Southport A&E


Notes to Hospital Trust for A&E Review

My recent experience with the wider A&E and support services went well. However, I felt I needed to take some control of the recovery process. I’ve had a previous Achilles injury, so I was much wiser this time. This is not a criticism of the staff, who were great, it’s the process that could be improved.

Most of the issues were around information and knowledge, and a disjointed process.

1. On initial contact I was informed that an ambulance wasn’t available and I would need to make my own way to A&E. Ideally some advice on how not to cause further damage would have been useful.

2. A temporary plaster cast was put on by two nurses, due to a shortage of minor components (wedges?). A proper cast was put on by the Plaster Cast department the following day. No problem but more time for the staff.

3. I was examined by a consultant but didn’t have an ultrasound.

4. I was given a boot designed for Achilles injuries but few instructions on hygiene or likely issues. Due to my previous experiences I have developed practices and purchased support aides. None of this type of information is readily available.

5. The boot is great but has design flaws around the vacuum insert.

6. I was given a single sheet of paper with a list of stages of development by week.

7. I found comprehensive accompanying exercises, to maintain core strength and muscle tone, at another teaching hospital. Many Trusts have this type of information but they all tend to be slightly different ?? The instructions I used also included hygiene checks.

8. I noticed that the consultants and staff tended to ask at which week I was in. Not sure if they were testing me or not aware but it always sounds a little strange. This happens throughout the wider system.

9. There was some confusion about the critical modifications to the boot position which resulted in my programme being put back.

10. Although I was supposed to have two weekly sessions to modify the boot and see the consultant, there was no availability for one of the later appointments. I was asked to chase this up nearer the time. I was then told not to contact them, as I would be contacted. Which didn’t happen.

11. My boot modifications were now completely out of step with the protocol that I was following from the other hospital.

12. I was also due to see a Physio earlier than my next visit. A problem as I needed to be signed off.

13. Realising that my Achilles was far better than would normally be expected, I decided to work out a programme that tied in with the Physio date. I had been given a key for the boot, at a first appointment, with an indication that I might be asked to use it. I worked out a staged approach to modifying the boot.

14 On seeing the Physio, I was told that I was far more advanced than could have been expected. However, I couldn’t be given an appropriate plan as I hadn’t been signed off. Also, he couldn’t advise that I stop using the boot, which I hadn’t been using for some time.

15. I then had to arrange an appointment to be signed off by the consultant.

16. Having been signed off, I then had to arrange a physio appointment. This was scheduled for 3 weeks later than the first Physio appointment. I changed physio and got an appointment the next day.

17. At this appointment I was given a new plan and signed off by the Physio. I was also given good advice on when I could restart various sport activities.

I should mention that when I was signed off by the consultant, a nurse asked for my support notes, which she said would be useful.

It would be useful if a charity could take some of my aids which are invaluable to facilitating a healthy recovery and improving safety in the home.

I would stress that ALL the staff were superb, it’s the process that needs to be looked at, particularly advice and guidance for the elderly. I’ve kept healthy during the recovery process and considered my whole body not just the injured Achilles.

I had major issues with physio practices during my hip problem. Due to referred pain, when walking a short distance, pain moves from the knee to the back, hip and groin. When I first saw a physio I was told that they were only allowed to discuss one of the areas of pain and provide a plan for it. It took quite some time to get a diagnosis.

To reiterate I always have full confidence in the staff but not the process.

What would I change?

1. Look at processes from a patient’s perspective.

2. Provide more advice to patients, using readily available info and feedback from patients on their wider experiences.

3. Consider the patient’s treatment from an overall health perspective (just simple stuff). For example Physio plans can also provide exercises on a good limb that will otherwise deteriorate.

4. Look at the integration between IT systems and possible use manual processes to overcome IT deficiencies.

Achilles Tendon Notes

AI Checks and balances

After internet searches AI is used as a check and balance

Sent by you:

provide information for patients, with an Achilles rupture, based on the use of a VACOped boot and East Kent Hospitals University documents, plus other NHS documents

Certainly! Here is some information for patients with an Achilles rupture, based on the use of a VACOped boot, as outlined by East Kent Hospitals University and other NHS documents:

Understanding Achilles Rupture

An Achilles tendon rupture is a break in the tendon at the back of your ankle, connecting the calf muscles to the heel bone. This injury can significantly affect your ability to walk and push up onto your toes.

