Virtual departmental accreditation

Ms Samantha Hill, Echo Service Lead at North Bristol NHS Trust, talks through the virtual DA process and how DA can help departments to perform at their best.

Towards the end of 2019, North Bristol NHS Trust’s Echocardiography service submitted its application for BSE Departmental Accreditation. Following the onset of the Covid-19 pandemic, our assessment by the BSE DA and Clinical Standards team and planned on-site visit, set for April 2020, was of course, postponed.

The team kept in touch with me about their efforts to get things back on track as soon as it was safe to do so but of course, the crisis continued, perhaps longer than any off us could have imagined, redirecting all our priorities, impacting on our services and our teams - on the very way we functioned as a group of clinicians. 

As a team, we quickly altered processes, adapted how we worked to optimise safety to our staff and our patients, we had to re-write risk assessments, update our Sops - all the things we had submitted in our application.  Add in some staff changes; new consultants, trainees becoming accredited… everything had changed.

‘Plan B’ was for our on-site visit to take place in September 2020, once things had ‘settled down’… 

Of course, things didn’t settle down and for us in the South West, things were far worse than in the first wave of the pandemic. It quickly became obvious that we were going to have to do this differently. 

So when I was asked if we would consider doing the visit virtually, (it was that or put it on hold indefinitely) I happily accepted to help the DA committee try out their own new way of working, though I’ll admit I had my reservations. 

For one thing, I was going to have to produce a video tour of our facilities (without sounding too Bristolian!) and do so, without having patients or staff in the film! That would mean some early starts! I was also conscious of the wealth of documentation we’d collated to evidence how we met requirements, which I’d planned to show the team when they visited. This would all now need to be uploaded electronically… 

The team and I liaised frequently so that we could keep on track with deadlines, ensure all the information they required to make an adequate assessment of our services was included and that we would be able to demonstrate how we fulfilled all requirements, to a virtual visiting team.

Our virtual visit was scheduled for 5th February 2021 and all the information we wanted to submit needed to be uploaded to a link, a minimum of one week in advance of the visit date. At this stage, Covid was still raging locally and there were times I was unsure we would make the deadline, given the clinical pressures. However, the links that were provided to upload evidence meant that I was able to easily submit some 65 documents - everything I would have wanted the team to see if they had actually visited the department in person. 

Pleasingly, there was no file size limit and the documents drifted effortlessly across the ether… The ‘video tour’s’ too, were easy to upload and all but a couple of late requests for items, (which I was able to submit a few days before the virtual visit) everything was available to the team to peruse prior to our virtual visit, scheduled via video call on 5th February. 

On the day of the virtual visit, the MS Teams link (and the NHS wifi Gods) were on our side, and the visiting team, which comprised of Dr Huggett, Cons Cardiologist, Stephanie Baker, Cardiac Physiologist and Catherine Townsend, Cardiac Clinical Scientist along with Mrs Zena Forster, acting in the capacity of patient representative, appeared on the laptop screen. Aside from a few intermittent sound issues, we spent a convivial 3 hours or so, discussing our service, answering questions and referring to the documentation that had been uploaded. 

The team ‘met’ with some of my colleagues; Dr Wong, consultant Cardiologist, Kate Jones and Owen Williams - Cardiac Physiologists, and together we answered the teams’ questions on our TTE service, our TOE service, and our success in training our physiologist trainees to BSE accreditation standards, while supporting our medical trainees (inc ICU colleagues) too. The team examined our quality control and audit measures, our mechanisms for ensuring we all actively maintain CPD and how we collect and act upon feedback about our service from all services users; our patients and their carers and those who refer in to our service.

The only technically tricky part was demonstrating our TTE and TOE studies to the team, which involved sharing our screen to allow the team to view the images and reports from our PACS. Not ideal, but certainly do-able and the team were happy that these demonstrated comprehensive and quality studies. They reviewed a range of trans-thoracic and trans-oesophageal studies, included those of our trainees.

Finally, the nail-biting moments while the DA visiting team deliberated our fate… 

Happily for the whole team at North Bristol NHS Trust, the visiting team awarded us BSE Departmental Accreditation in all three areas for which we had applied - for our TTE service, our TOE service and for Training to BSE standard, which validated our proven track record of successfully supporting numerous trainees (both physiologists and medics) to achieve BSE accreditation over many years. 

The team then wrote a preliminary report which was sent to me a week later to check for errors or omissions before being finalised and the process was completed as North Bristol NHS Trust was added to the BSE’s list of Accredited Departments, awarding us our certificate and access to the logo’s for our paperwork which illustrate this mark of excellence and the quality within our service, of which we are all rightly proud.

Departmental accreditation allows the team to highlight areas for improvement, to help teams plan  their service developments and to ensure 5 year re-accreditation is achievable. Where necessary, these recommendations add support to applications for investment to ensure improvements can be made; especially valuable where its proven challenging to harness support from divisional level colleagues who may otherwise not appreciate the complexities faced at ground level.

Departmental accreditation focuses attention on service attributes, and it's shortfalls, so that service leaders know what changes need to be made in order to achieve departmental accreditation. Just as importantly, it reaffirms the knowledge and reassurance that there is measurable quality in the service your team provides its users, every day.

And let's face it, who doesn’t need that in 2021?