Patient Safety Collaboratives Dr Chris Streather PSC Launch 14/10/14

Patient safety – a clinical leadership view

• Optimism, pessimism, ancient history and the adoption of innovation

•More modern history

•Local example

•Change the culture or fix problems?

A history lesson – we’re a bit slow unless it hurts

Mortality in adult cardiac surgery since 2003

2

3

4

5

6

7

8

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Chart Title

Mortality %

Progress on MRSA, C diff and VTE

• 2003 MRSA 7700 • 2013 MRSA 924 still falling Q2 2014

• 2007 C diff 57,217 • 2013 5974

• Just do simple things well

• Wash hands (Lister stops spinning in his grave) • Keep hospitals clean • Prescribe antibiotics wisely • Measure it

• Make failure consequential

Date of download: 10/10/2014

Copyright © American College of Chest Physicians. All rights reserved.

From: Comprehensive VTE Prevention Program Incorporating Mandatory Risk Assessment Reduces the

Incidence of Hospital-Associated ThrombosisRisk Assessment and Hospital-Associated Thrombosis

Chest. 2013;144(4):1276-1281. doi:10.1378/chest.13-0267

Percentage of patients with documented risk assessment.

96% patients assessed nationally, Kings study shows 12-20%

reduction in thrombotic events

Figure Legend:

Catheter-associated urinary tract infections (CAUTIs) – a Cinderella

issue? •Safety Thermometer data tells us 18.9% of inpatients in England are catheterised (substantial variation across Trusts) •Extrapolating from this and HES we estimate that 2.9 million inpatients are catheterised annually in England, and of these around 190,000 (6.7%) develop urinary tract infection (UTI). •Approximately 3.6% (95% CI 3.4–3.8%) of patients with CAUTI develop life-threatening secondary infections, where mortality rates range from 10% to 33%.

No Catheter, No CAUTI ‘Care Bundle’

Avoiding unnecessary placement

Prompt removal

Rapid review of incidents (CAUTIs or

bloodstream infections associated

with CAUTIs) for learning

and improvement

Quality and improvement

about the management of catheters

out of hospital

•Engage leaders

•Support organisational and reporting readiness

Set Up Feb 15 – Jul 15

•Initial Breakthrough series across 5 veritically integrated acute/ community trusts in South London

•GSTT

•Kings

•Lewisham

•Croydon

•St George’s

Phase I BTS •Open BTS to all acute and community trusts in South London

•Kingston / Your Healthcare

•Royal Marsden / Sutton & Merton

•Epsom & St Helier

•Oxleas

•BromleyHealthcare

•Hounslow and Richmond

•Consideration of care homes

Phase II – Scale up, sustain &

spread

South London Provider Rollout

Spend on excess bed days

£6m.

More potential quality improvements and

savings in Phase 2

27,000 fewer inpatient catheterisations

in our 5 Trusts

If catheterisation rate

reduced by 29%...

Potential impacts If CAUTIs reduced by

50%...

3,500 fewer inpatient CAUTIs in our 5

Trusts

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2013-14 29% reduction

£12.3m. a year spent in

these Trusts on excess bed

days alone for patients with

CAUTI

Also costs for ITU, A&E,

emergency readmissions,

community care

7.7% of patients with catheters will

have CAUTI at any given time

More than 90,000

inpatients with catheters

across our 5 Trusts each

year

Potential savings

£1,700 is the estimated cost of

treating a CAUTI episode

Estimates of patient numbers based on NHS-ST data and HES 2013-14, Cost estimate derived from Plowman et al. 2001, adjusted for inflation

Recent feedback on the Catheter Passport...

1. Patient: ‘Its nice and clear and answers my questions’

2. Nurse : ‘a really good idea that should be rolled out nationally’

3. GP : ‘Discharge summaries are my bugbear - the catheter passport gives me the important information’

4. Nurse – the idea has been so well received within the hospital that we have begun to develop a similar passports for falls and for pressure sores.

GSTT tested Reinertsen’s ‘Reality Rounding’ practice during Summer 2014, focused on CAUTIs. Here are some resulting actions...

Reality Rounds: A Leadership Practice to Improve

Implementation of “Vertical’ Processes

1. Pick a major safety practice critical to your aims for this year

2. Develop a scripted set of questions designed to expose

operational barriers to implementation of that practice, and

to drive positive feedback to staff who know and implement

the practice

3. Commit the leadership team to round

– CE 1 hour per month

– Director 1 hour per week

– Unit manager 1 hour per day

4. Fix the operational problems you learn about

5. Pick another safety practice, and repeat

1. Improve ward stores for " flip-flow" catheter valves

2. Add catheter care plan to checklist for patients stepped down from critical care wards

3. Catheters can be removed before bowel management is completed

4. Improve handover for Trial without Cathetter post- discharge

Reinertsen, James. ‘Leadership for Safety: A Masterclass for South London’s Academic Health Science Network’. St Thomas

Hospital. Power Point. 29 May 2014.

Sub-heading 18pt Arial Sub-heading 18pt Arial

The way forward

•Jim Reinertsen at our local launch challenged the value of fixing problems versus comprehensive change in culture

•Don’t underestimate how good we are at fixing problems

•Our task is to get best of both worlds by fixing problems whilst changing the culture

•AHSN well placed as we stretch beyond hospitals and beyond pure health

•Core business adoption and diffusion

Thankyou Dr Chris Streather