduce his need for further orthopaedic surgery in the future, and will give him more independence and a better quality of life in the future, as well as reduce his pain. We know the 2 year rehabilitation is going to be hard, but Finn is one happy, determined little man and knows the hard work is going too totally be worth it.
On Friday 09th August Finn had his SDR surgery in Bristol, although Finn’s surgery has been long in the planning and the surgery all went well, nothing could prepare us for how tough the last 72 hours have been as parents, an absolute rollercoaster of emotions, we have had to constantly remind ourselves why we have done this. Day 3 is hopefully our turning point but where the hard works now begins, after 72 hours of lying completely flat, Finn was able to sit up for the first time, each day is now little baby steps closer to a better future for Finn.
Day 5 following SDR, Finn’s first day stood up and our little superhero achieved this, as well as being able to kick a football. Another emotional but amazingly proud day for us as parents. Click on the below link to see Finn in action.
Day 10 Well done Finn, your a little superstar. Click on the below link to see how well Finn is doing.
Out little super hero is doing so well, here’s a few pictures of him doing his physio at home.
He has an extremely busy weekend ahead as he is taking part in the Great South Run!! Go Finn.
As a Network we are keen to gain a better understanding on long stay patients within ICUs within our Network. This process was used in the S.West where there were Complex Rehabilitation Case Managers within NHS England who could help facilitate any delays. It also gave commissioners an understanding on reasons behind and long stay patients they were commissioning.
We are keen to trial this process, and so we are requesting every Unit to complete this for every patient currently in their Unit with a length of stay > 28days (we will send a reminder to Lead Nurses at the start of each month – although do feel free to let us know if there is a better contact we should use).
If you have any queries, then please feel free to email us: firstname.lastname@example.org
SONeT Neonatal Transport Service
SONeT (Southampton Oxford Neonatal Transport Service) provides specialist transport for neonatal patients resident in Thames Valley & Wessex to be transferred to the nearest appropriate hospital for the level of care that they require. The service is collaboration between Oxford University Hospitals and University Hospital Southampton.
There is close co-operation between the SONeT hub teams and the regional Paediatric Intensive Care retrieval service SORT ( Southampton Oxford Retrieval Team) to provide a comprehensive service for Thames Valley and Wessex.
Registration details will be detailed soon.
The conference programme will include research, audit and practice improvement from across SECCN – please contact email@example.com with offers to present or with suggestions for topics to be included.
A poster competition will be run again in 2020 with a prize for the poster deemed the most creative and informative.
We hope to attract sponsors to support the event and we will run our fun quiz for delegates with a prize for the winner.
For details of previous conferences please see the general SECCN conference page.
The presentations that were shown at our Delirium Study Day on the 9th of October at the Southmead Hospital Learning and Research Department are now available to view and share. This was a very successful day with full attendance and inspirational speakers, please feel free to take a look at the information and use in your units. With thanks to all that attended and our speakers including: Kate Tantam, John Bell, Sam Heaton, Sonia Maisey, Tom Hulme, Natasha Rac, Allan Sinclair, John Warburton, Dr Roger Garrett, Graham Brant, Keith Davies and Ann Touboulic.
Please click here for the documents
If you would like any further information, please contact firstname.lastname@example.org
Time=Brain is a regional Neonatal Therapeutic Hypothermia project devised and led by Dr. Peter Reynolds and supported by South East Neonatal Network and the Maternity, Children & Young People’s Strategic Clinical Network.
The South East Neonatal Network (SENN) Time=Brain project aims to enhance the protection of babies’ brains when there is evidence of moderate or severe encephalopathy through optimising the use of therapeutic hypothermia (cooling).
There are four key aims to this project:
The key message for Time=Brain is that there is sufficient time to examine and document the baby’s neurology, diagnose the Grade of Encephalopathy and start servo-controlled cooling for moderate and severe grades, to reach the target temperature within 6 hours of birth according to NICE Guidelines.
NICHD Scoring for HIE
The NICHD chart (downloadable/printable below) should be used to guide clinicians as to when to commence cooling. This replaces the previously used Thompson/BadgerNet scoring. The criteria for babies being at particular risk of HIE has not changed. We continue to encourage clinicians to take time to evaluate the baby on the neonatal unit, with repeated clinical examinations, use of CFM where available, and discussion with a senior clinician at the local NICU, before initiation of cooling. Starting cooling on delivery suite is not recommended.
