Whenever I reflect on my role as a Patient Safety Improvement Lead here at the West of England AHSN I consider myself a very privileged person.
My day to day working life involves interacting with inspirational clinicians and patient safety leads from NHS and provider organisations across the region. Our little team encourages and supports them to work with us and collaborate across geographical and sector boundaries on programmes to improve healthcare safety for our population.
We ask busy people to be even busier and I am constantly humbled by the effort and goodwill we receive in response.
The success of our AHSN-led regional patient safety programmes relies heavily on organisations at the coal face doing the work for us. As improvement leads we don’t deliver patient safety improvements to patients; we only encourage and support them.
Last week I found myself in the unusual position of being the ‘deliverer’ – not directly to patients I hasten to add (with no clinical qualifications to speak of, that would clearly be bad for patient safety!) – but delivering presentations on two of our programmes that are attracting attention from health professionals across the country. The first of these is our fantastic cross-system work to roll out the National Early Warning Score (NEWS) across the West of England, and then there’s our support of the adoption and spread of the Emergency Department (ED) Safety Checklist; an elegantly simple but brilliantly effective patient safety intervention now in use in six out of seven of our EDs.
Anne Pullyblank is Clinical Director for Patient Safety at the West of England AHSN and Colorectal Surgeon at North Bristol NHS Trust. Anne and I were asked to talk at a national Deteriorating Patient conference and were joined by delegates from as far afield as Fyfe and the Channel Islands.
People were keen to hear about our ‘Share the NEWS’ concept, which sets out to improve the communication of NEWS at the interfaces of care, in particular the lessons we have learnt from our patient safety collaborative.
We looked back at our achievements since the launch of the West of England’s Deteriorating Patient programme in March 2015.
- All six of our acute trusts have standardised to NEWS across all services, including ED, and this includes NEWS on patient transfers within hospital and in transfers between acute trusts.
- The ambulance trust now has NEWS embedded into its electronic Patient Care Record, which automatically calculates NEWS from the vital signs monitoring equipment in the response vehicles and is handed over with the patient to the receiving department.
- All our regional community service organisations are using NEWS to assess cohorts of patients and as a trigger to escalate to either primary or acute care.
- Both our mental health trusts have improved the accuracy of NEWS calculation on their inpatient wards and are working collaboratively on non-contact physical observation policies and improved communication on transfer to acute trusts.
- All GP out of hours providers are routinely using NEWS when referring patients to Urgent Care. With the support of the Clinical Commissioning Groups through direct seminars, contractual incentives (primary care offers and CQUINS), far more in-hours GPs are now using NEWS to assess the acuity of patients, specifically when referring patients to hospital.
This is excellent progress in such a short time and we were able to explore our strategies for engaging our cross-system stakeholders. We adopted a hybrid of the Institute for Healthcare Improvement (IHI) model for improvement and standard project management methodology, using six monthly regional learning set events to focus on specific cross-sector themes to support the use of NEWS within organisations and the communication of NEWS at the interfaces of care, combined with regular meetings of sub-regional cross-sector groups to drive this work forward.
Delegates seemed impressed by our achievements and were very interested in the resources we’ve developed (implementation toolkits, information sheets, videos and blog posts – all available on the West of England AHSN website) to support our work. It was great to feel that our region is pushing the envelope in collaborating across systems for common outcomes, and that on a national stage we are one of the pioneers in using NEWS across sectors and at the points of handover of care to ensure patients are seen at the right time, in the right place by the right clinician.
In the same week, I was invited to present our work on the adoption and spread of the ED Safety Checklist to representatives from EDs across the Wessex AHSN region, along with my colleague Emma Redfern who is Associate Director for Patient Safety at the West of England AHSN and ED Consultant at University Hospitals Bristol NHS Foundation Trust (UHB).
Impressed with the West of England ED Collaborative’s approach, which regularly brings together representatives from all our regional EDs and the ambulance trust to share patient safety innovations and strategies, Wessex AHSN was keen to understand if there was an appetite within their region to adopt a similar model.
To demonstrate the impact of the West of England ED Collaborative, Emma and I presented our work on the adoption and spread of the UHB piloted ED Safety Checklist. We started with why the concept of the ED Safety Checklist had been developed in the first place: to address the issue of consistent crowding in ED leading to poor standards in basic clinical care and avoidable harm. We explained what the ED Safety Checklist is and how it had been developed through a review of baseline data to assess the performance of ED in the delivery of basic clinical care and patient comfort, a review of serious incidents and the employment of quality improvement methodology to rapidly test the use of a systematic hour-by-hour checklist when caring for patients in ED.
We then took delegates through how we rolled out the piloted concept to other EDs in the region, describing the toolkit we have developed which gives top tips on what to do and what not to do when introducing the ED Safety Checklist, and the benefits of the ED Collaborative as a network for sharing good practice. It was good to be able to show the impact of this work to date, which clearly shows an improving trend in the key performance indicators for standard clinical care such as NEWS and pain score at triage to ED, and timely instigation of appropriate investigations across the region (measured as an average across our implementation sites).
Again, the quality of our collaborative patient safety work was recognised, which is all about the sharing of good practice and the clear impact this is having on patient safety in a constantly pressured and stressed NHS department.
When reflecting on my experiences last week, I have to say it felt good to be a ‘deliverer’. I am honoured to have had the opportunity to represent our region and our fantastic stakeholders, and to promote our collaborative achievements. My hope is that we have inspired others to follow our lead; to breakdown geographical and sectoral boundaries within heath communities, to work together to achieve common aims and ultimately deliver safer standards of care to every patient.
I may not be a direct ‘deliverer’ of patient safety improvements, but I really am privileged to work with inspirational individuals and organisations that do.
Posted on December 15, 2016 by Ellie Wetz, Patient Safety Improvement Lead