Treatment with VACOped Boot

The VACOped boot is designed to help the Achilles tendon heal by keeping the foot in a specific position and restricting movement. Here’s a general guide to using the VACOped boot:

Initial Phase (Weeks 1-4)

  • Position: The boot is fixed at 30° to keep the foot pointed down (equinus position).
  • Activity: Minimal movement is recommended. You should avoid putting weight on the affected leg and use crutches for mobility.

Intermediate Phase (Weeks 5-6)

  • Adjustment: The range of movement is adjusted to 15° to 30° using the VACOped key.
  • Activity: Gradual increase in movement is allowed, but weight-bearing should still be limited.

Final Phase (Weeks 7-8)

  • Adjustment: The range of movement is further adjusted to 0° to 30°, and the flat sole is introduced.
  • Activity: You can start putting more weight on the affected leg, but continue to use crutches as needed.

Rehabilitation and Exercises

Rehabilitation is crucial for recovery. Here are some key points:

Care and Maintenance of the VACOped Boot

Additional Support

For more detailed information, you can refer to the East Kent Hospitals University NHS Foundation Trust’s guide1.

If you have any specific questions or need further assistance, feel free to ask!

Sent by you:

can you provide an accompanying exercise programme

Certainly! Here is a general exercise program for patients with an Achilles rupture using a VACOped boot, based on guidelines from East Kent Hospitals University NHS Foundation Trust and other NHS documents:

Exercise Program for Achilles Rupture with VACOped Boot

Weeks 1-4: Initial Phase

  • Boot Position: Fixed at 30° (equinus position).
  • Activity: Minimal movement. Focus on keeping the foot elevated and using crutches for mobility.
  • Exercises:
    • Toe Wiggles: Gently wiggle your toes to promote circulation.
    • Isometric Contractions: Tighten your thigh muscles (quadriceps) and hold for 5-10 seconds, then relax. Repeat 10 times.

Weeks 5-6: Intermediate Phase

  • Boot Adjustment: Range of movement adjusted to 15° to 30°.
  • Activity: Gradual increase in movement, still limited weight-bearing.
  • Exercises:
    • Ankle Pumps: Move your foot up and down within the allowed range of the boot. Repeat 10 times.
    • Seated Heel Raises: While seated, gently lift your heel off the ground, keeping your toes on the floor. Repeat 10 times.
    • Knee Extensions: Sit with your leg straight and slowly lift it, then lower it back down. Repeat 10 times.

Weeks 7-8: Final Phase

  • Boot Adjustment: Range of movement adjusted to 0° to 30°, and flat sole introduced.
  • Activity: Begin to put more weight on the affected leg, using crutches as needed.
  • Exercises:
    • Standing Heel Raises: Stand and gently lift your heel off the ground, keeping your toes on the floor. Repeat 10 times.
    • Balance Exercises: Stand on your affected leg for a few seconds, using support if needed. Gradually increase the duration as you feel more stable.
    • Gentle Stretching: Stretch your calf muscles by placing your hands on a wall and stepping back with the affected leg, keeping it straight. Hold for 15-20 seconds.

General Tips

  • Consistency: Perform exercises ‘little and often’ to avoid overloading the tendon.
  • Pain Management: Stop any exercise that causes pain and consult your physiotherapist.
  • Follow-Up: Regular follow-ups with your physiotherapist to adjust the program as needed.

For more detailed guidance, you can refer to the East Kent Hospitals University NHS Foundation Trust’s rehabilitation guide1.

If you have any specific concerns or need further assistance, feel free to ask!

Sent by you:

Are there any support aids that can be used at home during rehabilitation programs

Yes, there are several support aids that can be used at home to assist with rehabilitation programs, especially for conditions like an Achilles rupture. Here are some commonly recommended aids:

Mobility Aids

  • Crutches: Essential for non-weight-bearing phases.
  • Knee Scooters: Provide mobility without putting weight on the injured leg.
  • Walking Frames: Offer additional support when transitioning to partial weight-bearing.

Supportive Devices

  • Grab Bars: Installed in bathrooms and other areas to provide stability.
  • Shower Chairs: Allow you to sit while showering, reducing the risk of falls.
  • Raised Toilet Seats: Make it easier to sit and stand without straining the Achilles tendon.

