Improving health outcomes across England by providing improvement and change expertise Wrightington, Wigan and Leigh NHS Foundation Trusts
Jan 14, 2016
Improving health outcomes across England by providing improvement and change expertise
Wrightington, Wigan and Leigh NHS Foundation Trusts
Improving health outcomes across England by providing improvement and change expertise
Dr Sanjay AryaMBBS (Hons), FRCP (London), FRCP (Glasgow) Consultant Interventional CardiologistDivisional Medical Director, Division of MedicineClinical Lead for Heart Failure, AQuA, North West
Delivering NHS Services, Seven Days a Week
Improving health outcomes across England by providing improvement and change expertise
‘‘Patients who are admitted to hospital believe that they are entering a place of safety, where they, their families and carers, have a right to believe that they will receive the best possible care’’.
‘‘Yet there is evidence to the contrary. Patients who are unwell, or become acutely unwell in hospital, may receive suboptimal care’’
Dr Mary Armitage, Guideline Development Group ChairAcutely ill patients in hospitalRoyal College of Physicians
Delivering NHS Services, Seven Days a Week
Improving health outcomes across England by providing improvement and change expertise
Patients and family expect that the NHS will provide safe and high quality service consistently seven days a week
There is a variation in care depending upon time of the day and the day of the week
Improving health outcomes across England by providing improvement and change expertise
Where there is a 7 day service, there is no observed difference in mortality rates in the week and at weekend(Bell M et all: The New England journal of Medicine 345:9) (Schmulewitz L et all: Clinical medicine Nov 2005)
Improving health outcomes across England by providing improvement and change expertise
Weekend mortality: Wigan 2001-11
2011 Fosters report: 5th from the bottom
474 excess deaths
Improving health outcomes across England by providing improvement and change expertise
Weekend mortality: Wigan 2001-12
Improving health outcomes across England by providing improvement and change expertise
Weekend mortality: Wigan 2001-13
Improving health outcomes across England by providing improvement and change expertise
HSMR: March 12 – Feb 14
Improving health outcomes across England by providing improvement and change expertise
Our Patients
Outcome of Real Time Patient Surveys conducted monthlyOutcome of Real Time Patient Surveys conducted monthly Apr-14 May-14
Have staff treating and examining you introduced themselves? 90.8% 98.5%
Did you find someone to talk to about your worries and fears? 83.2% 88.5%
Do you think the hospital staff did everything they could to help control your pain? 93.5% 93.9%
If your family or someone else close to you wanted to talk to a doctor, did they have enough opportunity to do so? 87.0% 91.6%
Have you been involved as much as you wanted to be in decisions about your care and treatment? 77.7% 85.5%
Have you been offered a choice of food during your stay? 96.2% 97.7%
Has there been healthy food on the hospital menu? 91.8% 92.4%
Have you been involved in decisions about your discharge from hospital? 57.1% 57.3%
Do you know which consultant is currently treating you? 72.8% 87.0%
Have you been given enough privacy when being examined, treated or discussing your care? 99.5% 98.5%
Have you always had access to a call bell when you needed it? 98.4% 93.9%
During your stay have you been treated with compassion by hospital staff 98.4% 98.5%
Have you been given the care you felt you required when you needed it most? 95.1% 98.5%
AVERAGE 87.8% 90.9%
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
The 10 Clinical Standards
Patient Experience
Time to first consultant
review
MDTReview
Shift Handovers
Transfer to community and Primary
and social care
MentalHealth
Quality Improvement Diagnostics
On-going review
Intervention/Key services
Improving health outcomes across England by providing improvement and change expertise
Addressing delivery of the national clinical standards for 7 day services
‘A&E Clinical Quality Indicators’
Mr Ayaz AbbasiMBBS , FRCS, FCPS, FCEM, PGC
Consultant, Emergency Medicine
Clinical Director, Emergency MedicineWrightington, Wigan & Leigh NHS Foundation Trust
Improving health outcomes across England by providing improvement and change expertise
Weekends
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Monday to Friday
Improving health outcomes across England by providing improvement and change expertise
A&E Clinical indicators
• 1 Ambulatory emergency care• 2 Unplanned re-attendance rate • 3 Total time in the A&E department • 4 Left without being seen (LWBS) rate • 5 Service experience • 6 Time to initial assessment • 7 Time to treatment • 8 Consultant sign-off
Improving health outcomes across England by providing improvement and change expertise
Unplanned Re-Attendance Rate
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Ra
te
% UNPLANNED REATTENDANCE TARGET
Unplanned Re-Attendance Rate
Improving health outcomes across England by providing improvement and change expertise
Left Without Being Seen Rate
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Ra
te
% DID NOT WAIT TARGET
Left without being seen
Improving health outcomes across England by providing improvement and change expertise
Total time in EDSite performance against national benchmarks and performance
00:00
01:00
02:00
03:00
04:00
05:00
06:00
May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Tim
e (
hh
:mm
)
Threshold Non Admitted 95th
Improving health outcomes across England by providing improvement and change expertise
A&E 4 Hours
90%
91%
92%
93%
94%
95%
96%
97%
98%
99%
100%
CentralManchester
Stockport SouthManchester
Pennine Tameside Wigan Salford Bolton
Greater Manchester A&E Performance by Acute Trust1st April 2013 to 31st March 2014
Trust Stretch Threshold Monitor Threshold National Mean
Please note activity for Central Manchester is Level 1 activity only.
