Clinical quality indicators: progress update Jim Chalmers & Lindsay Mathie Information Services Division, NHS National Services Scotland

Overview –What is the project about –Approach to deriving indicators –Suggested indicators –Examples

What is it about? Investment in Children’s Specialist Services –Is it working? –How can we tell? What does “good” look like Need to measure relevant outcomes National Delivery Plan for Children and Young People’s Specialist Services in Scotland: –“71. There is, therefore, a need to be able to identify, gather and analyse a number of key clinical or service outcome measures that would allow an accurate and timely understanding of progress across the spectrum of specialist children’s services.”

Relevant Indicators Multiple dimensions of health care quality –safe, effective, efficient, patient-centred, timely, equitable Exploit currently collected data where possible Develop data collection/analysis without excessive costs

Approach Following Institute of Healthcare Improvement model and proposed Healthcare Quality Strategy for Scotland –Catalogue existing indicators –Engage with exemplar MCNs and Steering Group for further suggested indicators –Feed back to clinical leads –Compare indicators to dimensions specified by Association of Public Health Observatories Importance, relevance, validity, possibility, meaningfulness, implications

Examples of Indicators in Practice

EF06 Compliance with Standards & Protocols –Cincinnati Children's Hospital –Use of evidence Based Guidelines July - September 2009 – 92% compliance. (Percentage of condition specific evidence- based guidelines followed in the emergency department and on inpatient units) – Resulted in Fewer hospital admissions (12-71% decrease) Shorter average length of stay (12-37% decrease)

EQ02 How far the patient has to travel As an example the project group looked at Access to General Surgery of Childhood Looked at –Estimated travel times –Length of stay by travel time

Estimate Travel Time 1 Mean length of stay (days)Number of admissions 0 – 30 minutes2.31, – 60 minutes – 90 minutes – 180 minutes Table 1: Mean Length of Stay by Estimated Travel Time1 Elective Admissions to General Surgery of Childhood, 2008/09