Driving up Quality using a CQUIN

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Presentation transcript:

Driving up Quality using a CQUIN Preetham Boddana Consultant Nephrologist ,GHNHSFT AKI Celebration and Sharing Event 17 March 2015

Gloucestershire Hospitals

The scale of the problem AKI is common AKI is associated with considerable harm AKI causes significant costs The course and development of AKI is modifiable 360,000 cases per year in inpatients in England 20–30% of cases are avoidable Mortality is high: 16% in under 60s; 32% in over 60s 75,000–110,000 preventable cases/year (England) 20,000–30,000 preventable AKI-related deaths/year Source: Bedford, Kerr, Stevens et al. Forthcoming

AKI Opportunities AKI is not primarily a renal issue Renal leadership can help to establish this tenant Local groups can reiterate this and implement best practice CQUINS can incentivize Prevention will reduce: Proportion requiring RRT Long term conditions (LTC) burden CVD CKD Timely investigation and treatment will: Improve individual patient experiences and outcomes

Introduction of a pathway to identify and manage patients at risk of AKI @GRH Identification of AKI Implement the Care Bundle Measure progress

Acute Kidney Injury Management Guidelines For further information including management of grade 3 AKI, refer to the AKI protocol available on the trust intranet.

Gloucestershire Hospitals AKI FLAG Medication Review Early Warning Score Repeat Creatinine Fluid Balance Review Senior Review We launched an AKI care bundle and created an electronic alert in our chemical pathology reporting system based on serum creatinine. The care bundle is clearly stated on the AKI sticker which is placed on the patients’ case notes. The AKI care bundle comprises senior review, medication review, fluid balance, and repeat creatinine and the sticker helps trigger this pathway. AKI Care Bundle in Gloucestershire Hospitals

PDSA Testing Ramps for: AKI Care Bundle Improvement measured through monthly audit Cycle 2B: Spread sticker to wider Trusts through Safety Cafes and induction Cycle 2A: Development of Sticker wider testing Cycle 1B: Develop E-learning for AKI to support launch of form Cycle 1A: Design and complete local testing of sticker on - Ward 7b Process Change PDSA 43 9 9

AKI Learning Safety Café Briefings E-Learning module for junior doctors on AKI AKI covered during induction to trust Briefings on fluid balance to nurses during handover

AKI-CQuIN (2012-2013) Target 1 Target 2 Target 3 Programme = £880,000 30% compliant with Care bundle by September 2012 Target 2 45% Compliant with Care bundle by December 2012 Target 3 60% Complaint with care bundle by March 2013

AKI-CQuIN(2013-2014) Target 1 Target 2 Programme = £1.5 m Target 1 Complete Root Cause analysis on AKI patients each month Target 2 75% Compliant with Care bundle by March 2014

“Head of Marginal Gains” What can we (NHS) learn from We need to improve further - 95% reliability “Head of Marginal Gains” What can we (NHS) learn from British Cycling Success in Olympics?

AKI CQuIN Team @GRH