Great feedback from local QI days
Thank you all for attending the local Quality Improvement days. We had a great turn out and learnt a lot about what you have been doing. You have been busy! We have a list of some of the key points that stood out for us during the days in the three AHSN regions below.
If you can think of any others then let us know and we can add them into a further newsletter.
– East Sussex hospital have made a stamp to add a question to their existing WHO checklist which asked about NELA completion at SIGN OUT. This avoids having the stationary redesigned and printed. If you would like a stamp or more details of this idea please let us know.
– Medway have offered prizes (in this case a ‘proper’ coffee!) for the surgeon with the best NELA form completion every month. This has proven to be very successful! Incentives are key!
– William Harvey in Ashford have tried to reduce delays in sepsis treatment by introducing a first dose of antibiotic for all laparotomy patients that trigger the NEWS score. Microbiology have agreed to this dependent on a swift review, full sepsis assessment and de-escalation if required.
– Royal Sussex in Brighton have undertaken a snap audit of case notes to identify their antibiotic rate prior to surgery. Some notes identified good practice but others showed some missed opportunities that can be learnt from.
– Portsmouth has started using the RCS Surgical Quality Assurance Meeting model for their M+M on laparotomies.
- Bournemouth have a weekly ELC QI team meeting. This is at a set day and time very week to track and examine ELC goals.
- Snap sepsis audits are being carried out in various hospital trusts.
West of England
– North Bristol are undertaking a case note review after an upward trend in mortality.
- In Bath, all patients with a pre-operative P-POSSUM mortality of > 50% do not get booked for surgery until an urgent MDT ‘mini-case conference’ has been held between the surgeon, anaesthetists and intensivist to ensure that surgery is in the best interests of the patient.
NELA report Year 2
NELA published their Year 2 report in July. You can get the whole report or the executive summary from here:
The national (England and Wales) 30-day mortality rate has decreased from 11.7% to 11.1% which is significant given the numbers of patients data they collected (53,000).
Risk-adjusted 30-day mortality ranged from 5% to 17%. In this new report NELA give each individual hospital their adjusted-mortality rate but they are using something other than P-POSSUM to risk-adjust so be wary!
Interesting view of the Optimise trial that was tweeted recently. Check out this Bayesian analysis of the same trial: http://www.r- bloggers.com/bayesian- statistics-and-clinical-trial- conclusions-why-the-optimse- study-should-be-considered- positive/
The third Cross-AHSN Collaborative event will be at the Crowne Plaza in Reading on the 29th September. It is promised to be an interesting and jam-packed day with talks from Jugdeep Dhesi on elderly care and sustainability of your QI projects as well as leadership.
Register your attendance here:
Elderly Care project update
The elderly care project has reached the implementation phase. The project outline and preliminary results will be presented at the third cross- AHSN collaborative event on
July 2016 the 29th September.
Emergency Laparotomy Collaborative 25 July 2016 Letter to CEOs
You may be aware that a letter from the ELC leads to all the Chief Executives and Medical Directors was sent to help with re-engagement and awareness. Please let us know if we can help with Executive Board presentations or departmental engagement in any way – either with data or coming down for support/ presentations.
Q fellowship from The Health Foundation
The second round of Q fellowship is open for applications. This is an initiative to connect people with improvement expertise across the UK. The application closes on the 18th August 2016. Find out more and the application form here:
NICE sepsis guidelines
The new NICE guidelines on the management of sepsis were published on 13th July 2016. The guidelines can be found here: