1000 Lives Plus: National Learning Event David Fillingham 10th June 2011 © 2011 AQuA

Who are we? A membership organisation aiming to stimulate innovation, spread best practice and support local improvement Engaging Boards and front line staff The Quality Observatory for the North West Working across all sectors Working with commissioners and providers Leverage through external partnerships – NHS Institute, King’s Fund, Nuffield Trust, Health Foundation, IHI “AWR”

AQuA’s mission is to help our members to transform the care they deliver and the health of local people © 2011 AQuA

We support our members to make improvements in all of these areas AQuA’s Aims We support our members to make improvements in all of these areas © 2011 AQuA

AQuA’s Model of Spread Evidence and Intelligence Change Champions and Communities of Practice Robust Improvement Methods Incentives Peer to Peer Learning

Results

Original AQ measure sets Community-acquired pneumonia (CAP) Percentage of patients who received an oxygenation assessment within 24 hours prior to or after hospital arrival Initial antibiotic selection Initial antibiotic consistent with current recommendations - ICU Initial antibiotic consistent with current recommendations - Non ICU Blood culture collected prior to first antibiotic administration Antibiotic timing, percentage of pneumonia patients who received first dose of antibiotics within six hours after hospital arrival Smoking cessation advice/counseling Hip and knee replacement Prophylactic antibiotic received within one hour prior to surgical incision Prophylactic antibiotic selection for surgical patients Prophylactic antibiotics discontinued within 24 hours after surgery end time Recommended Venous Thromboembolism prophylaxis ordered Appropriate Venous Thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery Acute myocardial infarction (AMI) Aspirin at arrival Aspirin prescribed at discharge ACE or ARB for LVSD Smoking cessation advice/counseling Beta blocker at arrival Beta blocker prescribed at discharge Thrombolytic received within 30 minutes of hospital arrival PCI received within 90 minutes of hospital arrival Inpatient mortality rate Coronary artery bypass graft (CABG) Prophylactic antibiotic received within one hour prior to surgical incision Prophylactic antibiotic selection for surgical patients Prophylactic antibiotics discontinued within 48 hours after surgery end time Heart failure (HF) Left Ventricular Systolic (LVS) assessment Detailed discharge instructions ACEI or ARB for LVSD This slide shows the original 5 clinical areas that AQ focuses on. Within each clinical area, key measures of quality care / treatment have been identified.

New AQ measure sets - Assessment of functional capacity Stroke – live from October 2010 Admission to a stroke unit within 4 hours of hospital arrival Brain scan within 24 hours of hospital admission Swallow disorders screening with 24 hours of hospital admission Aspirin or antiplatelet within 24 hours of hospital admission Physiotherapy assessment within 72 hours of hospital admission Occupational Therapy assessment within 72 hours of hospital admission Patients weight recorded during hospital stay Dementia – live from January 2011 - Assessment of functional capacity - Assessment of cognitive ability - Assessment of physical health - Tailored care plan - Assessment of depression & anxiety Early Intervention Psychosis – live from January 2011 - Assessment of risk of harm - Care co-ordinator assigned - Anti-psychotic medication review During 2010, measure sets were also developed for acute stroke, and for dementia and early intervention psychosis within the specialist mental health setting.

Composite Process Score Performance Improvement Preliminary Data October 2008 – September 2010 Composite Process Scores Quarters

Stroke 90:10 drove up standards in stroke care 90% Phase 2 teams joined Phase 1 teams joined Stroke 90:10 drove up standards in stroke care

The Collaborative Rate of Improvement – Dr Foster This table tracks the 12 month rolling SMR according to Dr Foster. The rate of improvement in SMR is greater in the collaborative than the SHA.

Driver Diagram The driver diagram has been our road map. Developed as our hypothesis to what areas clinically and managerially should be worked on the make improvement. Agreed and signed off by the collaborative Steering group “A driver diagram is used to conceptualise an issue and to determine its system components which will then create a pathway to achieve the goal. Primary Drivers are system components which will contribute to moving the primary outcome. Secondary drivers are elements of the associated primary driver. They contain change concepts that can be used to create projects that will affect the primary driver.” © 2010 AQuA

AQuA Priorities 2011/12 Moved to before description of the 4 work stream areas © 2011 AQuA

© 2011 AQuA