Exercise and Rehabilitation Equipment

  • Resistance Bands: Useful for gentle stretching and strengthening exercises.
  • Balance Boards: Help improve stability and proprioception during later stages of rehabilitation.
  • Foam Rollers: Aid in muscle relaxation and improving flexibility.

Comfort and Safety Aids

  • Elevating Leg Rest: Helps keep the leg elevated to reduce swelling.
  • Ice Packs: Essential for managing pain and inflammation.
  • Non-Slip Mats: Prevent slipping in areas like the bathroom.

Home Adaptations

  • Ramps and Step Rails: Make it easier to navigate steps and uneven surfaces.
  • Adjustable Beds: Allow for easier positioning and getting in and out of bed.
  • Reachers and Grabbers: Help pick up items without bending or straining.

Digital Tools

  • Telehealth Services: Enable virtual consultations with physiotherapists.
  • Exercise Apps: Provide guided rehabilitation exercises and track progress.

For more detailed information on home adaptations and equipment, you can refer to the NHS guide on home adaptations1 and Carers First’s guide on specialist equipment2.

If you have any specific needs or questions, feel free to ask!

Sent by you:

are there any aids designed with the VACOped in mind

Yes, there are several accessories and aids specifically designed to complement the use of the VACOped boot, enhancing comfort and functionality during your recovery. Here are some of the key accessories:

VACOped Accessories

  1. Adjustment Key: Used to adjust the angle and range of motion of the boot.
  2. Vacuum Pump: Helps maintain the correct pressure and fit of the boot by adjusting the vacuum insert.
  3. Spare Cloth Liners: Additional liners are available to ensure hygiene and comfort, especially since the liners are washable and need time to dry.
  4. Rocker Sole: A detachable sole that helps with walking by providing a natural rolling motion.
  5. 15° Achilles Wedge Sole: Provides additional support and comfort by keeping the foot in a slightly elevated position.
  6. Flat Walking Sole: A detachable sole for transitioning to more normal walking patterns as you progress in your recovery123.

Additional Support Aids

These accessories are designed to make your recovery process smoother and more comfortable. If you need more detailed information or assistance with any specific accessory, feel free to ask!

Chatbot Brainstorming

Restructuring Southport and Ormskirk A&E (10 year vision)

The aim of the embryonic Southport Innovation Centre is to enable students to practice innovation and creativity skills by combining art and science in unique and innovative ways. AI often plays an important role by acting as an intelligent assistant and bridging the gap between the two disciplines. It can also greatly increases the breath and depth of a project. A recent arts project had evolved to included research into sports injuries and medical protocols. The project coincided with my completion of a questionnaire on A&E at Southport and Ormskirk. Building on the Chatbot conversation, I decided to see how AI could be used to brainstorm ideas on restructuring A&E. The example below is a small section of the overall conversation. I was driving the direction of conversation and determining what would be included.

Rather than treating the proposals as options to be implemented using AI, the aim is to see them as general approaches, a number of which could be investigated. AI is very new and improving all the time, so this should be viewed as an early example of what will be possible in the future. When comparing these proposals with the Trust’s Strategy. We are comparing two very different things. These proposals are more around 10 year strategic visions, rather than strategies to meet key operational priorities. However, they need to be considered with some urgency as business systems, use of estates and digital technologies all need to be agile and flexible. This requires strategies to consider potential future scenarios.

Sent by you:

using the information from the complete conversion and taking into consideration best practices in Accident and Emergency management, how could an outdated A&E system across Southport and Ormskirk hospitals be redesigned.

To redesign the outdated A&E system across Southport and Ormskirk hospitals, Aria can leverage AI, Chaos Theory, and best practices in Accident and Emergency management. Here’s a comprehensive approach:

Data Integration and Analysis

  1. Centralized Data Repository:
  2. Predictive Analytics:

Enhancing Patient Flow and Reducing Wait Times

  1. AI-Assisted Triage:
  2. Streamlined Processes:

Personalized Care and Treatment

  1. Tailored Treatment Protocols:
  2. Real-Time Monitoring:
    • Wearable Devices: Equip patients with wearable devices to monitor vital signs and detect any deterioration in their condition while waiting for treatment.
    • AI Alerts: Implement AI systems that provide real-time alerts to healthcare providers when a patient’s condition changes, enabling timely interventions.

