Information to support Enhanced
Recovery spread and sustainability
Spreading Enhanced Recovery across the South West SHA
T...
Orthopaedic Department
The Royal Bournemouth Hospital

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Our results - Enhanced Recovery

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Reducing length of stay

Introduction of pathway in 2007 = 50% reduction in LOS

www.enhancedrecoveryblog.com
www.enhanced...
Monitoring enhanced recovery
What to measure?

How to collect?

• Clinical outcomes
• Patient reported
outcomes
• Process ...
Centralising data collection

Data source – Derwent database
www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Ongoing monitoring

Daily, Weekly, Monthly, Annually

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Length of stay - Control chart

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Outcomes and complications logged and
used for clinical governance
 No cases of deep infection
 Complications rates redu...
Using Dr Foster to monitor LOS with CUSUM charts

Data source - Dr Foster
www.enhancedrecoveryblog.com
www.enhancedrecover...
How we check re-admissions with Dr Foster

Data source - Dr Foster
www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.c...
Ideas on how to use the Dr Foster tools
•
•
•
•
•

Getting started - How?
Benchmark against other trusts – How?
Look deepe...
TRUST
Dorset County Hospital NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
Great Western Hospitals N...
Get a password!
Get training and teach yourself
Benchmark example 1
Benchmark example 2
Benchmark example 3
Benchmark example 4
Benchmark example 5
Benchmark example 6
Look at your hospital in detail
Trust X SW SHA – Example LOS data 1

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Trust X SW SHA – Example LOS data 2

www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
RBH Discharge Data

Age (10-year)

Inpatients

% of all

Day Cases

LoS

Expected LoS

Difference

PBDS

ALL

2160

100%

...
Data source - Dr Foster
www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
Trust Y SW SHA – Example LOS data 1
RBH Data – LOS v Eng and Day of Operation
RBH Data – LOS v Eng and Day of Operation
RBH data – Smoothing variation in bed
profile

Data source – Derwent database
www.enhancedrecoveryblog.com
www.enhancedrec...
Trust X – Readmission example 1
Trust X – Readmission example 2
Trust X – Readmission example 3
Trust X – Readmission example 4
Trust X – Readmission example 5
Trust X – Readmission example 5
RBH data – Checking re-admission
destination
Start using data and it’s quality
will improve

Break the cycle
Break the cycle
and start using
and start using
the inform...
www.enhancedrecoveryblog.com
www.enhancedrecoveryblog.com
TRUST
Dorset County Hospital NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
Great Western Hospitals N...
Regional Business Manager (South West/South)
Mobile: 07738 028186
Email: malcolm.fitzsimmons@drfoster.co.uk
Thank you
Information to support Enhanced Recovery
spread and sustainability - 2
South West SHA Enhanced Recovery Meeting
Taunton Ra...
Who Are Dr Foster?
Dr Foster Limited is 100% owned by Dr Foster Intelligence Limited, which
is in turn a 50:50 joint ventu...
Data Flow
Inpatient/Outpatient
data submitted by
Acute Trusts

SUS

Imperial
College

Dr Foster
Intelligence

Tools

HES

...
Translation

Data

Information
Interpretation

Monitor

Knowledge
Consultation

Improvement

Action
Benefits Of Dr Foster Tools
•
•
•
•
•
•
•
•
•

47

The tools are web enabled, meaning access anywhere with internet
It is ...
Current Casemix Adjustment
Model For Each Procedure Or
Diagnosis Groups
Knowing Where You Are?
Establishing robust baseline
“Benchmarking Performance”
Managing Performance
“Performance Monitorin...
CUSUM

Outcome

Threshold 99%

Time
How to build a CUSUM...
How to build a LOS report..
Pyramid Model Of Investigation
To Find Credible Cause For……..

