Example: designing new care pathways

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Presentation transcript:

Example: designing new care pathways How safe is our proposed Care? Intraarterial thrombectomy pathway SRFT/CSC GM Ilse Burger Stroke team SRFT 11.07.17 Haelo

Overwhelming evidence for IAT - NNT is very low and overall the A framework for safety measurement and monitoring IAT service provision @ the CSC for GM . Overwhelming evidence for IAT - NNT is very low and overall the treatment is seen as being cost effective A framework for safety measurement and monitoring. Charles Vincent et al. BMJ Qual Saf doi:10.1136/bmjqs-2013-002757 Copyright © BMJ Publishing Group Ltd and the Health Foundation. All rights reserved.

! Patient IAT pathway 999/ED/DSC/GP/GM wards/WALKIN HOME/REPAT MEDICS Safe Transfer criteria NWAS SRFT NWAS PSC 1 INPATIENT BLOCK SRFT Humphrey Booth ASU/HASU ED entrance PSC Rapid AX CT/CTA – IVT Refer IAT Stroke SRFT 2222 pre alert 2 Other diagnostics SRFT MRI/XRAY & Other Safe Transfer criteria NWAS PSC 3 CRITICAL CARE SRFT HOPE - NHDU SRFT ED entrance 4 SRFT ED DEPARTMENT – STROKE TEAM RAPID ASSESSMENT AND TRIAGE SRFT ANGIOSUITE IMAGING xray CT/CTP/CTA IAT INR/Anaesthetist/ Stroke Consultant RESUS IVT MAJORS ! MINORS PANDA 5 EAU/AAA

PAST HARM Failure to provide treatment – nationally as well GM wide Current collection of measures: Stroke specific: SSNAP audit, SSNAP mortality statistics, Mortality& Morbidity (RCP guidance) , SI, concise SI, Datix, staff questionnaire, “walk about” Nonspecific: Dr Foster, HSMI…..

RELIABILTY

Sensitivity of operations Select an appropriate mix of formal and informal safety monitoring mechanisms & Use this information to take timely action to avert safety issues- process ongoing current structures and committees: Monthly stroke service team reviews – exec level Weekly Stroke OPs group & fortnightly SSNAP group Clinical governance structure QI project leads and meetings

Anticipation and preparedness – ongoing in development Don’t wait for things to go wrong before trying to improve safety Explore new opportunities to develop ways to anticipate future risks Use a variety of tools and techniques to build an understanding of the factors that give rise to safety issues

Integration and Learning ongoing in development Use the analysis of incidents as a starting point to reveal the wider issues in the system No current incidents but pathway tested for high risk patient - pregnancy Place more emphasis on learning, feedback and action than simply on data collection Integrate and tailor information to make it meaningful from the ward to the board- ongoing format but need to integrate live data once available

Current QI Project Door to needle Time (ongoing) Door to cannulation time (started) Stroke mimics – Healthier together - AJP project lead Patient Flow ( at various levels of the pathway) Digital solution ( GDE project stroke team @SRFT - just started ) Stroke team live Tracking boards & Dashboards Identifying safety indicators in key areas: procedure/ treatment related Patient flow Stroke Mimics Identify meaningful patient centred outcome measure – mRS only collected Review the qualitative aspect of data collection: feedback patient/ carer /staff reporting ? – aim to report qualitative and quantitative data from the “Shopfloor to the Board”