Neonatal Quality Standards Dr Sandra Calvert

Background 2009 NICE Commissioned by DoH to manage process for development of quality standards Initially pilot project running until April 2010 Four topics – dementia, stroke, VTE prevention and neonatal care Overtime a library of over a hundred topics will be developed sequenced by NQB

Definition of Quality Standard A quality standard is a set of specific, concise statements that: act as markers of high-quality, cost-effective patient care across a pathway or clinical area; are derived from the best available evidence; and are produced collaboratively with the NHS and social care, along with their partners and service users  

Components Qualitative statements Descriptive statements (5 to 10) of the critical infra-structural and clinical requirements for high quality care as well as the desirable/expected outcomes. Quantitative measures Measure of the expected degree of adherence/achievement.

Overview of Quality standards process Topic Evidence Source Guidance Recommendations Quality Standards Quality Indicators

Professional groups on the TEG Academic x2 Allied health professional x2 Audit (RCM & NNAP) x2 Clinician x3 Commissioner x1 DH representative x1 NHS Information Centre representative x1 NQB shadow x1 Patient / lay representative x1 Surgeon x1 Technical x1

Difficulties of developing QS for Neonatal Care VTE Specific diagnosis CG exist Evidence based research Neonatal Care Broad topic No existing CG No simple “gold” standard Very little or no evidenced based source or research Input based on consensus or opinion

Overall Approach Need to define what a high quality specialist neonatal care service should look like Tertiary, secondary and community care Need to use care pathway approach Allows safety, effectiveness and experience to be considered Ensure alignment with maternity services

Documents used for Development of Standards Toolkit for high quality neonatal services BAPM standards for hospitals providing neonatal intensive and high dependency care Standards for maternity care: report of a working party Use these documents as 1. primary evidence source (professional consensus of opinion) 2. recommendations as guidance to be developed into standards

10 areas of care which QS should focus on 15 draft quality statements Consultation and field testing Final 9 statements for published quality standards

Is there a quantitative measure of adherence/achievement Is there a measurable outcome? Is there a standard for comparison? What is the evidence that this standard is “best”

√ X √/x

Quality Statement 1 % babies < 28 wks who receive IC in NICU within network % babies with known fetal malformations requiring surgery delivered at designated network surgical centre % babies transferred back to local NNU within 24hr of request % babies undergoing surgery at designated network surgical centre % mothers still requiring inpatient care transferred with baby

Quality Statement 2 % mothers whose babies required specialist neonatal care who received all perinatal care within network % babies receiving specialist neonatal care in network who are from another network Bed occupancy at each level of care

Quality Statement 4 With emergency transfers proportion of transfer teams that depart from base with 1hr of referring call

Quality Statement 6 % babies < 33 wks who are breast fed at discharge % babies < 33 wks who remain in hospital and still receive MBM at 6 weeks

Quality Statement 8 Completion NNAP dataset % babies whose parents invited to participate in research studies

Quality Statement 9 % babies < 30 wks who have 2 yr outcome form completed % babies ≥ 30 wks receiving specialist neonatal care who have 2 yr outcome form completed % babies < 32 wks and/or <1501g who have ROP screening % babies < 32 wks and/or <1501g requiring laser surgery % babies wks receiving specialist neonatal care who have culture +ve blood or CSF culture