Lilford et al. Lancet 2004; 363: 1147-54
Monitoring Enhanced Recovery South West SHA Dr Foster Presentation 26th Jan 2011.
Monitoring Enhanced Recovery South West SHA Dr Foster Presentation 26th Jan 2011.
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Monitoring Enhanced Recovery South West SHA Dr Foster Presentation 26th Jan 2011.

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Information to support enhanced recovery spread and sustainability

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  • plymouth
  • Plymouth
    Basket: Procedures - ALL | Outcome: Length of Stay vs. England | Activity Mode: All | Tariff Year: Data year | Market Forces Factor: Appropriate to Tariff Year
    Chapter: All | Procedure: Hip replacement | Subgroup: All | Department: All | Team: All
    First / Last: Nov-09 / Oct-10 | Admission Type: Elective | Sex: All | Deprivation: All | Age Range: All
    Spells: 448 | Day Cases: 0 (-%) | Inpatients: 448 | LoS: 8.4 (6.8) | LoS (superspell): 9.1 (7.3)
  • RBH
    Basket: Procedures - ALL | Outcome: Length of Stay | LOS (Pre-op): 0 Days | Activity Mode: All | Tariff Year: Data year | Market Forces Factor: Appropriate to Tariff Year
    Chapter: All | Procedure: Hip replacement | Subgroup: All | Department: All | Team: All
    First / Last: Aug-07 / Aug-08 | Admission Type: Elective | Sex: All | Deprivation: All | Age Range: All
    Spells: 588 | Day Cases: 0 (-%) | Inpatients: 588 | LoS: 4.3 (7) | LoS (superspell): 4.3 (7.4)
  • RBH
    Basket: Procedures - ALL | Outcome: Length of Stay vs. England | LOS (Pre-op): 0 Days | Activity Mode: All | Tariff Year: Data year | Market Forces Factor: Appropriate to Tariff Year
    Chapter: All | Procedure: Hip replacement | Subgroup: All | Department: All | Team: All
    First / Last: Aug-07 / Aug-08 | Admission Type: Elective | Sex: All | Deprivation: All | Age Range: All
    Spells: 588 | Day Cases: 0 (-%) | Inpatients: 588 | LoS: 4.3 (7) | LoS (superspell): 4.3 (7.4)
  • Royal Cornwall
    Basket: Procedures - All Benchmarks: Data Year Outcome: Readmissions (28 days)
    Chapter: All Procedure Group: Hip replacement Department: All Team: All
    Admission Type: Elective Sex: All Deprivation: All Age Range: All
    Spells: 725 Superspells: 725 (724 / 1) First / Last: Jul-09 / Jul-10 Readmissions: 34 (4.7%) Expected: 46.0 (6.3%) Relative Risk: 73.9 (51.2 - 103.3) C-Statistic: 0.63 (Low) LoS: 8.3 / 7.6 Alerts: 0 FAR / SDR: 0.8% / 96.7%
  • RBH
    Chart | Table | Change Criteria
    Basket: Procedures - ALL | Outcome: 28 day readmissions (Dr Foster) | LOS (Pre-op): 0 Days | Activity Mode: All | Tariff Year: Data year | Market Forces Factor: Appropriate to Tariff Year
    Chapter: All | Procedure: Hip replacement | Subgroup: All | Department: All | Team: All
    First / Last: Apr-10 / Oct-10 | Admission Type: Elective | Sex: All | Deprivation: All | Age Range: All
    Spells: 636 | Day Cases: 0 (-%) | Inpatients: 636 | LoS: 5.1 (7) | LoS (superspell): 5.2 (7.5)
  • Do you know how good you are?
    Do you know what you are good at?
    What are your measures of quality?
    Do you know where you could make efficiencies
    How do each of your services compare to other similar providers?
    Do you know how the quality and efficiency of each of your services varies from month to month
  • Monitoring Enhanced Recovery South West SHA Dr Foster Presentation 26th Jan 2011.

