Acute Quality Standards

1. Acute Quality Standards Dan Beckett Acute Physician CMO Advisor for Acute & General Medicine

4. Adult Emergency Services – case for change • Adult emergency services: Case for Change. London Health Programmes(2011) • Increased risk of death for most emergency conditions if a patient is admitted at the weekend, compared to a weekday. • If weekend mortality rate was the same as weekday London 500 fewer deaths a year. • Evidence suggests services with high quality provision in place, seven days per week, reduces the gap between weekday and weekend mortality rates. • In addition variation exists for length of stay and re-admission rates.

5. Development of adult acute medicine and emergency general surgery standards • Improving 7/7 services is a key priority • Quality standards were developed to address the issues raised in the acute emergency services case for change: • Significant variation in service provision across London. • Marked variation in working patterns that takes place during normal working hoursvsthose at the weekend. • Standards are based on clinical evidence, national recommendations and best practice represent the minimum quality of care that patients should expect in every acute hospital.

6. London quality standards: Key themes • Admissions seen by consultant <12 hours • Twice daily ward rounds for all patients • MDT plan within 24 hours including EDD • Timely access to diagnostics and reports • Timely access to interventions including theatre • Good information for patients and their carers • Timely transfer to next place of care Continuity

7. Timeline • Case for change published September 2011 • NHS London commissioning standards for acute medicine and emergency general surgery published 2011 – quality standards in April 2012 • Audit of acute medicine and emergency general surgery in 2012/13 across all sites • Peer review, case note audit • Revised (broader) Acute Emergency and Maternity standards published February 2013 • Self-assessment 2013 • Signed off by CEO • Results available publically - transparency

13. 2012/13 Audit of acute hospitals - Standards met and not met by category The biggest challenges were in consultant delivered care and multidisciplinary assessment, 7 days a week.

14. 2013/14 Self-assessment of London Quality Standards • Providers of acute emergency and maternity services self-assessed their progress towards meeting the London quality standards • Highlights progress made in implementing the standards for adult acute medicine and emergency general surgery. • Commissioned from April 2012 and formally audited during 2012/13. • Improvements were seen across adult acute medicine and emergency general surgery.

15. Adult Acute Medicine Standards • Results from the 2013 self-assessment show there was no one standard not met by all hospitals during weekdays or weekends. • Key findings in 2013 v 2012 : • 55% v 35% of hospitals deliver consultant review within 12 hours. • 35% v 7% of hospitals have twice daily ward rounds by a consultant. • 72% v 28% of hospitals provide extended day working by consultants. • 38% v 4% of hospitals provide multi-disciplinary team assessment within 12 hours.. • 45% v 21% of hospitals meet the standard for 24/7 timely access to diagnostics.. 15

16. Improvements in adult acute medicine Improvements were reported in: Consultant-delivered review within 12 hours; extended day working; twice daily ward rounds; and multi-disciplinary team assessment.

17. Adult Emergency General Surgery Standards • There was no one standard not met by all hospitals during weekdays or weekends. • Key findings 2013 v 2012: • 50% v 15% of hospitals deliver consultant review within 12 hours for emergency surgery. • 38% v 7% of hospitals have twice daily ward rounds by a consultant. • 69% v 22% of hospitals provide extended day working by consultants during the week. • 23% v 0% of hospitals provide multi-disciplinary team assessment within 12 hours for emergency surgery. • 46% v 22% of hospitals meet the standard for 24/7 timely access to diagnostics for emergency surgery.. 17

18. Improvements in adult emergency general surgery Improvements were reported in: Consultant-delivered review within 12 hours; access to and provision of theatres; and multi-disciplinary team assessment.

19. Correlating Clinical Quality Standards Self-Assessment returns and A&E performance

20. Headlines • London hospitals achieve to a greater extent Acute Medical Care Quality Standards compared to Emergency General Surgery standards • The Emergency General Surgery standard achieved least consistently by London Hospitals is Standard 2, which refers to the prompt screening of all complex needs inpatients by a multi-professional team. • Those Hospitals that achieved a lower proportion of Emergency General Surgery standards typically experience a more challenged YTD All Type performance 20

21. Headlines • Less of a correlation is observed however between those hospitals that achieve a lower proportion of Acute Medical Care Quality standards and more challenged YTD All Type performance • There is also limited alignment between the achievement of Acute Medical Care Quality standards and YTD Type 1 performance across London hospitals. • Those Trusts with higher than average DTOC levels across London are observed as having a higher proportionof Acute Medicine and Emergency General Surgery Care Quality Standards that are not being met. 21

22. Next steps • UC Programme Board has given approval to proceed • Unscheduled Care Executive Leads – letter w/b 15th Sept • Self assessment template via Survey Monkey to be developed (examples on the table) • Self Assessment guidance issued w/b 29th Sept • Self Assessment to be completed 31st October

23. Future steps? • Random peer review • Broadening to all acute emergency and maternity services standards? • Revision of quality standards with NHS England (London) and relevant professional bodies to develop UK quality standards…