1. Hot Topics: Making sure we don’t drown in data
10th June 2011
Hot Topics: Making sure we don’t drown in data
Chris Hancock, 1000 Lives Plus Programme Manager, & Dr Phil Kloer, Associate Medical Director for Quality and Safety, Hywel Dda Health Board
Insert name of presentation on Master Slide

2. Situation
Many examples of real improvements in patient care and harm reduction.
Campaign to NHS programme transition phase
Need a national information strategy that drives improvement and demonstrates harm and waste reduction.

3. Situation: avoidable mortality
11% of hospital deaths were as a result of unrecognized or untreated deterioration.
National Patient Safety Agency, (2007) Safer care for the acutely ill patient: learning from serious incidents
21% of ICU admissions were avoidable.
NCEPOD, (2005) National Confidential Enquiry into Patient Outcome and Death.
Potential prevention of 1600 ICU admissions in Wales costing £12 million (one night’s stay only)

4. Situation: An acceptable level of harm?
Severe Sepsis
37,000 deaths pa in the UK (Daniels, 2009)
Welsh mortality – 1850 pa
Thrombosis
16,670 deaths pa in the UK (ONS, 2007)
Welsh mortality – 830 pa

5. Situation: waste, the cost of putting things right
Falls in hospital
UK - 200,000 pa (NPSA, 2010)
Wales - approx. 10,000 pa
Pressure Ulcers
UK - 15,000 pa (NPSA, 2010)
Wales - approx. 750 pa
HCAI-ID
CAUTI causes 16% of all hospital infections in Wales (Smyth et al 2006)

6. Background: 1000 Lives Plus
Acute care core collaborative programmes:
RRAILS, HAT, HCAI and Transforming Care
Improving process reliability and reducing variation within systems improves outcomes.
Mortality reviews
Metrics/spreadsheets/dashboards/databases
Competing demands for more data and information

7. Assessment: standardisation
NHS Early Warning Score (NEWS) - Wales
Physiological Parameters 3 2 1
Respiratory rate (bpm) ≤8
9-11
12-20
21-24
≥25
O2 Saturations (%)
≤91
92-93
94-95
≥96
Any supplemental Oxygen
Yes
None
Systolic BP (mmHg)
≤90
91–100
101–110
111–220
≥220
Pulse (bpm)
≤40
41-50
51-90
91-110
≥131
AVPU score
Alert
VPU
Temperature (C)
≤35.0
35.1–36.0
36.1–38.0
38.1–39.0
≥39.1
Concern about a patient should lead to escalation, regardless of the score.

8. You Tube link: http://youtu.be//yyCaU-6wVWI

9. NEWS
Monitoring
Alert …
Medical Review
0- 2
12 hourly
Nil
3–5
4-6 hourly
Nurse in Charge
6-8
6 = SICK!
1-2 hourly
FY2, CT or ANP
within 30 minutes, if not improved within 4 hours discuss with senior
>9
9 = NOW!
30 mins
SpR or equivalent
within 15 minutes, discuss with Consultant + outreach team or ICU
Note of Caution: Frequency of observations can be increased at the discretion of the clinical team. Equally concern about a patient should lead to escalation, regardless of the score.

10. Assessment: standardisation
Phil Kloer 2 slides on NEWS

11. Assessment: Highly visible communication tools
Single Point of Ward Information
PSAG Board
Safety
Briefings

12. Assessment: Standard Operating Procedures

13. Assessment: Real Time Data Collection
Integrate into everyday practice

14. Assessment: Single Data Repository

15. Recommendation 1: draw together and streamline 1000 Lives Plus methods and measures to achieve:
The AQF goals of ‘zero tolerance for infections’ and ‘improved care’ in the acute clinical area
Reductions in ward mortality, harm and waste
Earlier identification and treatment of ‘at risk’ patients
Reduction in duplication of measurement, paperwork and reporting

16. Recommendation 2: design real time data collection methods and a single point of data entry to generate:
Data for local improvements
Care metrics for ‘ward to board’ reporting
Nursing dashboard quality assurance measures
Ward acuity measures to enable effective management of staffing and resources.
Aggregated measures for population of the AOF and AQF monitoring tools.

17. An Important First Step in the Creation of a National Information Strategy for Driving Improvement.