In line with current NICE guidance, we aim for babies to be at the target temperature of 33-34 degrees C. The use of servo-controlled cooling devices will normally achieve this within an hour of commencing cooling.
The optimisation of recovery from critical illness, rather than mere survival, has developed increasing prominence as the physical and psychological ramifications of a stay in critical care have become widely acknowledged. Research on the longer term consequences of critical illness has shown that significant numbers of patients surviving critical illness have important continuing problems.
“For many, discharge from Critical Care is the start of an uncertain journey to recovery characterised by, among other problems, weakness, loss of energy and physical difficulties, anxiety, depression, post-traumatic stress (PTS) phenomena and, for some, a loss of mental faculty (termed cognitive function). Family members become informal care givers, and that itself can exert a secondary toll of ill-health; family relationships can become altered and financial security impaired.” (NICE 2009)
Information for patients and relatives
National Institute for Health and Care Excellence (NICE)
Recognition of the unmet clinical needs of patients surviving critical illness prompted NICE to publish guidelines for rehabilitation – Clinical Guidelines 83 and Quality Standards 158:
SECCN guidance documents to support critical care units to deliver rehabilitation throughout the critical illness pathway
The handover of care to fellow health professionals, both when a patient leaves critical care to go to the ward and when being discharged from hospital, is paramount to ensuring the smooth transition of care and on-going rehabilitation based on a patients needs and goals. The following documents may help to structure the handover and are free to use:
Link to Frimley Park Hospital on line training for patient diaries: http://www.frimleypark.nhs.uk/e-learning/PatientDiaryTraining/launch.html
ICU Steps – Intensive Care Patient Support Charity: http://www.icusteps.org
The Paediatric Critical Care network prides itself on maintaining a focus on training and education for all staff in the network to support paediatric critical care work in our Trusts. Where possible education will be free to attend.
All current courses available for paediatrics can be viewed on the Wessex PIER website.
In addition, keep your eyes peeled for specific ODN offerings such as the annual education day (May), and annual M&M (September).
If there is something you would like us to be focusing on, please get in touch and let us know.
The idea behind the dashboard was to develop a simple set of metrics which could demonstrate outcomes of our services, and more importantly could be used to monitor trends in performance so Trusts can explore and understand variation in performance.
The metrics focus on quality data measures such as;
The dashboard was started in early 2017 and some of our Trusts have done great work in using it to raise the profile of paediatric services within their Trusts.
The Nursing Competencies programme has been designed from the national Time to Move On document (RCPCH 2014) and offers a short course (2 days) for nurses wanting to refresh or develop their Level 1 Critical Care skills. Funding by Health Education England, the course is free to attend and is available six times a year across Thames Valley & Wessex locations.
Alongside the study days, a competency document must be completed back at your place of work. For more information and to book your place visit PIER website.
South East Neonatal Network covers Kent, Surrey & Sussex; there are 11 Acute Trusts and 13 units in the Network. Two acute Trusts straddle the borders with Thames Valley & Wessex Neonatal Network, we work collaboratively to ensure that patient flows are appropriate for the level of care required.
South East Neonatal Network consists of 4 Neonatal Intensive Care Units, 3 Local Neonatal Units and 6 Special Care Units. South East Coast Neonatal Transfer Service operates across the Network, undertaking both emergency retrievals and repatriation back to local units.
|Medway Maritime Hospital
|Lead Clinician:||Dr Aung Soe|
|Ward Manager:||Anna Francis|
|Darent Valley Hospital
|Lead Clinician:||Dr Abdul Hasib|
|Ward Manager:||Annette Pope/Kathy Wood|
|Queen Elizabeth the Queen Mother Hospital
|Lead Clinician:||Dr Kalu Ogbureke|
|Ward Manager:||Louise Ruiz|
|William Harvey Hospital
|Lead Clinician:||Dr Vimal Vasu|
|Ward Manager:||Louise Ruiz|
|The Tunbridge Wells Hospital at Pembury
|Lead Clinician:||Dr Hamudi Kisat|
|Ward Manager:||Julia Moat & Lou Mair|
|Royal Sussex County Hospital,
|Lead Clinician:||Dr Phil Amess|
|Ward Manager:||Julia Simpson|
St Leonards on Sea
|Lead Clinician:||Dr Mani Kandasamy|
|Ward Manager:||Wendy Thompsett|
|Princess Royal Hospital
|As for Royal Sussex|
|St Peters Hospital,
|Lead Clinician:||Dr Peter Martin|
|Ward Manager:||Sara Robertson|
|East Surrey Hospital
|Lead Clinician:||Dr Abdul Khader|
|Ward Manager:||Ingrid Marsden|
|Frimley Park Hospital
|Lead Clinician:||Dr Sanjay Jaiswal|
|Ward Manager:||Jennifer Lomas|
|Royal Surrey County Hospital
|Lead Clinician:||Dr Michael Hardo|
|Ward Manager:||Geizel Pulanco|
|Lead Clinician:||Dr Katia Vamvakiti|
|Ward Manager||Abi Seal|
The South East (formerly South East Coast) Critical Care Network was established in April 2013 as a result of the merger between the critical care networks of Kent & Medway; Surrey and Sussex.
