Patient Safety Collaboratives - Dr Chris Streather, Managing Director, South London AHSN Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014 More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx

1. Patient Safety Collaboratives
Dr Chris Streather PSC Launch 14/10/14

2. Patient safety – a clinical leadership view
• Optimism, pessimism, ancient history and the adoption of innovation
•More modern history
•Local example
•Change the culture or fix problems?

3. A history lesson – we’re a bit slow unless it hurts

4. Mortality in adult cardiac surgery since 2003
2
3
4
5
6
7
8
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Chart Title
Mortality %

5. Progress on MRSA, C diff and VTE
•2003 MRSA 7700
•2013 MRSA 924 still falling Q2 2014
•2007 C diff 57,217
•2013 5974
•Just do simple things well
•Wash hands (Lister stops spinning in his grave)
•Keep hospitals clean
•Prescribe antibiotics wisely
•Measure it
•Make failure consequential

6. Date of download: 10/10/2014
Copyright © American College of Chest Physicians. All rights reserved.
From: Comprehensive VTE Prevention Program Incorporating Mandatory Risk Assessment Reduces the Incidence of Hospital-Associated ThrombosisRisk Assessment and Hospital-Associated Thrombosis
Chest. 2013;144(4):1276-1281. doi:10.1378/chest.13-0267
Percentage of patients with documented risk assessment.
96% patients assessed nationally, Kings study shows 12-20% reduction in thrombotic events
Figure Legend:

7. Catheter-associated urinary tract infections (CAUTIs) – a Cinderella issue?
•Safety Thermometer data tells us 18.9% of inpatients in England are catheterised (substantial variation across Trusts)
•Extrapolating from this and HES we estimate that 2.9 million inpatients are catheterised annually in England, and of these around 190,000 (6.7%) develop urinary tract infection (UTI).
•Approximately 3.6% (95% CI 3.4– 3.8%) of patients with CAUTI develop life-threatening secondary infections, where mortality rates range from 10% to 33%.

8. No Catheter, No CAUTI ‘Care Bundle’
Avoiding unnecessary placement
Prompt removal
Rapid review of incidents (CAUTIs or bloodstream infections associated with CAUTIs) for learning and improvement
Quality and improvement about the management of catheters out of hospital

9. •Engage leaders
•Support organisational and reporting readiness
Set Up Feb 15 – Jul 15
•Initial Breakthrough series across 5 veritically integrated acute/ community trusts in South London
•GSTT
•Kings
•Lewisham
•Croydon
•St George’s
Phase I BTS
•Open BTS to all acute and community trusts in South London
•Kingston / Your Healthcare
•Royal Marsden / Sutton & Merton
•Epsom & St Helier
•Oxleas
•BromleyHealthcare
•Hounslow and Richmond
•Consideration of care homes
Phase II – Scale up, sustain & spread
South London Provider Rollout

10. Spend on excess bed days  £6m.
More potential quality improvements and savings in Phase 2
27,000 fewer inpatient catheterisations in our 5 Trusts
If catheterisation rate reduced by 29%...
Potential impacts
If CAUTIs reduced by 50%...
3,500 fewer inpatient CAUTIs in our 5 Trusts
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
2013-14
29% reduction

11. £12.3m. a year spent in these Trusts on excess bed days alone for patients with CAUTI Also costs for ITU, A&E, emergency readmissions, community care
7.7% of patients with catheters will have CAUTI at any given time
More than 90,000 inpatients with catheters across our 5 Trusts each year
Potential savings
£1,700 is the estimated cost of treating a CAUTI episode
Estimates of patient numbers based on NHS-ST data and HES 2013-14, Cost estimate derived from Plowman et al. 2001, adjusted for inflation

12. Recent feedback on the Catheter Passport...
1.Patient: ‘Its nice and clear and answers my questions’
2.Nurse : ‘a really good idea that should be rolled out nationally’
3.GP : ‘Discharge summaries are my bugbear - the catheter passport gives me the important information’
4.Nurse – the idea has been so well received within the hospital that we have begun to develop a similar passports for falls and for pressure sores.

13. GSTT tested Reinertsen’s ‘Reality Rounding’ practice during
Summer 2014, focused on CAUTIs. Here are some
resulting actions...
Reality Rounds: A Leadership Practice to Improve
Implementation of “Vertical’ Processes
1. Pick a major safety practice critical to your aims for this year
2. Develop a scripted set of questions designed to expose
operational barriers to implementation of that practice, and
to drive positive feedback to staff who know and implement
the practice
3. Commit the leadership team to round
– CE 1 hour per month
– Director 1 hour per week
– Unit manager 1 hour per day
4. Fix the operational problems you learn about
5. Pick another safety practice, and repeat
1. Improve ward stores for " flip-flow"
catheter valves
2. Add catheter care plan to
checklist for patients stepped
down from critical care wards
3. Catheters can be removed before
bowel management is completed
4. Improve handover for Trial
without Cathetter post- discharge
Reinertsen, James. ‘Leadership for Safety: A Masterclass for South
London’s Academic Health Science Network’. St Thomas
Hospital. Power Point. 29 May 2014.

14. Sub-heading 18pt Arial
Sub-heading 18pt Arial
The way forward
•Jim Reinertsen at our local launch challenged the value of fixing problems versus comprehensive change in culture
•Don’t underestimate how good we are at fixing problems
•Our task is to get best of both worlds by fixing problems whilst changing the culture
•AHSN well placed as we stretch beyond hospitals and beyond pure health
•Core business adoption and diffusion

15. Thankyou
Dr Chris Streather