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The deteriorating patient

Our West of England Patient Safety Collaborative is prioritising initiatives to improve the emergency management of the deteriorating patient, in particular how to spot patients most at risk and how we communicate this across different handovers of care.

Key stats

1,203 people in the West of England have benefited as a result of the Emergency Laparotomy Collaborative in the last year

93,219 people had their NEWScore calculated at triage into one of our emergency departments

554,489 people had their NEWScore recorded by the South Western Ambulance Service on an Electronic Patient Care Record (ePCR)

Sharing the NEWS

Too often, healthcare providers in different sectors do not speak the same ‘language’ across the various handovers of care. This can lead to a lack of consistency in detecting and responding to acute illness.

In the West of England, all acute trusts, out-of-hours GP services, mental health trusts, community service providers and clinical commissioning groups (CCGs) have signed up to support the adoption and spread of National Early Warning Score (NEWS), and communicating this score at the interfaces of care across the system.

NEWS is a simple scoring system, based on the six physiological measurements that make up the routine vital signs of an adult patient.

We have produced a toolkit to support the adoption and spread of NEWS in a variety of health care settings: www.weahsn.net/news-toolkit.

A video has also been produced telling the story of a patient called Paul in North Somerset who had sepsis but thanks to the early detection of his condition in primary care through the use of NEWS, it was treated within five hours of seeing his GP and he made a quick and full recovery.

“I think one of our challenges sometimes is to know firstly does somebody need to go to hospital, secondly how urgently they need to go in, and how we communicate that to the hospital – how worried we are about this patient when they can’t see them for themselves,” says GP Jon Rees in the video.

“And that’s where I found the NEWScore so helpful – it immediately clarified in my mind there was no doubt he needed to be in hospital, there was no doubt he needed 999, and as soon as I rang 999 it was clear they knew there was no doubt that they needed to respond quickly.”

Identifying patients most at need in the emergency department

Crowding has a profound impact on the ability of emergency department (ED) staff to deliver safe care. Delays in recognition and treatment of severe illness are common, with associated poor outcomes. This is particularly problematic for patients suffering from stroke, heart attack and sepsis.

The ED Safety Checklist is a simple response to this issue. Piloted at University Hospitals Bristol NHS Foundation Trust, it is a time-based framework of tasks completed for every patient, other than those with minor complaints.

With our support, the checklist has now been adopted by all acute trusts in the West, as well as the South Western Ambulance Service. This has been supported by a special toolkit, sharing lessons learned to support trusts to introduce the checklist in their own EDs.

As a result, the number of majors/ resus patients having their NEWScore calculated within an hour of admission to EDs has improved from an average of 55% to 84%, while those having their pain score calculated has gone up from 59% to 93%. The number of ECGs being instructed within 10 minutes of people arriving in ED has increased from 36% to 71% of all appropriate patients.

Download the toolkit at www.weahsn.net/emergency-department.

Emergency Laparotomy Collaborative

The West of England, Wessex and Kent Surrey Sussex AHSNs have joined forces to form the Emergency Laparotomy Collaborative.

The Collaborative is delivering a quality improvement (QI) programme that aims to save 1,000 lives over two years by improving standards of care and outcomes for patients undergoing emergency laparotomy surgery.

It involves the spread and adoption of the evidence-based Emergency Laparotomy Pathway QI Care bundle from four hospitals to 28 hospitals in our three regions, including all six acute hospitals in the West of England. It encourages a culture of cross-organisational collaboration, and is embedding QI skills to ensure sustainability of change.

Key outcomes so far include significant reductions in mortality rate and length of stay:

  • Risk-adjusted mortality rate fell by 18% in the first three months
  • Length of stay has fallen by 8.5% or 1.5 days, equating to non-cash releasing savings of £1.3m in the first nine months.

Structured Mortality Reviews

We have formed a collaborative with the six acute trusts in the West of England (as well as Musgrove Park and Salisbury Hospitals) to be early implementers of the national structured case note review programme.

While most hospitals undertake some form of mortality review, there is wide variation in terms of methodology, scope, data analysis and contribution to learning. By establishing a consistent process of reviewing care through a structured analysis of patient records, we aim to improve the quality of care by helping hospitals to learn from problems that contribute to avoidable patient death and harm.

Our collaborative will develop a best practice framework, train clinical reviewers, implement the new system and consider which emerging themes will lend themselves to a collaborative quality improvement approach.

Find out more at www.weahsn.net/structured-mortality-reviews.

Download the full annual report here as a PDF or read it below via Issuu.