acute quality standards dan beckett acute physician cmo advisor for acute & general medicine
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Acute Quality Standards
Dan Beckett
Acute PhysicianCMO Advisor for Acute & General Medicine
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Adult Emergency Services – case for change
• Adult emergency services: Case for Change. London Health Programmes (2011)
• Increased risk of death for most emergency conditions if a patient is admitted at the weekend, compared to a weekday.
• If weekend mortality rate was the same as weekday London 500 fewer deaths a year.
• Evidence suggests services with high quality provision in place, seven days per week, reduces the gap between weekday and weekend mortality rates.
• In addition variation exists for length of stay and re-admission rates.
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Development of adult acute medicine and emergency general surgery standards
• Improving 7/7 services is a key priority
• Quality standards were developed to address the issues raised in the acute emergency services case for change:
• Significant variation in service provision across London.
• Marked variation in working patterns that takes place during normal working hours vs those at the weekend.
• Standards are based on clinical evidence, national recommendations and best practice represent the minimum quality of care that patients should expect in every acute hospital.
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London quality standards: Key themes
• Admissions seen by consultant <12 hours
• Twice daily ward rounds for all patients
• MDT plan within 24 hours including EDD
• Timely access to diagnostics and reports
• Timely access to interventions including theatre
• Good information for patients and their carers
• Timely transfer to next place of care
Continuity
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Timeline
• Case for change published September 2011• NHS London commissioning standards for acute
medicine and emergency general surgery published 2011 – quality standards in April 2012
• Audit of acute medicine and emergency general surgery in 2012/13 across all sites– Peer review, case note audit
• Revised (broader) Acute Emergency and Maternity standards published February 2013
• Self-assessment 2013 – Signed off by CEO
• Results available publically - transparency
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2012/13 Audit of acute hospitals - Standards met and not met by category The biggest
challenges were in consultant delivered care and multidisciplinary assessment, 7 days a week.
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2013/14 Self-assessment of London Quality Standards
• Providers of acute emergency and maternity services self-assessed their progress towards meeting the London quality standards
• Highlights progress made in implementing the standards for adult acute medicine and emergency general surgery.– Commissioned from April 2012 and formally audited
during 2012/13.
• Improvements were seen across adult acute medicine and emergency general surgery.
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Adult Acute Medicine Standards
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Results from the 2013 self-assessment show there was no one standard not met by all hospitals during weekdays or weekends.
Key findings in 2013 v 2012 :
• 55% v 35% of hospitals deliver consultant review within 12 hours.
• 35% v 7% of hospitals have twice daily ward rounds by a consultant.
• 72% v 28% of hospitals provide extended day working by consultants.
• 38% v 4% of hospitals provide multi-disciplinary team assessment within 12 hours..
• 45% v 21% of hospitals meet the standard for 24/7 timely access to diagnostics..
79%
21%
Percentage of standards met or not met during weekdays
72%
28%
Percentage of standards met or not met during weekends
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Improvements in adult acute medicine
Improvements were reported in: Consultant-delivered review within 12 hours; extended day working; twice daily ward rounds; and multi-disciplinary team assessment.
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Adult Emergency General Surgery Standards
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There was no one standard not met by all hospitals during weekdays or weekends.
Key findings 2013 v 2012:
• 50% v 15% of hospitals deliver consultant review within 12 hours for emergency surgery.
• 38% v 7% of hospitals have twice daily ward rounds by a consultant.
• 69% v 22% of hospitals provide extended day working by consultants during the week.
• 23% v 0% of hospitals provide multi-disciplinary team assessment within 12 hours for emergency surgery.
• 46% v 22% of hospitals meet the standard for 24/7 timely access to diagnostics for emergency surgery..
79%
21%
Percentage of standards met or not met during weekdays
75%
25%
Percentage of standards met or not met during weekends
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Improvements in adult emergency general surgery
Improvements were reported in: Consultant-delivered review within 12 hours; access to and provision of theatres; and multi-disciplinary team assessment.
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Correlating Clinical Quality Standards Self-Assessment returns and A&E performance
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• London hospitals achieve to a greater extent Acute Medical Care Quality Standards compared to Emergency General Surgery standards
• The Emergency General Surgery standard achieved least consistently by London Hospitals is Standard 2, which refers to the prompt screening of all complex needs inpatients by a multi-professional team.
• Those Hospitals that achieved a lower proportion of Emergency General Surgery standards typically experience a more challenged YTD All Type performance
Headlines
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• Less of a correlation is observed however between those hospitals that achieve a lower proportion of Acute Medical Care Quality standards and more challenged YTD All Type performance
• There is also limited alignment between the achievement of Acute Medical Care Quality standards and YTD Type 1 performance across London hospitals.
• Those Trusts with higher than average DTOC levels across London are observed as having a higher proportion of Acute Medicine and Emergency General Surgery Care Quality Standards that are not being met.
Headlines
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Next steps• UC Programme Board has given approval to
proceed• Unscheduled Care Executive Leads – letter
w/b 15th Sept • Self assessment template via Survey Monkey
to be developed (examples on the table)• Self Assessment guidance issued w/b 29th
Sept• Self Assessment to be completed 31st October
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Future steps?
• Random peer review• Broadening to all acute emergency and
maternity services standards?• Revision of quality standards with NHS
England (London) and relevant professional bodies to develop UK quality standards…