1. Neonatal Quality Standards
Dr Sandra Calvert

2. 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

3. 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

4. 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.

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

6. 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

7. 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

8. 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

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

12. 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”

13. √ X
√/x

14. 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

15. 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

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

17. 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

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

19. 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