Patient Safety in Surgical Care Reducing Patient Harm due to APRIL 2017 Patient Safety in Surgical Care Reducing Patient Harm due to Acute Kidney Injury in Surgical Patients South Tees NHS Foundation Trust And CRAB Clinical Informatics

Context

Patient Safety Thermometer Relevant to Surgical Care CONTEXT AKI alert Deteriorating Patient AKI is… Vulnerable Patient AKI Risk Patient Safety Thermometer Relevant to Surgical Care

CONTEXT AKI Associated with poor patient outcomes

AKI 30% Recognised Late up to of AKI is avoidable Only receive GOOD CONTEXT AKI up to 30% of AKI is avoidable Only receive GOOD care in hospital Recognised Late

Surgery High AKI Risk Low AKI focus CONTEXT Surgery High AKI Risk Low AKI focus

No established best practice CONTEXT No established best practice £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ £

Ambition

AMBITION Reduce AKI by at least 20%

20% 1 3 2 Reduce AKI by at least Awareness Measure Intervention AMBITION Awareness 1 Promote & Sustain “AKI Culture” Trust-wide Multidisciplinary Approach Measure 3 Intervention 2 Reduce AKI by at least 20% AKI incidence Interventions impact Reduce AKI risks Expedite AKI detection Unify AKI care

Expedite AKI Detection AMBITION Expedite AKI Detection Implementation of automated AKI alerting system across Trust Guidelines e-linked to AKI alerts

Unify AKI care AKI detection and care variable: AMBITION Unify AKI care AKI detection and care variable: Establish Consensus & Promote Consistency

Involvement

Patient Safety Barometer Raise Awareness and Train Staff Promote “AKI Aware” Culture across High Risk Clinical Areas:- INVOLVEMENT Dedicated AKI Workshops 1 Patient Involvement 3 Education Centre Support 2 Renal Nurse Practitioner 4 Acute Kidney Injury Patient Safety Barometer

Spread

Internally across Trust SPREAD ‘Primary and secondary care’ – [Clare’s role in liaising with community] ‘Internally across Trust’ – [AKI improvement awareness campaign - all surgical and medical departments ] ‘Regionally’ – [regional guidelines and 7 NE trusts] ‘Nationally’ – [ shared pathway and/or consulted 10 other NHS trusts] ‘Halo effect’ – [law of unintended consequences – 1) become part of informal ward based teaching of junior doctors and nurses – Ross’s testimonial and 2)positive impact tracked with other triggers of avoidable harm including sepsis, nosocomial pneumonia, shock and cardiac arrest in both medical and surgical patients across the Trust – better recognition and management of the ‘deteriorating patient’ can use graph in slide 12] Internally across Trust

Local primary and secondary care SPREAD ‘Primary and secondary care’ – [Clare’s role in liaising with community] ‘Internally across Trust’ – [AKI improvement awareness campaign - all surgical and medical departments ] ‘Regionally’ – [regional guidelines and 7 NE trusts] ‘Nationally’ – [ shared pathway and/or consulted 10 other NHS trusts] ‘Halo effect’ – [law of unintended consequences – 1) become part of informal ward based teaching of junior doctors and nurses – Ross’s testimonial and 2)positive impact tracked with other triggers of avoidable harm including sepsis, nosocomial pneumonia, shock and cardiac arrest in both medical and surgical patients across the Trust – better recognition and management of the ‘deteriorating patient’ can use graph in slide 12] Local primary and secondary care

SPREAD ‘Primary and secondary care’ – [Clare’s role in liaising with community] ‘Internally across Trust’ – [AKI improvement awareness campaign - all surgical and medical departments ] ‘Regionally’ – [regional guidelines and 7 NE trusts] ‘Nationally’ – [ shared pathway and/or consulted 10 other NHS trusts] ‘Halo effect’ – [law of unintended consequences – 1) become part of informal ward based teaching of junior doctors and nurses – Ross’s testimonial and 2)positive impact tracked with other triggers of avoidable harm including sepsis, nosocomial pneumonia, shock and cardiac arrest in both medical and surgical patients across the Trust – better recognition and management of the ‘deteriorating patient’ can use graph in slide 12] Regionally

SPREAD ‘Primary and secondary care’ – [Clare’s role in liaising with community] ‘Internally across Trust’ – [AKI improvement awareness campaign - all surgical and medical departments ] ‘Regionally’ – [regional guidelines and 7 NE trusts] ‘Nationally’ – [ shared pathway and/or consulted 10 other NHS trusts] ‘Halo effect’ – [law of unintended consequences – 1) become part of informal ward based teaching of junior doctors and nurses – Ross’s testimonial and 2)positive impact tracked with other triggers of avoidable harm including sepsis, nosocomial pneumonia, shock and cardiac arrest in both medical and surgical patients across the Trust – better recognition and management of the ‘deteriorating patient’ can use graph in slide 12] Nationally

Outcome Measurement

Impact sustained ► Culture Change / Legacy Effect OUTCOME Independent Clinical Informatics Company (CRAB) ►measured South Tees AKI incidence in near real time National Range (1.5 to 2.0%) Workshops Oct 2015 – July 2016 Impact sustained ► Culture Change / Legacy Effect

OUTCOME ‘Primary and secondary care’ – [Clare’s role in liaising with community] ‘Internally across Trust’ – [AKI improvement awareness campaign - all surgical and medical departments ] ‘Regionally’ – [regional guidelines and 7 NE trusts] ‘Nationally’ – [ shared pathway and/or consulted 10 other NHS trusts] ‘Halo effect’ – [law of unintended consequences – 1) become part of informal ward based teaching of junior doctors and nurses – Ross’s testimonial and 2)positive impact tracked with other triggers of avoidable harm including sepsis, nosocomial pneumonia, shock and cardiac arrest in both medical and surgical patients across the Trust – better recognition and management of the ‘deteriorating patient’ can use graph in slide 12] Halo Effect

Value

£4.5K £1.65M pa ROI Business Case VALUE Cost saving per AKI episode avoided £4.5K 118 episodes avoided pa Current cost of AKI to trust £1.65M pa (based on 1.7% incidence) Cost saving per year to trust since intervention £533K Cost AKI improvement: ANP £45K (inc on-costs) Education campaign £25K Total £70K ROI £533K/£70K = 762% Business Case expand ANP role to provide 7 day/360 day service and further community outreach and prevention education Used multiple methods that come to similar figures 533K based on rolling 6 month average (latest even lower so this is conservative)

Summary

1 2 3 Why we should win…. National Patient Safety Issue Less Harm SUMMARY National Patient Safety Issue 1 Less Harm Less Costs 2 Easily Spread 3