Acute Quality Standards

Dan Beckett

Acute PhysicianCMO Advisor for Acute & General Medicine

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.

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 hours vs those 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.

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

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

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.

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.

Adult Acute Medicine Standards

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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..

79%

21%

Percentage of standards met or not met during weekdays

72%

28%

Percentage of standards met or not met during weekends

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.

Adult Emergency General Surgery Standards

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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..

79%

21%

Percentage of standards met or not met during weekdays

75%

25%

Percentage of standards met or not met during weekends

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.

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

• 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

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• 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 proportion of Acute Medicine and Emergency General Surgery Care Quality Standards that are not being met.

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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

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…