Reducing Mortality in AKI/ SEPSIS Patients Aintree University Hospital DEBBIE COWELL/SUE GALLAGHER...

Reducing Mortality in AKI/ SEPSIS Patients

Aintree University Hospital

DEBBIE COWELL/SUE GALLAGHER 2015

Reduction Of Mortality Rates Within Aintree

There are two national measures of mortality which help us to compare how we are performing compared to other organisations:

– Hospital Standardised Mortality Ratio (HSMR)– Standardised Hospital Mortality Index (SHMI)

Aintree, along with other hospitals, previously focused on HSMR. This was a key focus of our Quality Strategy, and we consistently had a better than average rating. However, when SHMI was introduced, a different picture emerged. Under SHMI, we had a very high ratio, one of the highest in the country. Professor Sir Bruce Keogh, the NHS Medical Director, has stressed that mortality indicators are not absolute indicators of quality of care but should be seen as ‘smoke signals’ to ensure focus on improvement.


The Avoidable Mortality Reduction Group Aintree’s response to this challenge is the creation of the Avoidable Mortality Reduction Group.The group consists of multi-disciplinary clinicians who are leading work to reduce avoidable mortality at Aintree. The Outreach support project is one such group that has been introduced to ensure the early recognition and management of patients at risk of AKI/SEPSIS/Pneumonia through a system of coordinated alerts, the purpose being early identification of those patients at risk and prompt implementation of appropriate care bundles known to reduce patient overall mortality.


TEAM MEMEBERSShirley Brady Clinical Manager Critical Care /Project Lead

Outreach Support Team Ext 2371

Sue Gallagher Specialist Nurse Critical Care Outreach/Met/AKI/Sepsis OSN Lead bleep 5540

Debbie Cowell Specialist Nurse Critical Care Outreach/Met/AKI/Sepsis OSN Lead bleep 5540

DR Thangavelu Chandrasekar

Consultant Nephrologist AKI Lead

DR Nihat Bhuiyan Consultant Critical Care Sepsis Lead

DR Neil Mercer Consultant Anaesthetist AVMRG Lead DEBBIE COWELL/SUE GALLAGHER

2015

Aim of project• Reduce mortality rates within the trust in this cohort of

patients• Deliver High Quality Safe Patient Care of patients with AKI/

SEPSIS• Raise awareness of AKI/ SEPSIS throughout the Trust• Ensure standardised care of AKI and Sepsis throughout the

trust through the introduction of care bundles, • Reduction in 30 day mortality in patients presenting with

sepsis within 12-18 months( initial overall mortality stood at 28% at start of project)

• Reduction within the trust in AKI level 1-3 Patients Initial aim was to reduce by 30%.


Aim Primary Drivers

AimReduce

mortality rates in patients who

have AKI / Sepsis

Identification of AKI stages 1-3 Identification of Sepsis, severe sepsis, septic shock

Effective intervention and monitoring

Robust IT systems

Medical and nursing engagement

Secondary Drivers

1.Effectively identify patients at risk of AKI/Sepsis2.Development of patient criteria i.e. WBC >20000 for Sepsis3.AKI Bundle ( creatinine rise as per guidelines) 4.Increase staff understanding of AKI/Sepsis through education and training i.e. HDU ,ALERT,RN induction, F1 induction5. Urgent communication of appropriate patients to own team and Critical Care

Implementation of AKI and Sepsis six care bundles throughout the trust.

Development of patient documentation and patient information leaflet

Development of IT data base to feed appropriate patient information and blood results to outreach support team

via SIGMA 3 times a day

Funding ….the project to maintain sustainabilityTeam expansion to incorporate increased work load of

outreach team

Audit .Work with business intelligence collating and analysing the

patient data and provide monthly reports on trust mortality

Approval from trust board clinical effectiveness board

DRIVER DIAGRAM


Measures and data

Outreach Support Team Outcomes - Narrative (10/09/2015)

Numbers of Patients Reviewed

Month Patients reviewed

% of Trust Inpatients

% of AKI/Sepsis/Pneumonia

Inpatients

Approximately 80% of patients reviewed are clinically assessed; 20% are telephone triaged/advice.


AKI

Month AKI1 AKI2 AKI3 Total AKIs

Sepsis

Month Pneumonia Urosepsis Intra-abdominal Other Total Sepsis

DEBBIE COWELL/SUE GALLAGHER

2015

Trust Overall Mortality

Month AKI Sepsis Pneumonia Trust

Dec-14 20.14% 14.48% 23.00% 3.73%

Jan-15 20.30% 12.68% 14.64% 3.59%

Feb-15 21.31% 12.52% 16.75% 3.42%

Mar-15 19.10% 11.16% 18.42% 2.63%

Apr-15 16.67% 10.55% 17.14% 3.01%

May-15 18.45% 11.61% 21.29% 2.92%

Jun-15 16.67% 10.04% 16.88% 2.54%

Jul-15 13.70% 9.18% 21.74% 2.58%

Aug-15 18.49% 9.41% 14.04% 2.67%

Trust Average LOS

Month AKI Sepsis Pneumonia Trust

Dec-14 18.9 12.5 8.4 5.1

Jan-15 18.3 12.4 9.3 5.1

Feb-15 17.5 12.4 12.5 4.8

Mar-15 17.5 12.5 10.7 4.6

Apr-15 18.1 11.6 8.7 4.7

May-15 17.0 12.6 11.1 4.7

Jun-15 19.3 13.3 11.1 5.1

Jul-15 17.0 11.8 10.0 4.8

Aug-15 16.0 10.9 10.0 4.7


Key achievements• Development of a bespoke web based system• Quality dashboard to demonstrate outcome measures• Implementation of Care bundles throughout the trust• AKI/Sepsis education training incorporated into:_F1 TrainingHDU Study DayAlert CourseRN InductionRole development team expansion• On going up to date training in all clinical areas• Proven reduction in mortality rates throughout the trust in patients with

AKI/Sepsis DEBBIE COWELL/SUE GALLAGHER

2015

Lessons learnt• Learning through trial and error ( paper work, data

base, consultant input, educational issues, asking for advice )

• Need for continual reassessing and need for change • Hospital politics, funding issues• Changes in team dynamics• Overcoming resistance to change• Outreach Team journey


WHAT SHOULD AQUA DO DIFFERENTLY


ANY QUESTIONS


Reducing Mortality in AKI/ SEPSIS Patients Aintree University Hospital DEBBIE COWELL/SUE GALLAGHER...

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