QUALITY FRAMEWORK – OUR START

QUALITY FRAMEWORK Disclaimers Have not got this right ourselves yet It is difficult to measure clinical outcomesLabour or IT resourcesHave tried to maintain a variety of types of measures

Proposed national measures Many are annual credentialing type measures Difficult to know how to maintain momentum and visibility

INSTITUTE OF MEDICINE FRAMEWORK Widely used (not a bunch of physicians!) Ensures good spread of measures Is referred to in NZ document Operationalises quality within a framework of domains

Safe Effective Efficient Timely Patient-centred Equitable

SAFE

Definition Care should be as safe for patients in health care facilities as in their homes

Measures Medication errors Hand hygiene Handover quality

TIMELINESS

Definition Patients should experience no waits or delays in receiving care and service

Not short on measures in this grouping! Includes triage related metrics Can include a number of clinical measures Time to analgesia

EFFICIENT

Definition Care and service should be cost effective, and waste should be removed from the system

Measures Number of financial measures assess this in our organisations

Generic Lab and radiology costs/patient presentation

Specific Condition related resource

EFFECTIVE

Definition The science and evidence behind health care should be applied and serve as the standard in the delivery of care

Measures Following pathways of care Representations Screening completed

PATIENT CENTRED

Definition The system of care should revolve around the patient, respect patient preferences, and put the patient in control

Measures Did not wait Satisfaction surveys http://www.rcpch.ac.uk/final-urgent-and-emergency-care-prem-tools

Complaints

EQUITABLE

Define Unequal treatment should be a fact of the past; disparities in care should be eradicated

Practically This can be implemented by stratification Ethnicity Deprivation score Gender ? Others

WORKLOAD

Decided we needed to report on workload Linked to other outcomes Has been used as a departmental indicator for many years

Include Resuscitation Procedural sedation Midnight occupancy Admission rates

WORKLOADWorkload   Feb 2015  Other Month ED Attendance n 2460 

ED Attendance by ATS category      

Triage 1 n 26 

etc etc etc 

ED Attendance By Ethnicity Prioritised      

Asian n 666 

Maori n 235 

Pacific n 493 

Other n 1066 

ED Attendance By Deprivation Scale     

Deprivation Scale 1 n Pending   

Deprivation Scale 2 n Pending   

Patients in Resus Area n  105 

Median (mins)  68 

Procedural Sedation n  95 

ED Midnight Occupancy > 20 n 7 

Admission Rate % 24%  

Admission Rate By Ethnicity     

Asian % Pending  

Maori % Pending  

Pacific % Pending  

Timely    Feb 2015 Other MonthED LOS Over 6Hr n 124 

% 5.1% ED LOS By Ethnicity Median (mins) 186  Asian Median (mins) 171.5  Maori Median (mins) 213  Pacific Median (mins) 193  Other Median (mins) 187.5 Triage Waiting Time and Compliance    various Triage 3 By Ethnic Group       Asian Median (mins) 15  Maori Median (mins) 16  Pacific Median (mins) 15  Other Median (mins) 17 ED Completion Median (mins) 130 Referral to Specialist Assessment Median (mins) 69 Specialist Assessment Completion Median (mins) 101 Bed Allocation Median (mins) 18 Bed Allocation to ED Departure Median (mins) 134 2 Hour Access Block % 26.3% CSS % 6.3% CSS LOS Under 12 Hrs (≥80%) % 91.8%CSS to Admission (≤ 20%) % 5.3%

Patient Centered    Feb 2015 Other Month DNW Before Seen % 1.0%

n 25 

Left Before Care Completion % 0.1%Discharge summary completion within 48 hours %  97%Consumer survey ("Excellent" or "Very good") % Manual  Maori % Manual  Pacific % Manual  Asian % ManualComplaints n 5Asthma action plan provided % Manual

Safety     Feb 2015  Other Month

Medication errors reported   n 6   

Hand hygiene audit score (all staff)   % 78%   

Handover related care failure   % Manual   

Staff survey (Excellent/Very good) % Manual 

Effective and Efficient       Feb 2015  Other Month Representations to ED within 48 hours n 78

% 3%  Representations to ED within 48 hours requiring admission n Pending   

% Pending  Child Protection screening completed % 65%  Time to antibiotics in neonatal sepsis Median min Manual  Time to FBC collect in febrile oncology Median min Manual  Time to salbutamol in acute asthma (TC 1 to 3) Median min Manual    Maori Median min Manual    Pacific Median min Manual    Asian Median min Manual  Steroid use in acute asthma (age > 5 years) % Manual  CXR use in acute asthma/bronchiolitis % Manual  CT Head in discharged head injury % Manual  Time to opiate analgesia in acute fracture (TC 1 to 3) Median min Manual    Maori Median min Manual    Pacific Median min Manual    Asian Median min Manual  Unplanned fracture remanipulation (if manipulated in ED) % Manual  Length of ED stay in patients requiring fracture manipulation Median min Manual  

SO …. We are in the process of ‘automating’ this Some of it is possible currently Some of it in preparation

We have/are developing standardised definitions We can then allocate resource to ‘manual’ measures SMO audit RMO audit Nursing audit Other Department auditing us Research assistants Clerical team

IMPROVEMENT

Monthly improvement focussed meeting Review ‘performance’ Identify how to improve Will also need to look to varying measures

Visibility Staff Will need to include staff education

Patients and families