The role of the network is to enable Critical Care Services to work together to promote the highest quality of care for people in the South East of England. Critical Care is a vital hospital service for people with life threatening injuries and illnesses. Critical Care encompasses intensive care and high dependency care units and is where the sickest patients in hospitals are treated. Critical Care staff also provide support to ward areas to ensure the early recognition and response to acutely ill patients wherever they are in the hospital.
The SECCN promotes clinical engagement and collaboration across the South East region to ensure the delivery of safe and effective services for critically ill patients throughout the patient pathway. It provides guidance on service standards to ensure equity of the care patients and their families and loved ones receive. Critical care pathways are audited and best practice identified to serve as a benchmark for service improvement.
The SECCN provides a link between commissioners and providers of critical care to promote integration and coordination of services. The SECCN assists commissioners and providers to coordinate resources to secure the best outcomes for patients. Critical Care activity is monitored across the region to assist capacity planning and to forecast demand, to ensure that supply and demand of Critical Care services are matched even at times of peak activity.
Members of the SECCN work collaboratively to share learning, experience, knowledge and skills; to enable staff to have the skills and confidence to develop Critical Care services in line with initiatives and progress in medical practice and to meet the expectations of commissioners and the public.
|Hospital||Lead Clinician||Lead Nurse|
|Darent Valley Hospital||Dr Mike Protopapas||Maria Crowley|
|Kent & Canterbury Hospital||Dr Martin Mayall||Julie Cristall|
|Maidstone General Hospital||Dr Dan Moult||Angali Clifton-Fearnside|
|Medway Maritime Hospital||Dr Paul Hayden||Jane Westhead|
|Queen Elizabeth the
Queen Mother Hospital
|Dr Craig Guest||Deirdre McFarlane|
|Tunbridge Wells Hospital
|Dr Dan Moult||Jane Sansom|
|William Harvey Hospital||Dr Mark Snazelle||Jane Kirk-Smith|
|East Surrey Hospital||Dr Claire Mearns||Caroline Allison/
|Frimley Park Hospital||Dr Mark Blackmore||Mary Virtue|
|Royal Surrey Hospital||Dr Amish Patel||Jackie Yeruva|
|St Peter’s Hospital||Dr Tony Parsons||Denise Hallet|
|Eastbourne General Hospital||Dr Alex Trimmings||Sylvia Harris|
|Princess Royal Hospital||Dr Owen Boyd/
Dr John Kilic
|Queen Victoria Hospital||Dr Matt Lees||Claire Tait|
|Royal Sussex Hospital||Dr Owen Boyd/
Dr John Kilic
|St Richards’s Hospital||Dr Justin Dickens||Emma D’arcy|
|The Conquest Hospital||Dr Alex Trimmings||Caroline Ellis|
|Worthing Hospital||Dr James Nicholson||Adam Rogers|
The SECCN transfer form and checklist for inter hospital ensure appropriate risk assessment prior to and preparation for transfer.
For ordering details: SECCN transfer charts ordering details
The principles of safe transfer are applicable to patients transferred between hospital departments. The SECCN intra hospital risk assessment and transfer form is available for printing in A4:
Safe handover of care from one team to another is promoted by a standardize controlled process.
