Table 1

Summary of selected case studies

NLD: Premton
Nurse-led discharge (NLD) was a suite of QI activities designed to speed up discharge initially on two specialised surgical units, but later adopted in other surgical wards. Led by senior surgical nurses, supported by most surgeons, the aim was to produce documents and checklists suitable for each surgical environment so that patients could routinely be discharged home or to less high-dependency wards without waiting for a doctor to decide.
HAN: Premton
Handover at night (HAN) attempted to build on the success of the Trust’s upgrade of ward daytime shift changeovers. HAN aimed to hold, besides the separate specialty-based handovers, an additional cross-disciplinary meeting of key night staff to discuss potentially problematic patients across the hospital.
EC: Middleswick
Enhanced care (EC) grouped patients with special nursing needs into one or more bays of a ward, so avoiding ‘specialing’ with 1:1 care, which put great strain on stretched wards. A team of enthusiastic nurses, led by selected senior nurses, developed the scheme over many months before rolling it out to a rigorous timetable across all wards.
PBP: Middleswick
Postural blood pressure (PBP) measurement helps avoid patients falling in hospital. It requires nurses to select at-risk patients and measure their BP standing and lying, which audits had shown was not done satisfactorily. A multidisciplinary team, led by an experienced specialist nurse, developed a programme to raise awareness and train ward staff.
MUB: Upsworth
Managing unprofessional behaviour (MUB), based on a proven US scheme, was designed to allow trained colleagues (‘peer messengers’) to avert poor behaviour by having carefully designed ‘cup of coffee’ conversations with ‘transgressors’, making them aware of their behaviour without the need of HR department’s disciplinary procedures, unless they ‘reoffend’.
A senior, doctor-initiated, multidisciplinary team lead the innovation.
TV: Upsworth
Tissue viability (TV), especially the excessive incidence of pressure sores, was a serious problem being tackled by a small, understaffed team of specialist nurses. One strand of activity was to introduce a new TV assessment tool (the Waterlow scale) across all relevant hospital wards.
  • BP, blood pressure; HR, human resource; QI, quality improvement.