1. 1000 Lives Plus: National Learning Event
David Fillingham
10th June 2011
© 2011 AQuA

4. 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”

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

6. 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

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

8. Results

9. 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.

10. 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.

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

12. 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

13. 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.

14. 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

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

16. © 2011 AQuA