SNAP Scottish National Audit Project CE Bucknall Chair, Bicollegiate Physicians Quality of Care Committee, on behalf of project team

SNAP Health Foundation funded (EwQ initiative) Community acquired pneumonia Epilepsy Long term aim – a model for quality improvement for medical topics

Epi-SNAP Improving the quality of annual review for epilepsy patients in primary care Quality of Outcomes Framework awards points for annual reviews which:  Record seizure frequency  Undertake medication review Epi-SNAP:  Protocol which targets poorly controlled  Guidance for exemption coding  Patient information leaflets with Epilepsy Scotland Collaborated to adapt SPICE* software epilepsy screens,used by approx 1/3 rd of Scottish GP practices *Scottish Programme for Improving Clinical Effectiveness

Epi-SNAP First Seizure Clinics  Problems: poor quality of referrals poor documentation of driving advice (medicolegal obligation)  Electronic First Seizure Service referral template – forces referrer to document driving advice  Fast track appointments for professional drivers  Re-audit started 1 st October

SNAP-CAP: Care bundle key aspects of care, linked to evidence delivered by a single team over a short period of time Influenced by parallel policy of SPSA & possibility of benefiting from developing experience of hospitals using these

SNAP-CAP Care bundle of key items 1.severity scoring using CURB65 2.Management guided by severity 3.first antibiotic dose within 4 hrs 4.Oxygen saturations ≥ 92% during first 4 hours Monthly monitoring & feedback Small changes in practice in response to data, using PDSA technique

Examples of Practice Changes  Having appropriate antibiotics (& formulations) in A&E  Writing up first dose as “once only”  Fast tracking patients for X-ray  System for enabling home Rx of mild CAP cases  Telephone follow-up of discharged patients  Electronic referrals  Structured/targetted annual review  Hyperlinks to Patient information leaflets SNAP-CAP:practicalEpi-SNAP:structural

Challenges  Persuading clinicians that monitoring the process of care is important  Rapid turnover of junior & middle grade staff (4 monthly)  Collecting bundle data in real time  (Unavoidable) delays involved in consulting with national bodies (eg electronic referrals, changes to GP data monitoring screens)  Engaging managers in non priority topics  In hospital: building useful prompts into systems which are still largely paper based

SNAP: secondary objectives Sharing experience in a network with other HF projects Developing professional leaders Ensuring sustainability – start-up packs, organisational prompts, long term “home” within quality organisation in NHS in Scotland, Identifying problem areas early using a mapping process

Royal College of Physicians and Surgeons of Glasgow Getting started with small number of committed sites & evolving Simple data entry systems / prompt feedback Collaborating with other agencies & health policy initiatives (Scottish Patient Safety Alliance) Feedback has some impact, but we need to incorporate quality reminders into system of care – not easy in Acute Medicine (paper based system;huge variety of caseload) Different approaches needed for different topics but adapting existing policies & practices to add value in terms of quality is the essence of the model which emerges. Lessons Learnt