1. Reducing Mortality in AKI/ SEPSIS Patients Aintree University Hospital DEBBIE COWELL/SUE GALLAGHER 2015

2. Reduction Of Mortality Rates Within Aintree There are two national measures of mortality which help us to compare how we are performing compared to other organisations: – Hospital Standardised Mortality Ratio (HSMR) – Standardised Hospital Mortality Index (SHMI) Aintree, along with other hospitals, previously focused on HSMR. This was a key focus of our Quality Strategy, and we consistently had a better than average rating. However, when SHMI was introduced, a different picture emerged. Under SHMI, we had a very high ratio, one of the highest in the country. Professor Sir Bruce Keogh, the NHS Medical Director, has stressed that mortality indicators are not absolute indicators of quality of care but should be seen as ‘smoke signals’ to ensure focus on improvement. DEBBIE COWELL/SUE GALLAGHER 2015

3. The Avoidable Mortality Reduction Group Aintree’s response to this challenge is the creation of the Avoidable Mortality Reduction Group. The group consists of multi-disciplinary clinicians who are leading work to reduce avoidable mortality at Aintree. The Outreach support project is one such group that has been introduced to ensure the early recognition and management of patients at risk of AKI/SEPSIS/Pneumonia through a system of coordinated alerts, the purpose being early identification of those patients at risk and prompt implementation of appropriate care bundles known to reduce patient overall mortality. DEBBIE COWELL/SUE GALLAGHER 2015

4. TEAM MEMEBERS Shirley Brady Clinical Manager Critical Care /Project Lead Outreach Support Team Ext 2371 Sue Gallagher Specialist Nurse Critical Care Outreach/Met/AKI/Sepsis OSN Lead bleep 5540 Debbie Cowell Specialist Nurse Critical Care Outreach/Met/AKI/Sepsis OSN Lead bleep 5540 DR Thangavelu Chandrasekar Consultant Nephrologist AKI Lead DR Nihat BhuiyanConsultant Critical Care Sepsis Lead DR Neil MercerConsultant Anaesthetist AVMRG Lead DEBBIE COWELL/SUE GALLAGHER 2015

5. Aim of project Reduce mortality rates within the trust in this cohort of patients Deliver High Quality Safe Patient Care of patients with AKI/ SEPSIS Raise awareness of AKI/ SEPSIS throughout the Trust Ensure standardised care of AKI and Sepsis throughout the trust through the introduction of care bundles, Reduction in 30 day mortality in patients presenting with sepsis within 12-18 months( initial overall mortality stood at 28% at start of project) Reduction within the trust in AKI level 1-3 Patients Initial aim was to reduce by 30%. DEBBIE COWELL/SUE GALLAGHER 2015

6. Aim Primary Drivers Aim Reduce mortality rates in patients who have AKI / Sepsis Identification of AKI stages 1-3 Identification of Sepsis, severe sepsis, septic shock Effective intervention and monitoring Robust IT systems Medical and nursing engagement S econdary Drivers 1.Effectively identify patients at risk of AKI/Sepsis 2.Development of patient criteria i.e. WBC >20000 for Sepsis 3.AKI Bundle ( creatinine rise as per guidelines) 4.Increase staff understanding of AKI/Sepsis through education and training i.e. HDU,ALERT,RN induction, F1 induction 5. Urgent communication of appropriate patients to own team and Critical Care Implementation of AKI and Sepsis six care bundles throughout the trust. Development of patient documentation and patient information leaflet Development of IT data base to feed appropriate patient information and blood results to outreach support team via SIGMA 3 times a day Funding ….the project to maintain sustainability Team expansion to incorporate increased work load of outreach team Audit. Work with business intelligence collating and analysing the patient data and provide monthly reports on trust mortality Approval from trust board clinical effectiveness board DRIVER DIAGRAM DEBBIE COWELL/SUE GALLAGHER 2015

7. Measures and data DEBBIE COWELL/SUE GALLAGHER 2015

9. Trust Overall Mortality MonthAKISepsisPneumoniaTrust Trust Average LOS MonthAKISepsisPneumoniaTrust DEBBIE COWELL/SUE GALLAGHER 2015

10. Key achievements Development of a bespoke web based system Quality dashboard to demonstrate outcome measures Implementation of Care bundles throughout the trust AKI/Sepsis education training incorporated into:_ F1 Training HDU Study Day Alert Course RN Induction Role development team expansion On going up to date training in all clinical areas Proven reduction in mortality rates throughout the trust in patients with AKI/Sepsis DEBBIE COWELL/SUE GALLAGHER 2015

11. Lessons learnt Learning through trial and error ( paper work, data base, consultant input, educational issues, asking for advice ) Need for continual reassessing and need for change Hospital politics, funding issues Changes in team dynamics Overcoming resistance to change Outreach Team journey DEBBIE COWELL/SUE GALLAGHER 2015

12. WHAT SHOULD AQUA DO DIFFERENTLY DEBBIE COWELL/SUE GALLAGHER 2015

13. ANY QUESTIONS DEBBIE COWELL/SUE GALLAGHER 2015