South East Coast AAAQIP ProgressSpreading and Sustaining Change. Roxanne Potgieter AAAQIP Project Manager
Criteria Led Discharge – Reducing HDU Usage Norfolk EVAR Nursing Care Pathway • EVARS 13 • Post-op • Vascular ward 12 • Planned HDU 1 • Unplanned HDU 0 • No unplanned HDU admissions • All complications dealt with on the ward. (March-July 2011)
Patient Feedback – AAA Recovery Leaflets Patient leaflets tested in all regions Consistently outperform other information leaflets Developed through patient groups Advice based on practical needs 86% response rate
Post-Operative Communication 86% response rate
NBT: Telephone Follow UpNov 2011-March 2012 (22 patients) Blood in urine Problems with bowels Patient sleeping on back due to worries about causing damage. Unaware of when to bath/shower and how to care for wound. Concerned about bowels and what/ what not to do. Reluctance to take pain killers. Unsure why he was given codeine but is not taking it. Dressing still in place, wounds dry. Pt unaware if stitches are dissolvable.
local NVD VGNW Ward Episode completed Coding Department File storage HES VGNW NVD CMUH: Data Validation Paper Trail Discrepancy between HES and NVD 1/10/10 to 31/3/11
Revised paper trail • Rules for data submission • Consultant verification • Code operations on op note • Use of discharge summaries Local data NVD VGNW Monthly report to Consultant Ward Episode completed Coding Department File storage Confirm with Consultant Quarterly report to Consultant HES
Regional Progress • EoE, Y&H and N.West • Now self sustaining AAAQIP Networks • C&S Network led (EoE, N.West), clinician led (Y&H) • Outputs: • Regional implementation of pre-operative care pathways • Regional adoption of AAAQIP patient leaflets • Setting minimum quality standards for each unit to meet • Where there is strong C&S network + commissioner support, they are now driving change
South East Coast AAAQIP Progress
SEC AAAQIP October Meeting Acknowledged variability in day to day practice Key areas for improvement Streamline pre-operative pathways to qualify for AAA screening. Documentation shared through clinical team Standards for surgical skill mix for complex OR Setting post operative milestone (OR/EVAR) Telephone follow up as a routine practice
Act Plan Study Do Adopt protocols throughout region Spreading a change to other locations Make part of routine operations Set criteria and standards for each unit to meet Implementing a change Test under a variety of conditions Test best practice from other units Testing a change Theory and Prediction Developing a change
Key Learning for Change • Local leadership is vital • A mutually supportive network encourages participation • Success more likely if all stakeholders engage; • VSGBI, VASGBI, BSIR, C&S Networks & Commissioners • Regular meetings to share best practice and focus on process and quality
Value in sharing best practice? Another meeting, take turns to host? Input from local C&S Networks and Commissioners? Evidence of best practice from today that should be adopted throughout region? Key areas to standardise in region? Risk assessment, MDT Patient Information Minimum standards Areas that still require testing? Discussion: The Next Steps for the SEC?