VANGUARD ENDOSCOPY QUALITY COLLABORATIVE Seward... · nhsiq.nhs.uk . BMT Nursing Highlights BMT...

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VANGUARD ENDOSCOPY QUALITY COLLABORATIVE Ed Seward Dec 2016

Transcript of VANGUARD ENDOSCOPY QUALITY COLLABORATIVE Seward... · nhsiq.nhs.uk . BMT Nursing Highlights BMT...

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VANGUARD ENDOSCOPY QUALITY COLLABORATIVE

Ed Seward Dec 2016

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OVERVIEW What is a Vanguard

Why endoscopy efficiency is important

What we’d like to achieve

How you can help

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National Cancer Vanguard

Part of the New Care Models

Programme (from NHS Five Year Forward

review)

Designed to try out novel ways of

working to inform the rest of the NHS

In collaboration with two other cancer

centres (Royal Marsden and The Christie)

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Waiting lists across the sector have grown by 82% (Colonoscopy) from December 2013 to December 2015

Total waiting lists grown

by 84% from

December 2013 to

December 2015 Increasing

proportion of

patients waiting 6+

weeks

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Most CCGs in NCEL/WE are below

national median in terms of

endoscopy access

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4000

6000

8000

10000

12000

14000

16000

18000

20000

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Sco

pes

NHS England Trajectory

Actual (attended)

PICTURE OF CURRENT ROLLOUT OF BSS

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nhsiq.nhs.uk

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TCST BASE LINING EXERCISE

Understanding capacity, demand and activity

Modelled 2015 baseline, provided a 2020 projection, and a

projection plus ‘optimisation’

JAG return

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WHAT DO WE MEAN BY ‘OPTIMISATION’

DNA/same day cancellation

List utilisation

Room utilisation

Start/stop audits

Bowel prep/surveillance/ STT

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WHAT DO WE MEAN BY ‘OPTIMISATION’

But mostly – it’s up to you!

What does good look like?

What do you do well? What do you do less well?

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90%

6%

1%

3%

How likely are you to recommend our clinic

to friends/ family?

Extremelylikely

Likely

Extremelyunlikely

Don't know

Endoscopy Information - October

*based template points against actual points; excluding BCS, bronchoscopy and cystoscopy

Referral Triage – outstanding

1

All staff were excellent, helpful and very informative.

Good communica

tion from all staff

Patient comments

80%

85%

90%

95%

100%

105%

Room1

Room2

Room3

Room4

Room5

Room7

Total

This month's utilisation

0

50

100

150

200

250

300

350

Monthly average

Waiting <24hours

Waiting <48hours

Waiting <72hours

Waiting 72>hours

The whole experience

was excellent.

In October 56% morning sessions started late, totalling 2040 mins lost – equivalent to 136 points!

0%

20%

40%

60%

80%

100%

AM PM AM PM

Starts Finishes Total

Start and End Times

> 30 mins late

16-30 mins late

0-15 mins late

On Time

Early

Late Cancellations 2% - 36 points

(Last month 3%)

DNA Rate 3% - 53 points

(Last month 3%)

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Endoscopy Information - November

*based template points against actual points; excluding BCS, bronchoscopy and cystoscopy

The staff were incredible,

professional, empathetic, kind

and very knowledgeable and reassuring.

Patient comments

Well done on first

class 5 star treatment.

In November 23% of sessions ended more than 20 minutes early. Thank you to Phoebe for the Comfort Score information

Late Cancellations 4% - 72 points

(Last month 2%)

DNA Rate 3% - 55 points

(Last month 3%)

Friends & family test: 96.4% would recommend

0

5

10

15

20

25

30

Notrecorded

None,resting

comfortably

1 or 2episodes of

milddiscomfort

> 2episodes of

milddiscomfort

Significantdiscomfort

CO2

AIR

CO2/Air COMFORT SCORE – Results of Nurses’ Audit Diagnostics waiting

time compliance

Routine patients seen within 6

weeks 84.8%

Urgent patients seen withn 2

weeks 85%

80%

85%

90%

95%

100%

105%

Room1

Room2

Room3

Room4

Room5

Room7

Total

Monthly Utilisation Oct % Nov %

0%

20%

40%

60%

80%

100%

AM PM AM PM

START FINISH

Start and Finish Times (%)

>30 mins late

16-30 mins late

1-15 mins late

On time

Early

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WHAT TO DO WITH THE DATA

Do not allow it to be a one off

It must inform ongoing practice

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OTHER IDEAS

Process mapping – optimise patient pathway

Split dosing of bowel prep – to reduce repeat procedure rate

Home enemas – to reduce pressure on recovery beds

Unsedated/entonox recovery pathways

In patient liaison nurse – to improve prep and smooth patient flow

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TEAM HUDDLE

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Measure Outcome RAG

STT Pathway in place

Demand/capacity awareness IMAS support tool or similar

List utilisation Backfilling >90%

DNA/cancellation rates <4%

Room utilisation Points on list optimised

Start/stop audits Lists start and finish on time >90%

Surveillance request

validation

100% of surveillance requests

Bowel prep adequate >90% of procedures

QUALITY COLLABORATIVE DASHBOARD

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OBJECTIVE OUTCOMES

Measured at 6 and 12 months (and thereafter?)

Improvement in dashboard RAG status

Improvement in throughput: activity/capacity = efficiency

ratio

Possible clinical outcomes such as unit ADR to follow

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OTHER OUTPUTS FROM VANGUARD

Colon capsule

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CONCLUSIONS

Service improvement is a necessity

Service improvement can allow every department to run more

efficiently, be more patient focused, be more team centred and

be more fun

Vanguard wide quality collaborative should provide support

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THANK YOU

[email protected]