1. SICSAG Report 2013 Clinical Governance meeting

2. General information This report is based on critical care activity in the year 2012. Data collected on 13,103 patients admitted to Scottish ICUs in 2012. (10,555 in 2011) Admissions to HDUs in Scotland for 2012 was 26,887 as compared to 25,821 in the previous year. This may partly reflect an increase of number of HDUs participating in the audit

3. New features for report in 2013 Data on 10 Quality indicators published The APACHE 2 scores on which the standard mortality rates are based, has been recalibrated. This has led to an increase in SMR, but is more accurate to predict outcomes Monthly trends are sent to each unit to based on last 300 admissions.

4. VHK identity

5. Quality Indicators for ICU structureprocessoutcomes Participation in national auditOOHs dischargeEarly discharge Daily management plan documented by consultant VAP, CVC and PVC bundles Questionnaire/ Survey of patients and relatives HAI surveillanceEnd of life careRegular M&M SMR

6. Number of ICU admissions/year

7. Levels of care

8. Levels of illness

9. SMR

10. OOH discharge from ICU

11. OOHs Discharge ranking

12. Delayed discharges

13. Number of admissions to HDUs

14. Levels of care

15. Quality Indicators for HDUs structureprocessoutcomes Participation in national auditOOHs dischargeEarly discharge Daily management plan documented by consultant VAP, CVC and PVC bundles Questionnaire/ Survey of patients and relatives HAI surveillanceEnd of life careRegular M&M SMR

16. Problem area 1 Consultant led management plans recorded in notes everyday. Achieved in SHDU during weekdays, but weekends could potentially be a problem MHDU and Renal HDU patients seem to have consultant led plans during the week, again not clear about weekends. There will be a robust audit by SICSAG on this aspect soon.

17. Problem area 2 Hospital Acquired Infection Surveillance All HAIs are investigated by a Microbiology driven rapid event analysis in our hospital. Our inability to participate in the surveillance is essentially because we need to be scrupulous about data input. We might be able to extend surveillance to SHDU in the near future

18. Problem area 3 and 4 End of life care documentation Patients/Relatives Survey These issues have been addressed in ICU fairly recently and we should be able to extend this to the HDUs.

19. Problem area 5 Regular Mortality and Morbidity meetings Both surgical and acute care M&M take place regularly. We have to ensure that all the HDU mortality and morbidity are included and documented either as part of these meetings or a separate forum. I will explore possibilities

20. Problem area 6 Out Of Hours discharges This was flagged up as an issue last year and has featured again this year SICSAG acknowledge that this might reflect capacity issues Locally there is consensus that addressing issues of flow of patients through the hospital might help to minimise OOHs discharge

21. MHDU/SHDU

22. OOHs Discharge Ranking

23. Local data for 2013 from April to October

24. Initiatives to keep OOHs discharges low At capacity meetings (3 x daily) Critical Care requirements are now treated as a priority Critical care coordinator attends bed capacity meetings at weekend which helps flow. Telephone handover of patients being discharged from SHDU have minimised delays in discharge Decision by ICU consultants on fitness for discharge before the 1 st capacity meeting at 8 :30 AM might help with flow

25. Possible solutions Minimise the admissions of level 0 and level 1 patients to MHDU which will then allow bed capacity to improve in this area. Improved capacity will allow for OOHs admission without necessitating OOHs discharge. Early identification of patients fit for discharge Actively creating bed spaces for potential OOHs admissions