London AAAQIP Progress: Spreading and Sustaining Change.

1. London AAAQIP Progress:Spreading and Sustaining Change. David Mitchell VS Audit & QI Committee Chair AAAQIP Project Director

2. Last Phase of Implementation P

3. 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

4. QI in action – examples from UK

5. 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)

6. 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

7. Post-Operative Communication 86% response rate

8. Medway: Telephone Follow Up • Findings: • Dietary concerns and lack of appetite revealed • Caused extreme anxiety for wives • Provided patients as well as partners with reassurance • Despite being provided with contact numbers patients reported “we didn’t like to bother you” • Identified areas for improvement

9. 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

10. 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

11. London AAAQIP Progress

12. London AAAQIP October Meeting Acknowledged variability in day to day practice Key areas for improvement Implement the AAA pre-operative care bundle consistently Agree intra-operative team composition standards Set common criteria and procedures for post op admission Educate vascular nurses on specific post op recovery advice.

13. Implementing Change

14. Act Plan Study Do Set criteria and develop protocols Spreading a change to other locations Make part of routine operations Implement care pathway throughout London Implementing a change Test under a variety of conditions Implement best practice from other units Testing a change Theory and Prediction Developing a change

15. 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 QI

16. Sustaining Change Working to a single set of standards nationally (VSGBI/ NAAASP) Measurement of service delivery against standards The new National Vascular Registry (NVR) Regular reporting to monitor progress

17. Sustaining Change - Practicalities • Measurement • All cases into NVD (NVR) • Coding validation • Regular update and review • Meetings • Focus on quality and process • Regular audits: MDT, communication, turn down • Ongoing improvement projects: nurses, junior doctors, senior staff support

18. Discussion: Next Steps for London? • Value in sharing best practice • Agree next meeting • Who hosts it, take turns to host? • Reconfiguration • The importance of refining referral pathways • Protocols & standards to be adopted throughout region? • Build in regular patient involvement and feedback • Local-PROMS • Regional-Patient Groups • Should there be a London QI Network? • Linked to local meetings