Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
Drop the-pre-op-info-sheet - Washington Health Alliance Mick Brown
Providing high-quality care to patients includes eliminating unnecessary tests, treatments and procedures.
A recent study in Washington state reveals that at least 100,000 patients received unnecessary pre-op testing during a one-year period, at an estimated cost of over $92 million—a very conservative estimate.
Routine preoperative lab studies, pulmonary function tests, X-rays and EKGs on healthy patients before low-risk procedures are not recommended because they are unlikely to provide useful, actionable information.
Improving the prevention, recognition and management of AKI: the ‘Think Kidne...Renal Association
NHS England ‘Think Kidneys’ programme gave a presentation:
Improving the prevention, recognition and management of AKI: the ‘Think Kidneys’ initiative at the RCPSG meeting on 18.03.2016
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Drop the-pre-op-info-sheet - Washington Health Alliance Mick Brown
Providing high-quality care to patients includes eliminating unnecessary tests, treatments and procedures.
A recent study in Washington state reveals that at least 100,000 patients received unnecessary pre-op testing during a one-year period, at an estimated cost of over $92 million—a very conservative estimate.
Routine preoperative lab studies, pulmonary function tests, X-rays and EKGs on healthy patients before low-risk procedures are not recommended because they are unlikely to provide useful, actionable information.
Improving the prevention, recognition and management of AKI: the ‘Think Kidne...Renal Association
NHS England ‘Think Kidneys’ programme gave a presentation:
Improving the prevention, recognition and management of AKI: the ‘Think Kidneys’ initiative at the RCPSG meeting on 18.03.2016
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Clinical Audits and Process Improvement in HospitalsLallu Joseph
How to conduct a clinical audit, differences between research and clinical audit, medical audit, History of audit, benefits of audit, standard, criteria, benchmarks, compare performance, examples of clinical audit, audit cycle, types of audit, NABH, JCI, QAPI, PDCA, Hospital accreditation,
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
N-QI-CAN brings together the regional clinical audit / effectiveness networks from across England. There are 14 regional clinical audit/effectiveness networks all of whom have representatives regularly attending NQICAN meetings. Wales and Northern Ireland are also represented on the group to enable sharing of good practice and collaborative working.
NQICAN has several 'stakeholder members' including NHS England, HQIP and NICE. Several of the Royal Colleges and other key stakeholders are represented.
This is the NQICAN annual report for 2016.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
QI initiative: Acute Kidney Injury (AKI) Care in Acute OncologyCarl Walker
Dr Al-Sayed et al (The Christie NHS Foundation Trust) share their successful QI project to improve patient care in AKI as part of NQICAN Patient First 2016 presentation.
Julie Henderson (Acting Head of Clinical Services) discusses the Clinical Audit Service:
- Clinical Leadership and Engagement
- Inclusive Approach
- Audit Measurement
This presentation includes two case studies:
1) National Diabetes Audit
2) National Lung Cancer Audit
Clinical Audits and Process Improvement in HospitalsLallu Joseph
How to conduct a clinical audit, differences between research and clinical audit, medical audit, History of audit, benefits of audit, standard, criteria, benchmarks, compare performance, examples of clinical audit, audit cycle, types of audit, NABH, JCI, QAPI, PDCA, Hospital accreditation,
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
N-QI-CAN brings together the regional clinical audit / effectiveness networks from across England. There are 14 regional clinical audit/effectiveness networks all of whom have representatives regularly attending NQICAN meetings. Wales and Northern Ireland are also represented on the group to enable sharing of good practice and collaborative working.
NQICAN has several 'stakeholder members' including NHS England, HQIP and NICE. Several of the Royal Colleges and other key stakeholders are represented.
This is the NQICAN annual report for 2016.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
QI initiative: Acute Kidney Injury (AKI) Care in Acute OncologyCarl Walker
Dr Al-Sayed et al (The Christie NHS Foundation Trust) share their successful QI project to improve patient care in AKI as part of NQICAN Patient First 2016 presentation.