    1. 1. Information to support Enhanced Recovery spread and sustainability Spreading Enhanced Recovery across the South West SHA Taunton Racecourse, Taunton, TA3 7BL 26th January 2011 Tom Wainwright
    2. 2. Orthopaedic Department The Royal Bournemouth Hospital www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    3. 3. Our results - Enhanced Recovery www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    4. 4. Reducing length of stay Introduction of pathway in 2007 = 50% reduction in LOS www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    5. 5. Monitoring enhanced recovery What to measure? How to collect? • Clinical outcomes • Patient reported outcomes • Process measures • Patient experience • Staff experience • • • • • • Hospital IT system Database Excel sheets Paper solutions Dr Foster National data sets
    6. 6. Centralising data collection Data source – Derwent database www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    7. 7. Ongoing monitoring Daily, Weekly, Monthly, Annually www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    8. 8. Length of stay - Control chart www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    9. 9. Outcomes and complications logged and used for clinical governance  No cases of deep infection  Complications rates reduced  Decreased % of patients readmitted  Patient satisfaction is extremely high  Length of stay dramatically decreased Wainwright T, Middleton R, An orthopaedic enhanced recovery pathway, Current Anaesthesia & Critical Care. Volume 21, Issue 3, June 2010, Pages 114-120 www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    10. 10. Using Dr Foster to monitor LOS with CUSUM charts Data source - Dr Foster www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    11. 11. How we check re-admissions with Dr Foster Data source - Dr Foster www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    12. 12. Ideas on how to use the Dr Foster tools • • • • • Getting started - How? Benchmark against other trusts – How? Look deeper at your own hospital – How? Assess changes to your practice - How? Ongoing monitoring - How?
    13. 13. TRUST Dorset County Hospital NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust Great Western Hospitals NHS Foundation Trust North Bristol NHS Trust Northern Devon Healthcare NHS Trust Plymouth Hospitals NHS Trust Poole Hospital NHS Foundation Trust Royal Cornwall Hospitals NHS Trust Royal Devon and Exeter NHS Foundation Trust Royal United Hospital Bath NHS Trust Salisbury NHS Foundation Trust South Devon Healthcare NHS Foundation Trust Taunton and Somerset NHS Foundation Trust DR Foster Access YES NO YES YES YES YES YES YES YES YES NO YES YES The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust Yeovil District Hospital NHS Foundation Trust YES NO NO YES Tools PPM available RTM PPM PPM PPM PPM PPM PPM PPM PPM RTM RTM RTM RTM RTM RTM RTM RTM PPM PPM RTM RTM PPM CHKS CHKS RTM RTM
    14. 14. Get a password!
    15. 15. Get training and teach yourself
    16. 16. Benchmark example 1
    17. 17. Benchmark example 2
    18. 18. Benchmark example 3
    19. 19. Benchmark example 4
    20. 20. Benchmark example 5
    21. 21. Benchmark example 6
    22. 22. Look at your hospital in detail
    23. 23. Trust X SW SHA – Example LOS data 1 www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    24. 24. Trust X SW SHA – Example LOS data 2 www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    25. 25. RBH Discharge Data Age (10-year) Inpatients % of all Day Cases LoS Expected LoS Difference PBDS ALL 2160 100% 0 4.3 6.5 -2.3 737 25-34 4 0.2% 0 3.3 5.1 -1.9 0 35-44 8 0.4% 0 3 4.8 -1.8 0 45-54 82 3.8% 0 3.8 5.2 -1.4 30 55-64 396 18.3% 0 3.6 5.2 -1.6 49 65-74 845 39.1% 0 3.9 5.9 -2 205 75-84 713 33% 0 4.8 7.5 -2.7 368 85+ 112 5.2% 0 5.9 10.6 -4.7 86 Data source - Dr Foster www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    26. 26. Data source - Dr Foster www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    27. 27. Trust Y SW SHA – Example LOS data 1
    28. 28. RBH Data – LOS v Eng and Day of Operation
    29. 29. RBH Data – LOS v Eng and Day of Operation
