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Trust's in-house one-to-one care team cut agency spend and patient stays

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A hospital trust is to expand its in-house nursing team for patients that require one-to-one care, after the new model decreased its use of agency staff and is thought to have contributed to reduced length of stay and better care.

East and North Hertfordshire NHS Trust’s enhanced nursing care team, which mainly comprises of healthcare assistants, is also thought to have improved patient outcomes by reducing the proportion of pressure ulcers and falls.

“With one-to-one specialling, using agency nurses was not the best model and it was an expensive one”

Liz Lees

The team was introduced in January 2016 as part of a safer staffing initiative. It includes a matron, clinical manager and 17 band 3 support workers, which allows for three HCAs to be available at night and three during the day shift.

It was initially aimed at providing care predominately for elderly patients and the HCAs were given training in areas such as dementia, and regulations, including the Mental Capacity Act and Deprivation of Liberty Safeguards.

Previously the trust had used band 2 agency workers for patients that required “specialling” as and when they were required, but it was not always possible to get them and they were not necessarily trained in these areas, the trust’s acting chief nurse told Nursing Times.

In addition, HCAs in the new team are moved around every three hours to vary the work, instead of spending 12 hours with the same patients, she said.

“What we were finding was, with one-to-one specialling, using agency nurses was not the best model and it was an expensive one,” said interim director of nursing Liz Lees.

“Our acuity of patients requiring one-to-one care was almost becoming unmanageable, which is one of the reasons we piloted the enhanced care team,” she said.

“Under the new model, we have a virtual roster so the day before the staff come on we know where our higher risk patients are and the team members are deployed in three-hour shifts,” she added.

“It’s a really responsive model. Despite the additional care needs for some patients having risen, the unit cost has gone right down because we are using our resources more carefully,” said Ms Lees.

“Due to the comprehensive assessments the staff do, we are finding the care homes…are able to lift that assessment we have done”

Liz Lees

She told Nursing Times the trust was still analysing its data but, anecdotally, it was thought that the team had reduced length of stay for patients by an average of two days because care home staff and other providers did not need to repeat assessments.

“Due to the comprehensive assessments the staff do, we are finding the care homes and other providers do not need to re-assess and they are able to lift that assessment we have done,” she said.

Meanwhile, the trust’s pressure ulcer rates had declined in the past year and its number of falls had not increased, despite admissions having risen – though the trust was still analysing its data and this could partly be a result of other new initiatives as well, she said.

Due to the team’s success, the trust will now expand it to include nine extra team members. This will allow for five support workers on shift in the day, and also five at night.

The organisation is also looking at introducing training for the team on care for patients with mental health issues – such as young adults – to ensure it offers enhanced care for all age groups.

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