neonatal quality standards dr sandra calvert. background 2009 nice commissioned by doh to manage...
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Neonatal Quality Standards
Dr Sandra Calvert
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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
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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
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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.
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Overview of Quality standards process
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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
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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
Difficulties of developing QS for Neonatal Care
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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
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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
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10 areas of care which QS should focus on
15 draft quality statements
Consultation and field testing
Final 9 statements for published quality standards
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Is there a quantitative measureof adherence/achievement
• Is there a measurable outcome?
• Is there a standard for comparison?
• What is the evidence that this standard is “best”
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√
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X
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X
√/x
X
√/x
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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
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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
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Quality Statement 4
With emergency transfers proportion of transfer teams that depart from base with 1hr of referring call
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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
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Quality Statement 8
Completion NNAP dataset
% babies whose parents invited to participate in research studies
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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