Hot Topics: Making sure we don’t drown in data 10th June 2011 Hot Topics: Making sure we don’t drown in data Chris Hancock, 1000 Lives Plus Programme Manager, & Dr Phil Kloer, Associate Medical Director for Quality and Safety, Hywel Dda Health Board Insert name of presentation on Master Slide

Situation Many examples of real improvements in patient care and harm reduction. Campaign to NHS programme transition phase Need a national information strategy that drives improvement and demonstrates harm and waste reduction.

Situation: avoidable mortality 11% of hospital deaths were as a result of unrecognized or untreated deterioration. National Patient Safety Agency, (2007) Safer care for the acutely ill patient: learning from serious incidents 21% of ICU admissions were avoidable. NCEPOD, (2005) National Confidential Enquiry into Patient Outcome and Death. Potential prevention of 1600 ICU admissions in Wales costing £12 million (one night’s stay only)

Situation: An acceptable level of harm? Severe Sepsis 37,000 deaths pa in the UK (Daniels, 2009) Welsh mortality – 1850 pa Thrombosis 16,670 deaths pa in the UK (ONS, 2007) Welsh mortality – 830 pa

Situation: waste, the cost of putting things right Falls in hospital UK - 200,000 pa (NPSA, 2010) Wales - approx. 10,000 pa Pressure Ulcers UK - 15,000 pa (NPSA, 2010) Wales - approx. 750 pa HCAI-ID CAUTI causes 16% of all hospital infections in Wales (Smyth et al 2006)

Background: 1000 Lives Plus Acute care core collaborative programmes: RRAILS, HAT, HCAI and Transforming Care Improving process reliability and reducing variation within systems improves outcomes. Mortality reviews Metrics/spreadsheets/dashboards/databases Competing demands for more data and information

Assessment: standardisation NHS Early Warning Score (NEWS) - Wales Physiological Parameters 3 2 1 Respiratory rate (bpm) ≤8 9-11 12-20 21-24 ≥25 O2 Saturations (%) ≤91 92-93 94-95 ≥96 Any supplemental Oxygen Yes None Systolic BP (mmHg) ≤90 91–100 101–110 111–220 ≥220 Pulse (bpm) ≤40 41-50 51-90 91-110 111-130 ≥131 AVPU score Alert VPU Temperature (C) ≤35.0 35.1–36.0 36.1–38.0 38.1–39.0 ≥39.1 Concern about a patient should lead to escalation, regardless of the score.

You Tube link: http://youtu.be//yyCaU-6wVWI

NEWS Monitoring Alert … Medical Review 0- 2 12 hourly Nil 3–5 4-6 hourly Nurse in Charge 6-8 6 = SICK! 1-2 hourly FY2, CT or ANP within 30 minutes, if not improved within 4 hours discuss with senior >9 9 = NOW! 30 mins SpR or equivalent within 15 minutes, discuss with Consultant + outreach team or ICU Note of Caution: Frequency of observations can be increased at the discretion of the clinical team. Equally concern about a patient should lead to escalation, regardless of the score.

Assessment: standardisation Phil Kloer 2 slides on NEWS

Assessment: Highly visible communication tools Single Point of Ward Information PSAG Board Safety Briefings

Assessment: Standard Operating Procedures

Assessment: Real Time Data Collection Integrate into everyday practice

Assessment: Single Data Repository

Recommendation 1: draw together and streamline 1000 Lives Plus methods and measures to achieve: The AQF goals of ‘zero tolerance for infections’ and ‘improved care’ in the acute clinical area Reductions in ward mortality, harm and waste Earlier identification and treatment of ‘at risk’ patients Reduction in duplication of measurement, paperwork and reporting

Recommendation 2: design real time data collection methods and a single point of data entry to generate: Data for local improvements Care metrics for ‘ward to board’ reporting Nursing dashboard quality assurance measures Ward acuity measures to enable effective management of staffing and resources. Aggregated measures for population of the AOF and AQF monitoring tools.

An Important First Step in the Creation of a National Information Strategy for Driving Improvement.