Impact Measures Nhs Institute

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Impact Measures Nhs Institute

  1. 1. NECLEs HIEC January 2011<br />Pathways to Success:<br />Making an Impact<br />
  2. 2. If we change our service:<br />When will we see the impact?<br />How big will the change be?<br />
  3. 3. Implementation time<br /> Time from implementation to getting results<br />When?<br />
  4. 4. Implementation time<br />Deciding on changes<br />Getting agreement (and funding)<br />Planning<br />Communication and training<br />Set-up time<br />Pilot or big bang?<br />Full implementation<br />
  5. 5. Timescale of change<br />The woman’s journey: VBAC<br />Letter to each woman post CS <br />VBAC clinic <br />Management guidelines for labour<br />24 hour case review<br />
  6. 6. Timescale of change<br />The woman’s journey: VBAC<br />Letter to each woman post CS <br />VBAC clinic <br />Management guidelines for labour<br />24 hour case review<br />3 years<br />6 months<br />28 days<br />28 days<br />
  7. 7. Low hanging fruit<br />Quick wins can be useful for<br /> morale<br /> credibility of project<br />But: <br />May not engage others<br />May not be sustainable<br />
  8. 8. How big will the change be?<br />Is your change an improvement?<br />You can only prove it if you measure it!<br />
  9. 9. Measures: are wehaving the impact we intend?<br />primary: <br /> reduced CS rate<br />secondary: <br />reduced PPH, <br />reduced staff sickness,<br />increased user satisfaction<br />
  10. 10. Measures: are wehaving the impact we intend?<br />final: <br /> reduced elective CS rate<br />intermediate : <br />increased numbers of women opting for VBAC at booking<br />
  11. 11. Measures: are wehaving the impact we intend?<br />primary: reduced CS rate<br />secondary: reduced PPH, reduced staff sickness, increased user satisfaction<br /> or:<br />final: reduced elective CS rate<br />intermediate : increased numbers of women opting for VBAC at booking<br />
  12. 12. First pregnancy and labour<br />?Target population: <br /> typically 45% all births<br /> of which >20% CS<br />?Where could we make an impact:<br /> Unplanned CS: in labour/prelabour<br /> pre-labour<br />
  13. 13. VBAC pathway: once a CS always a CS<br />Target population:<br /> multips 55% all births<br /> of which 1 previous CS - 15%<br />Of which repeat CS indicated for 10%<br /> Emergency CS in labour 30%<br /> Vaginal birth in 70%<br />Potential reduction in overall CS: 5%<br />
  14. 14. Management of breech births<br />Target population:<br /> 3% all pregnancies at term<br />Breech diagnosed: 2%<br />ECV: 50% success<br />Reduction in CS rates: 1%<br />
  15. 15. Optimising normality<br />Target population:<br /> Low risk women opting for CDS care<br />Women with some risk factors<br />? Optimal usage of MLU<br />?Transferrable skills in normality<br />

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