The SECCN standard operating procedure for handover is available for printing in A4:
The SECCN transfer guidelines are currently being updated and will be uploaded as soon as possible. In the interim, please contact email@example.com for any information or access the Intensive Care Society guidelines for the critically ill adult:
Each critical care unit runs transfer training for staff. An Intensive Care Society accredited simulation based transfer course (STricT) has been developed by St Peter’s Hospital and Royal Surrey County Hospital critical care units supported by SECCN and Health Education Kent, Surrey & Sussex. This course is also run at East Sussex Hospitals. For further information on STricT please visit https://strictcourse.co.uk or contact firstname.lastname@example.org,
The North West London Critical Care Network website contains comprehensive critical care transfer information and can be found at: www.londonccn.nhs.uk
SECCN has held a critical care conference annually since 2014 and the event continues to go from strength to strength. We are fortunate to be able to attract renowned speakers from within and outside the network and our conferences are attended by members of all health professional groups working in critical care. The event is kindly sponsored by a variety of companies which ensures that the event is free to delegates. A poster competition is held each year as well as a short quiz and each has a small prize for the winner.
** 2020 date to be announced soon **
The event was attended by over 100 delegates and supported by a range of sponsors who participated in a fun quiz competition. Presenters came from Critical Care across Kent Surrey and Sussex and we were delighted to have Dr James Haslam for Salisbury NHS Foundation Trust as our special guest speaker.
Development of Critical Care Research
Some feedback from our delegates
“Good topic selection, I particularly enjoyed the clinical psychology … and the Lung Ultrasound Demonstration”
“Useful and interesting talks that have been thought provoking”.
“Very good – everyone was very passionate about the presentations”.
The use of high-flow nasal oxygen therapy (HFNOT) outside critical care – a deanery wide survey
Dr P T Thorburn, Dr I Francis and Dr F Baldwin (Brighton & Sussex University Hospital)
Use of Simulation Based Learning in Critical Care Transfer Training
R.Mody, P. Wilder (Frimley Health)
Audit: Use of stress ulcer prophylaxis in critically ill patients
Dr. Sinan Bahlool, Dr. Krushna Patel, Dr. Andrew Baigey (East Kent Hospitals)
The Kent, Surrey and Sussex Neonatal Transfer Services is comprised of three separate teams which operate to cover the entire region and offers a comprehensive planned and unplanned neonatal transfer service. This enables the movement of critically ill patients 24 hours a day, 7 days a week across the region and the elective transfer of less unwell infants.
Kent, Surrey & Sussex Neonatal Transfer Service is part of the London, Kent, Surrey and Sussex Neonatal Transport Service coordinated through the Emergency Bed Service. During the daytime two teams operate over the three regions between 08:00 – 20:00 for planned and unplanned transfers. From 20:00 – 08:00 one of the three teams offers the night cover for the region on a rotational basis.
The Network has an active Transfer Group, led by Carolyn Barrett & Nikos Makris (Thames Valley) and Neil Johnson (Wessex). Recent priorities for the group include standardising the Network Transfer Form and a Network Competency Workbook, as well as an audit of the current provision of Transfer Training that is being delivered within the Network and Transfer Equipment.
Combined quality improvement work with NHS South is ongoing and a NHS South strategy for capacity, currency and costing is being developed. This will necessitate active engagement with STP’s and CCG’s as well as provider trusts. A programme of engagement events will continue throughout 2018/19 and units will be supported to complete a demand, capacity and costing review by a programme of network visits.
More details to follow.
The team has been working with the Children’s Epilepsy Surgery Service (CESS) based at Bristol Children’s Hospital, and the epilepsy teams at Southampton and Oxford Children’s Hospitals. The project aims to ensure that children with complex epilepsy from the Wessex and Thames Valley regions who are being considered for epilepsy surgery are able to receive as much of their pre-surgical care and diagnostics at their home tertiary centre as possible. This means less travel for the families and improved consistency of care from the epilepsy teams that they already have a relationship with.
A ‘hub and spoke’ model has been developed with the regional centres to ensure that access to paediatric epilepsy clinical care, neuro-psychological and psychiatric assessment, MRI, Video EEG and other diagnostic requirements can be provided as close to home for the patients as is appropriate.
There is a set tariff for pre-surgical evaluation (PSE) for epilepsy surgery and we have negotiated a division of the tariff between the CESS centre and the tertiary neurosciences centres to support the teams delivering the care.
From 1st April 2018 all PSE for children from the Wessex region will be delivered at Southampton Children’s Hospital. A similar arrangement for children from the Thames Valley region is being developed at Oxford Children’s Hospital.
Life is not measured by the number of breaths we take, but by the moments that take our breath away. Maya Angelou
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