Julie Henderson (Acting Head of Clinical Services) discusses the Clinical Audit Service:
- Clinical Leadership and Engagement
- Inclusive Approach
- Audit Measurement
This presentation includes two case studies:
1) National Diabetes Audit
2) National Lung Cancer Audit
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
in this slide you will learn about
what is screening
types and uses of screening
difference between screening and diagnostic tests
criteria of screening
and
evaluation of screening tests
Clinical Science for Medical Devices: A Guide for Entrepreneurs | Jim Gustafs...UCICove
About UCI Applied Innovation:
UCI Applied Innovation is a dynamic, innovative central platform for the UCI campus, entrepreneurs, inventors, the business community and investors to collaborate and move UCI research from lab to market.
About the Cove @ UCI:
To accelerate collaboration by better connecting innovation partners in Orange County, UCI Applied Innovation created the Cove, a physical, state-of-the-art hub for entrepreneurs to gather and navigate the resources available both on and off campus. The Cove is headquarters for UCI Applied Innovation, as well as houses several ecosystem partners including incubators, accelerators, angel investors, venture capitalists, mentors and legal experts.
Follow us on social media:
Facebook: @UCICove
Twitter: @UCICove
Instagram: @UCICove
LinkedIn: @UCIAppliedInnovation
For more information:
cove@uci.edu
http://innovation.uci.edu/
Measurement for Improvement - Management of Acute Kidney Injury in primary c...Renal Association
Charlie Tomson, Consultant Nephrologist at theFreeman Hospital Newcastle upon Tyne and Chair of the Intervention Workstream, NHS England/UKRR Think Kidneys Programme
presented at a Measurement for Improvement event on 16th March.
Presentation by Dr Martin Myers MBE, PhD, FRCPath, Consultant Clinical Biochemist, Lancashire Teaching Hospitals NHS Foundation Trust at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
Similar to Pathology Optimisation in Chronic Blood Disease Monitoring (20)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. Chronic Disease Blood Monitoring
• Significant workload for primary care and labs
• Number of conditions (and drugs) that need monitoring in order
to achieve QoF targets
• How do we ensure a “clean” approach to chronic disease
monitoring?
3. QoF Blood Test requirements 2015-16
FBC Renal ALT HbA1C
Fasting
LIPIDS
Non-HDL
Cholesterol TSH LFTS Bone
B12 +
Folate
ACR micro
albumin
Cardiovascular
disease New X X X X X
Cardiovascular
disease Annual X X X
Chronic Kidney
Disease Annual X X
Dementia New X X X X X X X
Diabetes New X X X X X X
Diabetes Annual X X X X X
Diabetes 6 Months X
Downs Syndrome X
Heart Failure New X X X X X
Heart Failure Annual X
Hypertension New X X X X
Hypertension
Annual X
Hypothyroid Annual X
Mental Health
Annual X X
Obesity X
4. Liver function tests / ALT
• What percentage of citizens of North Devon had their ALT
measured last year?
• What percentage of these have ‘abnormal’ ALT?
• What happens to these patients?
5. Patient Story
Liver Function Tests
76 year old man
History of leukaemia (8 years
previously) and TIA (6 years
previously)
On simvastatin 40mg for secondary
prevention for 6 years
Had come in for “blood tests”,
because Liver Function Tests
(LFTs) had been raised at annual
review
6. Patient Story
Liver Function Tests
Results:
GP undertook further blood tests,
still abnormal results,
simvastatin reduced (twice)
Patient has had 14 GP interactions
in previous 12 months
GP assumed abnormal tests were
due to statin usage, so statin
reduced to much lower efficacy
(if at all)
No referral for investigation, e.g.
liver ultrasound
7. Patient Story
Liver Function Tests
Results:
Patient uncertainty and worry
increased:
“I’m just coming in next week
before I go on holiday to check
with my doctor that the tests are
all alright”
Also has false reassurance:
When patient asked about his
tests:
“the bloods should know most of
the problems you have”
8. From an inside out lab perspective
• Each transaction was technically correct
• Assuming the result was accurate and timely, it therefore was
“clean-through”
9. Is this clean in?
• Consideration of appropriate test
• NICE Guidance on LFTs in patients on statin: “Measure baseline liver
transaminase enzymes (alanine aminotransferase or aspartate
aminotransferase) before starting a statin. Measure liver transaminase
within 3 months of starting treatment and at 12 months, but not again
unless clinically indicated.
