Local improvement following national clinical audit - HQIP by pptfiles


									            • Furness General Hospital
            • Royal Lancaster Infirmary
            • Westmorland General Hospital

Dr Pradeep Kumar, Consultant Physician
12th October 2012
                About our hospital

University Hospitals of Morecambe Bay NHS Foundation Trust
§ Furness General, Royal Lancaster Infirmary, Westmorland
  General Hospital (an hours drive from FGH – RLI)
§ Three outpatient centers
§ Population of 350,000 approx.
§ Geographical area of over 1,000 square miles
§ 6000 staff
How we acted on the results:
•The results were disseminated to various stakeholders
•Presented at the cross-bay medical audit meeting
•Cardiac & Stroke network meeting
•Trust Board
§ These were some of the results of the 7th round of the
  sentinel audit (2010)
§ Bearing in mind the audit was retrospective and only
  looked at some case notes
§ Therefore quality of the audit was debatable
§ Yet important learning points
               - Key 9 process indicators
                        National     FGH    RLI
90% of stay in stroke    62.2%       67%    41%
Swallowing disorder      84.1%       94%    87%
screen <24 hours
since admission
Brain scan <24 hours     70.5%       63%    67%
since stroke
               - Key 9 process indicators
                       National      FGH    RLI

Aspirin by 48 hours    94.1%        95%     88%
since stroke
Physio assessment      93.0%        98%     80%
<72 hours
OT assessment          87.1%        95%     73%
<4 working days
since admission
               - Key 9 process indicators
                        National     FGH    RLI
90% of stay in stroke    62.2%       67%    41%
Swallowing disorder      84.1%       94%    87%
screen <24 hours
since admission
Brain scan <24 hours     70.5%       63%    67%
since stroke
Sequence of events:
•Took part in the 90:10 Northwest stroke project, subsequently
also entered the next round of the national sentinel stroke audit
•Figures significantly fell in that round (chart)
•We won’t go into the reasons behind it as it was due to a variety
of factors
Where are we now since the peer
            What went wrong

 Our key indicators started falling well below national
 There were a number of reasons behind this
 Perhaps best not dwell on it
 Best if I start to say how we started progressed
What is a national clinical audit

 Health care across the country is involved
 Improve the quality of clinical care for patients
 Improve patient outcomes
 Prospective
 Based on national clinical guidelines
 Based on evidence
 Includes patient involvement
Next steps:
•Close working relationship with the cardiac & stroke network
-Understanding the reasons for poor results
-Put in place processes to improve performance
-External peer review of stoke services presented by RCP & BASP
      External stroke peer review

 Close working with cardiac and stroke network.
 Organised external peer review conducted by joint Royal College
  of Physicians and British association of Stroke Physicians
 End of the review there was a presentation by the peer review –
  with recommendations
 A comprehensive review and recommendations were sent to the
  Clinical Lead and the Trust chief executive and to the cardiac and
  Stroke Network
Key recommendations from external peer
•Better engagement of the management team with the
clinical team (service re-alignment)
•Identify Executive Champion (Medical Director)
•Review overall stroke care pathway
•Robust high quality data capture system
            Key recommendations

 A constructive and open dialogue with the commissioners –
  formulate a cohesive local strategy
   Acute stroke care pathway with agreed goals and targets
   time frames
 Establish an acute stroke unit for the first 72 hours as a matter of
 Identification of a “stroke champion at the board level
 Forming a strategic working group to focus on key priorities and
  recommit to the provision for acute stroke as a “core business”
    Steps to implement the process

 As a priority a task group was established
 This involved key stakeholders from the Trust and the commissioners
 At the Trust board level –Programme Management Office for stroke set up
 Identified key stake holders to represent this Office
 Highlighted the key recommendations of the peer review
 Established the key performance indices (KPIs)
  Steps to implement the process

 Incorporated all these info into the SharePoint
 Clear time frames and targets and ways to progress
 Traffic light system
 Share point updated on a weekly basis by the members of
  the task group
    Steps to implement the process
 Weekly meetings
   Discuss the progress of the project
   Highlight areas of concern or where no progress made and have
    clear action plans and time scales
   celebrate the achievements within the group and all the staff
    involved in the delivery of the stroke care
   engage the senior management team at the board level and
    constantly updating our progress of the project
   Communicate! Communicate!! Communicate!!!
                       Data issues

 In previous years it was retrospective National sentinel audit
 We are now into SINAP ( Stroke Improvement Programme)
  – real time data for the first 72 hours of care
 The results of the data are published on a quarterly basis
 Public domain
                    Data issues

 An area of serious concern was the data quality and coding
   Inconsistent
   Poor quality
   Incomplete
 Poor grasp and focus on the pressing priorities for
  improvement of stroke service
Steps to implement the process

Team effort
  Clinical audit team
  Information and technology
  Clinical lead for stroke
  Senior manager
  Senior nurse from the stroke unit
  Coding managers
Where are we now?
        Operational changes

 5 bedded acute stroke unit
 Dedicated stroke data collection clerk
 Business case for early supported discharge
 An executive “champion” at board level-medical
 Regular audit meetings to discuss stroke mortality
        Summary and conclusions

 National clinical audit
   Helped to implement local delivery process
   Have clear communication and discussions with the senior
    executives and better working relationship to improve service
   Monitor progress and implement change
   Business planning
   Service development and service redesign
        Summary and conclusions

   Evidence based quality care
   Benchmark against national standards
   Has hugh influence in the future direction of the services
   Provide information on re-commissioning
   Value for money
     CEQUIN
     AQ (North west)
       Summary and conclusions

 Upmost satisfaction for the staff knowing that the local
 population are getting the best care
 Patient and public confidence as the results are now in
 public domain
 We have a long way to go but it is a huge step in the
right direction and the National Clinical Audit has been
         the key mechanism to drive change

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