head of maternity and neonatal transformation programmes€¦ · mother learns about her baby’s...

Avoiding admission of term infants to neonatal units ATAIN – Improving Value Scheme Michele Upton Head of Maternity and Neonatal Transformation Programmes NHS Improvement

8th March 2018

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• What is Atain?

• Why this is important

• Findings

• The IV scheme

• Opportunities for influencing change - 2018

• Your contribution to implementing the IV scheme

Presentation

Atain – insights from the national programme

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Acronym for

Avoiding Term Admissions Into Neonatal units

Programme of work initiated under patient safety to identify harm leading to term admissions

Current focus on reducing harm and avoiding unnecessary separation of M&B

What is Atain?


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2010 - NHS Mandate & Outcomes

Framework

National perspective Seen as a signal of sub-optimal care during antenatal, intrapartum or post natal period – few fully grown babies should need neonatal services Signal that avoidable harm might have been caused Significant but avoidable cost to NHS and families Maternity and neonatal teams long recognised as an issue – will to resolve

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• The first hour of life following birth is a once-in-a-lifetime experience to be cherished and protected.

• Mothers and babies have a physiological and emotional need

to be together: hours and days following birth. • Important for physiological stability of baby and beginning of

maternal infant interaction

• The benefits of skin-to-skin care extend beyond birth. The mother learns about her baby’s needs and how to care for, comfort and soothe her newborn.

Why is this important

Current initiatives for improving safety for newborns

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Why is this important

There is overwhelming evidence that separation of mother and baby so soon after birth interrupts the normal bonding process, which can have a profound and lasting effect on maternal mental health, breastfeeding, long-term morbidity for mother and child. This makes preventing separation, except for compelling medical reason, an essential practice in maternity services and an ethical responsibility for healthcare professionals.


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Complexity


Which term babies? Data collection system – accuracy of data entry Data on place of admission - TC Different commissioning arrangements across networks and even within trusts - variation in TC Incentives for admission – income via Neonatal services Local variation: clinical practice/admission policies…. Midwifery skills/resource Maternal morbidity Early discharge / transfer Fail safe decision-making + inexperience of junior doctors Some term admissions are entirely appropriate

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Atain work programme

Six working groups

20 strands of work Data analysis >136 000 babies Academic publications – Open Access Analysis of litigation claims Prospective scoping of practice E-Learning to address knowledge gaps leading to atain Parental involvement in recognising the sick newborn MDT workshops for LW leaders Supernumerary status for the LWC Cross collegiate safety huddles and handovers

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Findings

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Term live births in England (2011-2014) 3.6%


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Care days for term admissions ( 31%) (>60%)


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Atlas of Variation: 2015 Term Admissions by Neonatal Networks.

( Light blue lowest – dark blue highest. 2013/14 data )

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136 036 babies care analysed: 2013 – 2015:

• ~8.8% of all live births resulted in a L1,2 or 3 NNU

admission

• Additional 10,000 care days delivered for term babies in

2015 compared to 2011

• Increase predominantly in Special Care category

• ~20% - 30% of admissions were avoidable - intervention

received did not warrant admission – ~13 000/ annum

What we know


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• Unnecessary intervention

• Risk factors not identified

• Evidence based guidance not followed

• Babies born at 37-38 weeks twice as likely to be admitted to neonatal services as those born at 39-42 weeks gestation

• Role for Transitional Care facilities

What we know


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National Drivers


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National Drivers


2017 SofS Safety strategy

CNST

Incentivisation scheme

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The IV scheme


The case for change • Benefits • Deliverables • Next steps

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The IV scheme – benefits: families


Significant health benefits through:

• Improved identification of at risk infants

• Reduction in avoidable morbidity

• Where breast feeding is by choice – optimising

realisation and short/long term benefits of

• Avoiding contributory factors leading to maternal

perinatal mental health morbidity

• Improved experience for families

• Reduction in costs to families

• Provision of models of care which keep M&B together -

choice

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• Develop maternity/neonatal team working relationships

• Unnecessary activity reduced

• Improved use of workforce – roles, skills, place

• Improved capacity in NNU - capacity transfers

• Enhancing workforce skills

• Prevention plays a major role in safety

• Provision of high quality care

• Investment in long term outcomes – positive societal impact

• Right baby, Right Cot, Right Time

The IV scheme – benefits: clinicians


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Reduced Specialised Commissioning costs

lower NNU admission rates

reduced LOS with TC and pathway improvements

• Improved quality of care within commissioned

services

• Reduced variation in practice

• Ability to benchmark across regional network

geographies

• Improved Value for Money

• Improved use of NNU workforce


The IV scheme – benefits - commissioners


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The IV scheme – benefits: system


Reduction in health associated costs as:

• breastfeeding leading to improved long term outcomes

• Reduced NNU cost – (TC tarrif)

• Whole pathway review = identifying modifiable clinical

factors for avoiding admission

= offers potential for improvements pre conception, AN, IP

= LOS reduced; admission avoided

• Develop models of care which promote bonding

• Develop national pool of skills and workforce roles to

deliver care for the


Key deliverables and next steps

ODN and MC Networks:

• Support to implement NHSE IV scheme

• Address as a joint MCN/ODN/PSC network priority

• Identify named Atain leads in every unit – mat&neo

• Baseline using BadgerNet data to understand local

admission rates and issues

• Verification role for local findings

• Draw on national guidance and regional work to address

relevant issues

• Consider model of transitional care and ensure staffing and

skills appropriate

• Work with units to address, share and benchmark Atain – insights from the national programme


Commissioners:

Implement NHS England Improving Value scheme:

Work with clinical colleagues to address requirements

identified from audits

Focus on quality

NICU staffing and capacity addressed in part if babies in

right place at right time

Improved outcomes

TC – virtual or integrated – staffing numbers and skills

Co-commissioning


23 I Atain – insights from the national programme


Frontline maternity and neonatal teams:

Perinatal collaboration crucial

Identify Atain leads – mat and neo

Undertake in partnership with your CN and ODN

Review/audit of admissions

BadgerNet and MSDS +review to understand

contributory factors for admissions

Draw on atain findings to inform audit questions/review

Rigour, transparency

Involve your maternity safety champions


Frontline maternity and neonatal teams:

Implement FfP

Undertake Atain eLfh programme

Consider use of Bobble Hat bundle or similar

Admissions for IVAB

NEWTT for monitoring on postnatal ward and TC

TC – virtual or integrated – staffing numbers and skills

Use the MNHSC to turn plans for measurable

improvements to local services.


Atain as part of a national programme

April 17

Formal deliverable within WS2 of the MTP

PS Alert Mandated

action August 17

NHS England

Improving Value

Scheme

HEE, RCM and RCOG to support

overcoming barriers to

implementation

NMPA Resources for implementing

TC E-Learning programme

2016 – Safer

Maternity Care

Action Plan

Unthinkable not to have service and

staffing models which

keep M&B together

↓ trajectory

of ATAIN

2017 SofS Maternity safety strategy

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Join the Journey!


@atain7 [email protected]

head of maternity and neonatal transformation programmes€¦ · mother learns about her baby’s...

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