Addressing Demographic Inequalities

  1. Targeted Interventions:
    • Health Disparities: Use AI to identify health disparities among different demographic groups and develop targeted interventions to address these inequalities.
    • Community Outreach: Implement community outreach programs to educate and support underserved populations, ensuring they have access to necessary healthcare services.
  2. Equitable Resource Distribution:
    • Data-Driven Decisions: Use AI to ensure that resources are distributed equitably across different demographic groups, addressing any disparities in access to care.

Knowledge Management

  1. Continuous Learning Systems:
    • Feedback Loops: Implement feedback loops to continuously learn from new data and refine AI models and treatment protocols.
    • Knowledge Sharing: Facilitate knowledge sharing among healthcare professionals by providing access to AI-generated insights and recommendations.
  2. Decision Support Systems:
    • Implementation: Implement AI-powered decision support systems that provide real-time recommendations to healthcare providers based on the latest evidence and best practices.
    • Personalization: Tailor these recommendations to individual patient needs, considering factors such as medical history, current health status, and genetic information.

Implementation and Monitoring

  1. Embedded AI Systems:
    • Smart Devices: Use smart devices and wearables to continuously monitor patients’ vital signs and health metrics.
    • Telemedicine Integration: Expand telemedicine services to provide remote consultations and reduce the need for in-person visits.
  2. Outcome Tracking:
    • Continuous Improvement: Track patient outcomes and use feedback to refine AI models and improve treatment protocols.
    • Quality Indicators: Monitor key quality indicators such as patient satisfaction, treatment outcomes, and wait times to ensure continuous improvement.

By leveraging AI and best practices in A&E management, Aria can help transform the A&E system at Southport and Ormskirk hospitals into a more efficient, patient-centered environment. This approach not only improves patient outcomes but also ensures that healthcare services are equitable and accessible to all.

Would you like to explore more about specific AI applications in healthcare or other areas?

1: PNAS Nexus 2: Nature 3: BMJ 4: BMC Health Services Research 5: McKinsey 6: BMJ Open Quality 7: CQC 8: HealthRay 9: SpringerLink : SpringerLink : DigitalDefynd : Pickler : Pickleball Union : Pickletip : The Manual : Sporty Escapade : Stanford Medicine : RCEM : BMJ Open Quality : CQC : HealthRay : McKinsey

Sent by you:

based on the previous responses how could Aria help in developing an overarching strategy for A&E that builds on a strategy framework that includes: Financial Strategy; Patient and Community Strategy; Operational Strategy; Infrastructure Strategy; Supplier Strategy and Regulations Strategy.

Aria can help develop an overarching strategy for the A&E departments at Southport and Ormskirk hospitals by leveraging AI and best practices across various strategic areas. Here’s how she might approach each component of the strategy framework:

Financial Strategy

  1. Cost Optimization:
  2. Revenue Enhancement:

Patient and Community Strategy

  1. Personalized Care:
  2. Community Outreach:

Operational Strategy

  1. Process Optimization:
  2. Real-Time Monitoring:

Infrastructure Strategy

  1. Smart Infrastructure:
  2. Facility Upgrades:

Supplier Strategy

  1. Supply Chain Optimization:
    • Inventory Management: Use AI to optimize inventory levels, ensuring that medical supplies are available when needed without overstocking.
    • Supplier Performance: Analyse supplier performance data to identify the most reliable and cost-effective suppliers.
  2. Strategic Partnerships:
    • Collaborations: Develop strategic partnerships with suppliers to ensure a steady supply of high-quality medical products and services.
    • Innovation: Work with suppliers to develop and implement innovative solutions that improve patient care and operational efficiency.

Regulations Strategy

  1. Compliance Monitoring:
    • Regulatory Updates: Use AI to monitor regulatory changes and ensure that the hospital remains compliant with all relevant laws and regulations.
    • Audit Preparation: Implement AI-driven systems to prepare for audits, ensuring that all documentation and processes are in order.
  2. Risk Management:
    • Predictive Risk Analysis: Use AI to identify and mitigate potential risks, ensuring patient safety and regulatory compliance.
    • Incident Reporting: Implement AI systems to track and analyse incidents, providing insights into how to prevent future occurrences.