    30. 30. RBH data – Smoothing variation in bed profile Data source – Derwent database www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    31. 31. Trust X – Readmission example 1
    32. 32. Trust X – Readmission example 2
    33. 33. Trust X – Readmission example 3
    34. 34. Trust X – Readmission example 4
    35. 35. Trust X – Readmission example 5
    36. 36. Trust X – Readmission example 5
    37. 37. RBH data – Checking re-admission destination
    38. 38. Start using data and it’s quality will improve Break the cycle Break the cycle and start using and start using the information the information www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    39. 39. www.enhancedrecoveryblog.com www.enhancedrecoveryblog.com
    40. 40. TRUST Dorset County Hospital NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust Great Western Hospitals NHS Foundation Trust North Bristol NHS Trust Northern Devon Healthcare NHS Trust Plymouth Hospitals NHS Trust Poole Hospital NHS Foundation Trust Royal Cornwall Hospitals NHS Trust Royal Devon and Exeter NHS Foundation Trust Royal United Hospital Bath NHS Trust Salisbury NHS Foundation Trust South Devon Healthcare NHS Foundation Trust Taunton and Somerset NHS Foundation Trust DR Foster Access YES NO YES YES YES YES YES YES YES YES NO YES YES The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust Yeovil District Hospital NHS Foundation Trust YES NO NO YES Tools PPM available RTM PPM PPM PPM PPM PPM PPM PPM PPM RTM RTM RTM RTM RTM RTM RTM RTM PPM PPM RTM RTM PPM CHKS CHKS RTM RTM
    41. 41. Regional Business Manager (South West/South) Mobile: 07738 028186 Email: malcolm.fitzsimmons@drfoster.co.uk
    42. 42. Thank you
    43. 43. Information to support Enhanced Recovery spread and sustainability - 2 South West SHA Enhanced Recovery Meeting Taunton Racecourse, Taunton, TA3 7BL 26th January 2011 Kelly Griffiths – Customer Support Manager
    44. 44. Who Are Dr Foster? Dr Foster Limited is 100% owned by Dr Foster Intelligence Limited, which is in turn a 50:50 joint venture between Dr Foster Holdings LLP and Department of Health We aim to improve the delivery of quality information to the NHS, by developing information systems to drive improvements and promote effective decision-making
    45. 45. Data Flow Inpatient/Outpatient data submitted by Acute Trusts SUS Imperial College Dr Foster Intelligence Tools HES 1st working day - BT/SUS run a data extract on behalf of Imperial College. The extract is guaranteed to include submissions from providers that are accepted by BT/SUS during the previous month. 6th working day - Imperial College receive the data extract from BT/SUS. Imperial College then apply their data cleaning rules to the dataset. 13th working day - Dr Foster receives the data extract from Imperial College and requires 10 working days to process the data. Last working day  New and updated data is published on or before this date.
    46. 46. Translation Data Information Interpretation Monitor Knowledge Consultation Improvement Action
    47. 47. Benefits Of Dr Foster Tools • • • • • • • • • 47 The tools are web enabled, meaning access anywhere with internet It is secure website (similar to banks) for data safety Separate password to access the patient identifiable data Time saving Bench mark against any trust in England Case mix adjusted - possible to compare like to like Ability to share reports with other users and save your own to favourite A range of outcomes, LOS, pre-op, post-op, by team, discharge day, day of op, trends by month, year etc Online support, by phone, email, and your CSM
    48. 48. Current Casemix Adjustment Model For Each Procedure Or Diagnosis Groups
    49. 49. Knowing Where You Are? Establishing robust baseline “Benchmarking Performance” Managing Performance “Performance Monitoring”  
    50. 50. CUSUM Outcome Threshold 99% Time
    51. 51. How to build a CUSUM...
    52. 52. How to build a LOS report..
    53. 53. Pyramid Model Of Investigation To Find Credible Cause For…….. Lilford et al. Lancet 2004; 363: 1147-54

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