Improving health outcomes across England by providing improvement and change expertise
Time to TreatmentSite performance against national benchmarks and performance
00:00
00:15
00:30
00:45
01:00
01:15
01:30
May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Tim
e (
hh
:mm
)
Target Median
Improving health outcomes across England by providing improvement and change expertise
Initial AssessmentSite performance against national benchmarks and performance
00:00
00:05
00:10
00:15
00:20
00:25
00:30
May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14
Tim
e (
hh
:mm
)
Target 95th Percentile
Improving health outcomes across England by providing improvement and change expertise
Ambulatory CareProportion of Attendances who are Admitted
0%
10%
20%
30%
40%
50%
2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/15 Q1
Ra
te
% A&E Admissions with diag Cellulitis
% A&E Admissions with diag DVT
Improving health outcomes across England by providing improvement and change expertise
Consultant sign off
• Non traumatic chest pain in age seventeen and above.• Any re attendance within 72 hours with a similar condition.• Febrile child less then one year old.
All these conditions if discharged from ECC require consultant sign off.
Improving health outcomes across England by providing improvement and change expertise
NB/ August Audit:◦ Sign off done – 46%◦ Sign off not done – 54%
SIGN-OFFDONE SIGN-OFF NOT DONE
CHEST PAIN 45% (34/ 76)
55%(42/ 76)
CHILDREN <1YR WITH PYREXIA
9% (2/ 22)
91% (20/ 22)
REATTENDERS 36% (4/ 11)
64% (7/ 11)
OVERALL 37% (58/ 109)
63% (69/ 109)
Improving health outcomes across England by providing improvement and change expertise
Friends and Family Test
Accident & Emergency Friends & Family TestQuality Scores for the Greater Manchester Area
Trust Jan Feb Mar April May
Wrightington, Wigan & Leigh NHS FT 69 75 70 66 63
Central Manchester University NHS FT 62 50 64 61 60
Bolton NHS FT 59 49 44 47 56
University South Manchester NHS FFT 55 54 47 53 58
Salford Royal NHS FT 56 58 56 58 59
Pennine Acute Hospital NHS Trust (Oldham Hospitals) 48 42 41 45 51
Stockport NHS FT 45 42 42 46 41
Tameside Hospital NHS FT 27 15 11 21 38
Improving health outcomes across England by providing improvement and change expertise
Thank you
Improving health outcomes across England by providing improvement and change expertise
The whole health community needs to address the problem of increased mortality over the weekend
•Engaged clinicians (medical,nursing,physio,OT) and managers•Developed leadership: Divisional Director & 4 Clinical Directors•Involved everyone: Martin Farrier’s weekly mortality data:
There should be a 7 day access to all aspects of care: medical, nursing, diagnostics, GPs, Social services, Palliative care
• COE Consultants in the community – supporting GPs• Engaged Nursing / Care homes – advanced care planning• Improved end-of-life care for terminally ill patients – rapid discharge
Is there a solution? Wigan experience
Why are there more deaths? ‘Weekend Effect’
Improving health outcomes across England by providing improvement and change expertise
Increased Consultant presence: Cost effective / Reduces mortality
• Recruited more A&E and MAU consultants• Increased presence of Consultants on A&E, MAU and Medical wards on weekends and bank holidays • 7 day 12 hour consultant delivered/presence service
Is there a solution? Wigan experience
Why are there more deaths? ‘Weekend Effect’
Right patient Right ward, beyond the first 24 hours of admission
•Specialists felt engaged, valued & comfortable in managing patients•Increased daily senior review on medical wards•Improved patient pathway / journey / care bundles
Improving health outcomes across England by providing improvement and change expertise
Support services will also need to adopt 7 day working practice ifthe full benefits of 7 day Consultant service are to be realised
•Increased presence of Physio, OT and Social services over weekends and bank holidays
•Increased availability of diagnostics over weekends and bank holidays
Is there a solution? Wigan experience
Why are there more deaths? ‘Weekend Effect’
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Improving health outcomes across England by providing improvement and change expertise
Addressing delivery of the national clinical standards for 7 day services
Two questions to address –
1) What are the key challenges around the clinical standards?
2) What suggestions do you have on how those challenges can be overcome?
Please use post-it notes to capture your thoughts on key challenges in your locality, you may add your contact details if you would like to discuss this further with us at a later date
Improving health outcomes across England by providing improvement and change expertise
Refreshments