IMPROVING PRODUCTIVITY BY FOCUSSING ON QUALITY OF CARE - A PROGRAMME OF RESEARCH AT THE HOSPITAL Dr...
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Transcript of IMPROVING PRODUCTIVITY BY FOCUSSING ON QUALITY OF CARE - A PROGRAMME OF RESEARCH AT THE HOSPITAL Dr...
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IMPROVING PRODUCTIVITY BY FOCUSSING ON QUALITY
OF CARE - A PROGRAMME OF
RESEARCHAT THE HOSPITAL
Dr Gill ClementsRoger KillenMarch 2006
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“Patients do not die of their disease, they die of the
physiologic abnormalities of their disease”
Sir William Osler
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PATIENT ASSESSMENT
• Blood pressure• Heart rate• Respiratory rate (oxygen levels)• Urinary output• Temperature• Conscious level
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EARLY WARNING SCORES
• Measure of physiological illness• Marker of increased mortality risk• Linked to action
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SPECIALIST CRITICAL OUTREACH TEAMS
• Hospital wide• Multidisciplinary• Ensure appropriate intensive care
unit (ICU) admissions• Provide training and education
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NATIONAL CONFIDENTIAL ENQUIRY into PATIENT
OUTCOME and DEATH (NCEPOD) report 2005
• Inconsistent recognition of physiological instability
• Inconsistent action• Inappropriate intensive care unit
admissions• Inequality in early warning score
measurement and outreach team implementation
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COCHRANE REVIEW OF THE EVIDENCE
• Many hospital deaths potentially predictable and possibly avoidable
• Clinical deterioration preceded by changes in physiological measurement
• Changes often misses, misinterpreted, mismanaged
• Delays in seeking advice, failure to recognise clinical urgency
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SHREWSBURY AND TELFORD HOSPITAL
• Early warning scores across the 2 sites
• Critical outreach teams on both sites• Two busy ICUs• ALERT (acute life threatening events
recognition and treatment) training courses
• Hospital Standardised Mortality Ratios (HSMRs) low
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• Desire to improve quality of care and productivity
• Enthusiastic team• Research opportunity• Hospital research money
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RESEARCH PROGRAMME
Two projects:• implementing electronic decision support
tools• development of a more sophisticated
patient risk assessment toolIn partnership:
- Portsmouth and Birmingham Universities- Portsmouth Hospital- private limited company - The Learning Clinic
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VitalPAC
• Improve accuracy and timeliness of observation data collected by nurses
• Automatic creation of early warning scores (EWS)
• Linked to decision support (bedside and remote)
• Reduce nurses work burden (remove paper)
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• Wireless handheld computers
• Touch screen guides nurse through data input
• Calculates EWS • Protocols embedded• Personalised reminders
and order of observations• On line nurse training
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PROGRESS SO FAR
• In use on 2 surgical assessment units
• Evaluation of improvement in quality and productivity
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RESULTS
• Accuracy of scores improved from 63% to 90%
• Time to produce a score reduced from 37 seconds to 24 seconds
• Popular with staff
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NEXT STEPS
• Remove paper• Add in access to blood results• Remote access for critical outreach
teams• Role out to medical assessment
units
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VitalPAC+
• Development of a more sophisticated risk prediction/early warning score using data collected as a by product of clinical care (blood tests)
• Based on original work done in Portsmouth (Prytherch, Br J surg 2003)
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Category Mortality risk (%)1 0 to 5
2 >5 to 7.5
3 > 7.5 to 10
4 > 10 to 12.5
5 > 12.5 to 15
6 >15 to 20
7 >20 to 25
8 >25 to 33
9 > 33 to 50
10 > 50 to 100
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• Model replicated at Shrewsbury and Telford Hospital
• Model fits surgical and medical patients
• 90% emergency patients have routine bloods taken on admission
• Data in hospital systems
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Percentage of low risk and high risk patients at SATH
over 5 yearsRisk category
1Risk category8, 9 and 10
2000 49 8
2001 45 8
2002 40 8
2003 42 10
2004 44 8
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SO WHAT?
• Improvement in the quality of care• Improvement in productivity
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QUALITY IMPROVEMENT
• Systematic implementation of accurate risk scoring of patients
• Systematic link to appropriate action• Effective, appropriate use of resources
(doctors, critical outreach nurses, ITU)• Audit tool Reduction in mortality and morbidity
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PRODUCTIVITY IMPROVEMENT
• Stream emergency patients• Identify “appropriate” admissions –
emergency triage• Appropriate level of resources to
patients• Predict LOS• Predict risk of readmission
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Any questions?