Avoiding admission of term infants to neonatal units ATAIN – Improving Value Scheme Michele Upton Head of Maternity and Neonatal Transformation Programmes NHS Improvement
8th March 2018
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• What is Atain?
• Why this is important
• Findings
• The IV scheme
• Opportunities for influencing change - 2018
• Your contribution to implementing the IV scheme
Presentation
Atain – insights from the national programme
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Acronym for
Avoiding Term Admissions Into Neonatal units
Programme of work initiated under patient safety to identify harm leading to term admissions
Current focus on reducing harm and avoiding unnecessary separation of M&B
What is Atain?
Atain – insights from the national programme
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Atain – insights from the national programme
2010 - NHS Mandate & Outcomes
Framework
National perspective Seen as a signal of sub-optimal care during antenatal, intrapartum or post natal period – few fully grown babies should need neonatal services Signal that avoidable harm might have been caused Significant but avoidable cost to NHS and families Maternity and neonatal teams long recognised as an issue – will to resolve
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• The first hour of life following birth is a once-in-a-lifetime experience to be cherished and protected.
• Mothers and babies have a physiological and emotional need
to be together: hours and days following birth. • Important for physiological stability of baby and beginning of
maternal infant interaction
• The benefits of skin-to-skin care extend beyond birth. The mother learns about her baby’s needs and how to care for, comfort and soothe her newborn.
Why is this important
Current initiatives for improving safety for newborns
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Why is this important
There is overwhelming evidence that separation of mother and baby so soon after birth interrupts the normal bonding process, which can have a profound and lasting effect on maternal mental health, breastfeeding, long-term morbidity for mother and child. This makes preventing separation, except for compelling medical reason, an essential practice in maternity services and an ethical responsibility for healthcare professionals.
Atain – insights from the national programme
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Complexity
Atain – insights from the national programme
Which term babies? Data collection system – accuracy of data entry Data on place of admission - TC Different commissioning arrangements across networks and even within trusts - variation in TC Incentives for admission – income via Neonatal services Local variation: clinical practice/admission policies…. Midwifery skills/resource Maternal morbidity Early discharge / transfer Fail safe decision-making + inexperience of junior doctors Some term admissions are entirely appropriate
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Atain work programme
Six working groups
20 strands of work Data analysis >136 000 babies Academic publications – Open Access Analysis of litigation claims Prospective scoping of practice E-Learning to address knowledge gaps leading to atain Parental involvement in recognising the sick newborn MDT workshops for LW leaders Supernumerary status for the LWC Cross collegiate safety huddles and handovers
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Atain – insights from the national programme
Findings
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Term live births in England (2011-2014) 3.6%
Atain – insights from the national programme
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Care days for term admissions ( 31%) (>60%)
Atain – insights from the national programme
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Atlas of Variation: 2015 Term Admissions by Neonatal Networks.
( Light blue lowest – dark blue highest. 2013/14 data )
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136 036 babies care analysed: 2013 – 2015:
• ~8.8% of all live births resulted in a L1,2 or 3 NNU
admission
• Additional 10,000 care days delivered for term babies in
2015 compared to 2011
• Increase predominantly in Special Care category
• ~20% - 30% of admissions were avoidable - intervention
received did not warrant admission – ~13 000/ annum
What we know
Atain – insights from the national programme
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• Unnecessary intervention
• Risk factors not identified
• Evidence based guidance not followed
• Babies born at 37-38 weeks twice as likely to be admitted to neonatal services as those born at 39-42 weeks gestation
• Role for Transitional Care facilities
What we know
Atain – insights from the national programme
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National Drivers
Atain – insights from the national programme
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National Drivers
Atain – insights from the national programme
2017 SofS Safety strategy
CNST
Incentivisation scheme
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The IV scheme
Atain – insights from the national programme
The case for change • Benefits • Deliverables • Next steps
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The IV scheme – benefits: families
Atain – insights from the national programme
Significant health benefits through:
• Improved identification of at risk infants
• Reduction in avoidable morbidity
• Where breast feeding is by choice – optimising
realisation and short/long term benefits of
• Avoiding contributory factors leading to maternal
perinatal mental health morbidity
• Improved experience for families
• Reduction in costs to families
• Provision of models of care which keep M&B together -
choice
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• Develop maternity/neonatal team working relationships
• Unnecessary activity reduced
• Improved use of workforce – roles, skills, place
• Improved capacity in NNU - capacity transfers
• Enhancing workforce skills
• Prevention plays a major role in safety
• Provision of high quality care
• Investment in long term outcomes – positive societal impact
• Right baby, Right Cot, Right Time
The IV scheme – benefits: clinicians
Atain – insights from the national programme
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Reduced Specialised Commissioning costs
lower NNU admission rates
reduced LOS with TC and pathway improvements
• Improved quality of care within commissioned
services
• Reduced variation in practice
• Ability to benchmark across regional network
geographies
• Improved Value for Money
• Improved use of NNU workforce
• Right baby, Right Cot, Right Time
The IV scheme – benefits - commissioners
Atain – insights from the national programme
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The IV scheme – benefits: system
Atain – insights from the national programme
Reduction in health associated costs as:
• breastfeeding leading to improved long term outcomes
• Reduced NNU cost – (TC tarrif)
• Whole pathway review = identifying modifiable clinical
factors for avoiding admission
= offers potential for improvements pre conception, AN, IP
= LOS reduced; admission avoided
• Develop models of care which promote bonding
• Develop national pool of skills and workforce roles to
deliver care for the
• Right baby, Right Cot, Right Time
Key deliverables and next steps
ODN and MC Networks:
• Support to implement NHSE IV scheme
• Address as a joint MCN/ODN/PSC network priority
• Identify named Atain leads in every unit – mat&neo
• Baseline using BadgerNet data to understand local
admission rates and issues
• Verification role for local findings
• Draw on national guidance and regional work to address
relevant issues
• Consider model of transitional care and ensure staffing and
skills appropriate
• Work with units to address, share and benchmark Atain – insights from the national programme
Key deliverables and next steps
Commissioners:
Implement NHS England Improving Value scheme:
Work with clinical colleagues to address requirements
identified from audits
Focus on quality
NICU staffing and capacity addressed in part if babies in
right place at right time
Improved outcomes
TC – virtual or integrated – staffing numbers and skills
Co-commissioning
Atain – insights from the national programme
23 I Atain – insights from the national programme
Key deliverables and next steps
Frontline maternity and neonatal teams:
Perinatal collaboration crucial
Identify Atain leads – mat and neo
Undertake in partnership with your CN and ODN
Review/audit of admissions
BadgerNet and MSDS +review to understand
contributory factors for admissions
Draw on atain findings to inform audit questions/review
Rigour, transparency
Involve your maternity safety champions
Key deliverables and next steps
Frontline maternity and neonatal teams:
Implement FfP
Undertake Atain eLfh programme
Consider use of Bobble Hat bundle or similar
Admissions for IVAB
NEWTT for monitoring on postnatal ward and TC
TC – virtual or integrated – staffing numbers and skills
Use the MNHSC to turn plans for measurable
improvements to local services.
Atain – insights from the national programme
Atain as part of a national programme
April 17
Formal deliverable within WS2 of the MTP
PS Alert Mandated
action August 17
NHS England
Improving Value
Scheme
HEE, RCM and RCOG to support
overcoming barriers to
implementation
NMPA Resources for implementing
TC E-Learning programme
2016 – Safer
Maternity Care
Action Plan
Unthinkable not to have service and
staffing models which
keep M&B together
↓ trajectory
of ATAIN
2017 SofS Maternity safety strategy
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