By leveraging AI and best practices across these strategic areas, Aria can help develop a comprehensive and effective strategy for the A&E departments at Southport and Ormskirk hospitals. This approach not only improves patient outcomes but also ensures that healthcare services are efficient, equitable, and sustainable.

Would you like to explore more about specific AI applications in healthcare or other areas?

1: PNAS Nexus 2: Nature 3: BMJ 4: BMC Health Services Research 5: McKinsey 6: BMJ Open Quality 7: CQC 8: HealthRay 9: SpringerLink 10: SpringerLink 11: DigitalDefynd 12: Pickler 13: Pickleball Union 14: Pickletip 15: The Manual 16: Sporty Escapade : Stanford Medicine : RCEM : BMJ Open Quality : CQC : HealthRay : McKinsey : BMC Health Services Research : PNAS Nexus

Sent by you:

Following on from the previous question: How can Aria, support the Hospitals in creating and managing the Security Strategy, which encompasses Patient Confidentiality, Business Continuity, Cyber Security, Systems Availability, Intellectual Property Rights and Malicious Actors.

Aria can play a pivotal role in creating and managing a comprehensive Security Strategy for Southport and Ormskirk hospitals. Here’s how she might approach each component:

Patient Confidentiality

  1. Data Encryption:
  2. Access Control:

Business Continuity

  1. Disaster Recovery Planning:
  2. Incident Response:

Cyber Security

  1. Threat Detection and Prevention:
    • AI-Powered Security: Use AI to detect and respond to cyber threats in real-time, leveraging machine learning to identify patterns and anomalies.
    • Defense-in-Depth: Implement a multi-layered security approach, combining firewalls, intrusion detection systems, and endpoint protection.
  2. Employee Training:
    • Awareness Programs: Develop AI-driven training programs to educate staff on cyber security best practices and the importance of maintaining strong passwords and recognizing phishing attempts.
    • Simulated Attacks: Use AI to conduct simulated phishing attacks and other security drills to test and improve staff readiness.

Systems Availability

  1. Proactive Maintenance:
    • Predictive Analytics: Use AI to predict and prevent system failures by analysing usage patterns and identifying potential issues before they occur.
    • Automated Updates: Implement automated patch management systems to ensure that all software and systems are up-to-date with the latest security patches.
  2. Load Balancing:
    • Resource Optimization: Use AI to optimize resource allocation and load balancing, ensuring that critical systems remain available even during peak usage times.

Intellectual Property Rights

  1. Data Protection:
    • Encryption and Access Control: Use encryption and strict access controls to protect sensitive research data and intellectual property.
    • AI Monitoring: Implement AI systems to monitor data access and detect any unauthorized attempts to access or exfiltrate intellectual property.
  2. Compliance:
    • Regulatory Adherence: Use AI to ensure compliance with relevant regulations and standards, such as GDPR and HIPAA, protecting both patient data and intellectual property.

Malicious Actors

  1. Threat Intelligence:
    • AI-Driven Insights: Use AI to gather and analyse threat intelligence, identifying potential malicious actors and their tactics.
    • Proactive Defence: Implement proactive defence measures based on AI insights, such as blocking known malicious IP addresses and monitoring for suspicious activity.
  2. Incident Response:
    • Automated Mitigation: Use AI to automate the detection and mitigation of attacks, reducing the time it takes to respond to and neutralize threats.
    • Continuous Monitoring: Implement continuous monitoring systems to detect and respond to threats in real-time.

By leveraging AI across these strategic areas, Aria can help Southport and Ormskirk hospitals create a robust and comprehensive Security Strategy that ensures patient confidentiality, business continuity, cyber security, systems availability, intellectual property protection, and defence against malicious actors.

Would you like to explore more about specific AI applications in healthcare or other areas?

1: BMC Medical Informatics 2: NHS England 3: SentinelOne 4: Care Learning : PNAS Nexus : Nature : BMJ : BMC Health Services Research : McKinsey : BMJ Open Quality : CQC : HealthRay : SpringerLink : SpringerLink : DigitalDefynd : Pickler : Pickleball Union : Pickletip