Discovery In Action Investigating variation in BADS Same Day Surgery rates in a Health Board

Background This Health Board established an ‘Impact Huddle’ to ensure a systematic approach to investigating, analysing and addressing variation identified by Discovery and other data sources. This example summarises their investigation into BADS same day surgery rates. Huddle includes: Clinical leads General Manager Realistic Medicine Pathways Lead Transformation Programme Lead Business Unit rep Service Improvement rep Clinical staff and managers co-opted as required Process - Areas of investigation agreed, Potential opportunities prioritised, Executive Team informed of actions and decisions, Local engagement essential.

Discovery Dashboard - Level 1 Overview Treatment The ‘Impact Huddle’ group developed initial data packs based on information from Discovery and other sources to help identify potential productive opportunities that could be explored further. This is the Discovery Level 1 Overview Treatment view which shows how a selected location compares to its peers across a range of indicators for a specific time period. This visualisation is intended to present a quick “temperature check” of the indicators for the organisation at a certain point in time, denoted by Red/Amber/Green (RAG) status. Further analysis was undertaken into their BADS same day surgery rate.

BADS Same Day Surgery rates - Efficiency Dashboard Level 1 This dashboard provides monthly trend information for a range of indicators along with peer location comparisons. At Level 1 information is often available by specialty. Hovering over an area provides a tool tip which shows more information. The view shows that this Board has one of the lowest BADS day case rates in Scotland and that the rate had been consistently lower than the national average over the specified time period. Level 2 views can then be used to explore this further.

BADS Same Day Surgery Rates – BADS Group/Procedure view Level 2 Level 2 dashboards in Discovery provide access to more detailed and comprehensive information on: Data by age, gender and deprivation Individual clinician level information Figures for specific services/procedures Further analysis and review of the Discovery data led the Huddle to focus on Breast Surgery as a potential area for improvement (the orange areas represent the difference between the Board’s rates and the BADS target rates).

BADS Same Day Surgery Rates - Breast Surgery The Board was able to view same day surgery rates for specific Breast Surgery procedures and compare their rates to the national average for the same procedures. The view provides: Board rates for specific procedures compared to BADS target Views of specific BADS groups/procedures Comparisons of Board and Scottish average (Board rate 35.3%, Scottish average 54.3%) BADS Breast Surgery - Additional Analysis Breast Surgery Board Scotland No. Procedures 692 6886 Same Day % 35% 54% IP Ave LOS 1.9 Days 1.7 Days % of IP with a Pre-Op Stay 65% 26% % bed days attributed to Pre-Op Stay 34% 15%

Local Engagement An SBAR was produced to summarise the investigations and findings and inform Executive Team Local discussions and exploration to understand issues and potential causes Pathway mapping exercise to understand patient journeys and identify potential redesign opportunities Workshop with key clinicians, senior managers, support staff, transformation team, etc.

Actions Consensus that admission on the day prior to surgery needed to stop in all but exceptional cases. Agreed a peer review process, with feedback to clinicians on a monthly basis, in order to embed and sustain changes. Agreement to re-organise these patient pathways to ensure that the majority of cases will go through the theatre admission suite (rather than being admitted to a ward on the day prior to surgery).

Impact and Improvement Time Period Board Scotland April 2016 – June 2017 35.5% 54.7% July 2017 – March 18 57.6% 58.1% Since implementing the agreed changes, the Board’s same day Breast Surgery rate has improved to and remained at levels similar to the Scottish average (increasing from around 36% to almost 58%)

Impact and Improvement Time Period Board Scotland April 2016 – June 2017 0.55 0.26 July 2017 – March 18 0.23 0.21 Time Period Board Scotland April 2016 – June 2017 0.36 0.28 July 2017 – March 18 0.14 0.21 The changes have also resulted in improvements in the pre-operative stay rates for both General Surgery and Plastic Surgery (these are now similar to or lower than the Scottish average) (Note: 0.2 = an average of 1 day of pre-operative stay for every 5 cases)

Summary This case study demonstrates how an NHS Board has used Discovery to identify variation, explore the potential reasons for that variation and support change It has shown how Discovery can report and monitor the effect of any transformation and redesign We are able and keen to support all Boards in utilising Discovery in similar ways

For Discovery support and more information on accessing and using NSS Discovery, contact us at:  nss.discovery@nhs.net or visit our website: nssdiscovery.scot.nhs.uk