• Patient had been on statin for 6 years – so would not have been
tested if per NICE guidance
• The patient is not consented. This leaves potential for
misunderstanding about what has been done and why…
• ...we were not checking for relapse of leukaemia
10. Is this clean out?
• Difficult to say - as wasn’t clean in…
• But, assumption that statin was responsible and reduced to 10mg
day (when this was clinically unlikely): more harm than good?
• Is patient lucky or unlucky he hasn’t received a referral for
investigation?
• How do I know ‘what is normal for me’?
• Everything outside a reference range looks red.
• Results do not help anyone decide on the next step
11. How can we Improve?
Actions:
• Consent for blood tests- pilot study
• Evidence based, rational testing for annual QOF monitoring-
multidisciplinary team (secondary care specialists, pathologists
and GP leads across NEW Devon)
• Results in meaningful format that patients can understand ‘what’s
normal for me’, direct to patients- pilot
12. How do we get to an optimised service?
There is real similarities with pathology services and medicines
optimisation:
• Both described as “golden thread” running through healthcare
• Drugs/tests usually delivered from separate clinical provider
• Optimal use of drugs/tests is complex
• Both under scrutiny to save money by reducing costs
14. Ensuring end-to-end effectiveness
“clean in”:
Right drug choice
“clean through”:
Correctly
dispensed
“clean out”:
Correctly taken,
good patient
outcome
Pre-analytical? Analytical Post-analytical?
15. Designing a pathology optimisation service
• Deliver through:
– Clinical effectiveness
– Identifying and understanding variation
– Engagement
• Outside-in focused BMS
• Clinical leads
• Link clinicians in primary care
• Half day peer to peer meetings
• Practice visits
16. Designing a pathology optimisation service
Clinical Effectiveness
• Clinical and Cost Effectiveness assessment
• Clinical decision support
Understanding and reducing variation
• Information sources
• Benchmarking
Relationships and Engagement
• Clinical support and challenge
• Incentivisation
17. Designing a pathology optimisation service
All factors equally important
In order to optimise care all
three factors need to be
successful
Medicines Optimisation started
as a small team and grew –
consider how to start this
approach.
19. Weekly ALTs from one practice
Practices that have fully implemented order comms have pushed
requesting levels back to near 2002-4 levels.
Order sets for
chronic diseases
2004 control limits
21. Data provides assurance that clinically safe
Weekly number of ALTs above 120
2012
control
limits
22. The future for pathology
• Effectiveness vs efficiency
• Needs increased focus for clean in and out
• Detail is important and requires expertise. Help interpret and
implement complex guidance in a complex world
23. Our patient in an optimised world
Clinical Effectiveness
• Have a pathology group agreeing pathways of testing for chronic conditions
• Include in formulary and decision-support tool
Understanding Variation
• Benchmark GP practices to understand, following implementation, whether there
has been change in LFT requests, and differences in requesting patterns
Engagement
• Discuss and challenge GPs on latest guidance on LFTs, and use this to deliver
patient care. Be available for clinical guidance on interpretation of results.
24. Our patient in an optimised world
For our patient:
• Less inappropriate testing
• More effective lipid modification
• Less uncertainty and concern
• less time
• less change of harm through unwarranted testing
Care of the patient is more optimal
25. Our patient in an optimised world
For the system:
• 14 less GP appointments taken up in 12 months
• Less chance of admission for further cardiovascular events
• Reduced number and cost of unnecessary testing
• Reduced cost of unwarranted further investigations
Improved patient care, reduced cost