"General comments and suggestions about..."

About: Addenbrooke's Hospital

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I have visited Addenbrooke's on a number of occasions in recent months, accompanying an elderly relative as he is admitted for tests and treatment.

Care at Addenbrooke's is excellent, staff professional and courteous, thank you!

However, there are a couple of things which really bug me...

The first is the entrance to A&E.

There are 2 doors between the street and A&E, however you have a reception desk just inside the second door where patients are asked to check in. At busy times patients queue to be seen which results in the door remaining open and every time someone arrives, a cold wind blows straight in There's also a lack of seating until you get to the reception desk which results in some patients needing wheelchairs or having to walk past the queue and asking to sit until their turn comes around.

Another observation about this set-up is you have a red line around the main reception at the other end of the waiting area, apparently for patient privacy, yet the walk in admission process sees patients standing right next to each other as they are asked for personal details and medical information.

Would it be possible to move the check-in desk back a bit and create a small area for people waiting to be seen? Signs say the partitions behind the line of chairs are temporary, could they be moved back to provide a pre-triage waiting area?

The second point is a major inefficiency at Addenbrooke's, namely the pharmacy. On several occasions, my father has been told he could go home in the morning, only to sit around waiting for a prescription to arrive. In one case the wait was over 6 hours, resulting in a bed being occupied for this entire period and on another occasion there was a great deal of uncertainty and we had to keep asking the nursing staff for an update, wasting their valuable time.

Surely a hospital of your size and status can provide a more efficient pharmacy, not only for the convenience of patients but more for the additional burden on the nursing staff, not to mention freeing up bed space.

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Responses

Response from Lee Bennett, Head of Patient Liaison, Cambridge University Hospitals NHS Foundation Trust

Thank you for taking the time to post your comments. We were pleased to note that your experience of the care and treatment was positive. Thank you also for your constructive comments and observations regarding both the Emergency Department and Pharmacy. Here is the response from the senior nursing team in the Emergency Department:

"Further to the comments below regarding the front door processes. These are concerns that we ourselves are attempting to address and thank you for this feedback.

Regarding the front door.

Work is being done with the staff nurses to address the bottle neck that occurs at this stage. We have written a process guidance and altered the roles at the door to address the queues that occur. This is taking some time to embed but myself and senior colleagues are reiterating this on a daily basis to the nursing team to make sure this issue is addressed

With regard to confidentiality, we have placed signage like the red line to prevent patients over hearing each other but this is again being overlooked by patients resulting in crowding. Moving the desk back ward is a simple solution which is easily done. For a more long term plan members of the ED team are meeting to look at signage and improve the aesthetic of the front door (this will encompass signage and layout of the waiting room). Personal details should not be asked at this point and patients are reminded that private rooms are available as needed. A pre triage waiting idea is not something we want to encourage as we want their to be minimal wait at this point.

If you require any further information please let me know. And thank you again for this feedback it is very helpful in highlighting our own concerns about this area."

I have also received a response from our Chief Pharmacist and this is as follows:

If the patient’s bedside locker has all the medicines that are required to match the discharge prescription then discharge can be immediately organised with the nurses on the ward. Nurses also have access to some pre-packaged medicines that can be used at discharge. If any additional medicines need dispensing by the Pharmacy they will are provided once they are ordered and checked. Pharmacy dispensing turnaround performance is consistently less than 2 hours but this is only a part of the overall process. This includes the ward staff writing the prescription; the drug chart being taken to Pharmacy for checking, and then once dispensed, the collection of the required medicines by the ward staff. From the patients ' perspective the overall process is all that is seen, and may all be labelled as a ‘Pharmacy’ delay unfortunately.

How to improve things?

· One solution is ordering any medicines the day before discharge. This advice has recently been communicated again, as part of a new initiative by the Trust to achieve earlier discharge for our patients each day.

· We are making more use of label printers around the hospital so we can re-label at ward level, avoiding a trip to Pharmacy in some cases. This is useful if doses on available medicine supplies have changed.

· And for many patients - they do not need any additional medicines - since they have them at home already- especially planned admissions. So for these patients we can discharge immediately as long as the right checks are made. We want our patients to have at least 7days supplies when they leave us.

We hope you find this response acceptable and useful. Thank you once again for posting.

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Response from Addenbrooke's Hospital

Thank you for your comments and for taking the time to post. We asked one of the senior nursing team to respond with regard to the Emergency Department and their response is as follows: "Further to the comments below regarding the front door processes. These are concerns that we ourselves are attempting to address and thank you for this feedback. Regarding the front door; Work is being done with the staff nurses to address the bottle neck that occurs at this stage. We have written a process guidance and altered the roles at the door to address the queues that occur. This is taking some time to embed but myself and senior colleagues are reiterating this on a daily basis to the nursing team to make sure this issue is addressed. With regard to confidentiality, we have placed signage like the red line to prevent patients over hearing each other but this is again being overlooked by patients resulting in crowding. Moving the desk back ward is a simple solution which is easily done. For a more long term plan members of the ED team are meeting to look at signage and improve the aesthetic of the front door (this will encompass signage and layout of the waiting room). Personal details should not be asked at this point and patients should be reminded that private rooms are available as needed. A pre triage waiting idea is not something we want to encourage as we want patients' wait to be minimal at this point. If you require any further information please let me know. And thank you again for this feedback it is very helpful in highlighting our own concerns about this area." With regard to the Pharmacy is not accurate to suggest that the pharmacy is generally inefficient. There are many reasons why a delay can occur when a patient is discharged. Whilst the medical staff may state that a patient go home it is the medical team who are responsible for completing the discharge summary and take home prescriptions. The medical, nursing and senior management team are constantly looking at ways to improve this process including with nurse-led discharge and earlier planning and completion of the relevant paperwork. That said we were very sorry to learn that your father has experienced such unacceptable delays.

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