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Sustaining Quality

Sustaining Quality. “Expectations will always exceed capacity. The service must always be changing, growing and improving…”. Aneurin Bevan, 1948.

dillon-arnold
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Sustaining Quality

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  1. Sustaining Quality

  2. “Expectations will always exceed capacity. The service must always be changing, growing and improving…”. Aneurin Bevan, 1948

  3. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trialsGordon C S Smith, Jill P Pell. BMJ 2003;327;1459-1461 Aim: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. Design: Systematic review of randomised controlled trials Results: Our search strategy did not find any randomised controlled trials of the parachute.

  4. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trialsGordon C S Smith, Jill P Pell. BMJ 2003;327;1459-1461 Conclusion: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute

  5. “Society’s huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves.” “Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.”

  6. Fidelity vs Efficacy $100 Million $29 Billion $32 Billion 0.002%

  7. The aspirin example • In patients who have had a stroke or TIA aspirin reduces risk by 23% • 100,000 patients – 23,000 fewer strokes • 58% of eligible patients receive aspirin = 13,340 fewer strokes

  8. Two options • Fidelity – increase to 100% of eligible patients = 9,660 strokes • Efficacy – requires a proportional improvement over aspirin of 74% • Clopidogrel = 10% more efficacy than aspirin

  9. Outcome Aims • Mortality: 15% reduction • Adverse Events: 30% reduction • Ventilator Associated Pneumonia: 0 or 300 days between • Central Line Bloodstream Infection: 0 or 300 days between • Blood Sugars w/in Range (ITU/HDU): 80% or > w/in range • MRSA Bloodstream Infection: 30% reduction • Crash Calls: 30% reduction

  10. Example Interventions • Critical Care • Ventilator acquired pneumonia bundle, central line • Ward • Early rescue • Communication • Medicines • Medicines reconciliation • Theatres • Surgical pause • Infection prevention/control • Leadership • Safety walkrounds • Executive leadership board patient safety profile

  11. But Does It Work Outside SPSP? Acute pain management in orthopaedics

  12. Spread to 5 days per week Test script of questions for recovery nurses to use 2 days per week Meet anaesthetists SH, CR, TMcL, JD – describe tests with recovery nurses Test drug recognition with recovery room nurses Meet Julie – ward manager – set AIMS Start data collection

  13. Only 45% patients with no or only mild pain in 1st 24 hours postoperatively 75% patients with no or only mild pain in 1st 24 hours postoperatively 526 patients 337 patients

  14. Winter review • Patient safety walk rounds continued during the winter period • Daily monitoring and reporting of 8 hour trolley waits in the Emergency Departments • An action tracker has been established to ensure that the key lessons for improvement are being progressed • Data: • Breach Analysis of A&E waiting times • Boarder numbers • Delayed Discharges • Elective cancellations • Re-admission rates

  15. The Healthcare Quality Strategy for NHSScotland Person-Centred- Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Clinically Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

  16. “We look to Scotland for all our ideas of civilisation.”   Voltaire (Francois Marie Arouet, 1694–1778) jason.leitch@scotland.gsi.gov.uk

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