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The innovation journey: Improvement

This phase in the innovation journey is about delivering and implementing, then growing and scaling an idea or solution. This involves taking an innovation out into the wider world and trying to encourage engagement and uptake. Our Evidence into Practice challenge takes a proven, evidenced intervention and spreads it across the region, and possibly beyond.

This phase also involves the use of quality improvement (QI) methods or tools to engage local stakeholders and implement the idea into current practice. This might mean changing practices to accommodate the innovation, which is exactly the approach taken by our ReSPECT programme.

There will often be an element of local testing (through the Plan, Do, Study, Act cycle) with impacts measured to support ongoing evaluation. If successful, the ongoing development of an evidence base, alongside adoption of QI and project management techniques, will support the scaling up of the initiative to more sites. This is what our PreciSSIon project aims to achieve.

Evidence into Practice

Our Evidence into Practice challenge identified opportunities for the regional adoption and spread of initiatives. Clear patient and financial benefits of the initiatives had been established following the implementation of a local innovation or improvement project within our member organisations.

The proposals inform future learning to strengthen adoption and spread of evidence, alongside building new collaborations, across the West of England.

An independent panel reviewed 20 applications, with seven selected to meet and present to the panel.

Two projects, PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) and SHarED (Supporting High ImpAct UseRs in Emergency Departments) were selected to continue working with us.

During 2019/20, we provided project management expertise and back-filled clinical lead posts. Local project champions participated in, and gained, regional stakeholder engagement experience with NHS trusts, clinical commissioning groups (CCGs) and our wider networks.

Launched early in 2020/21, PERIPrem is the combination of two applications from University Hospitals Bristol and Weston and Great Western Hospitals. PERIPrem supports implementation of a new perinatal care bundle to improve the outcomes for premature babies. The project consists of ten evidence-based interventions that will demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

SHarED aims to improve outcomes for the most frequent and/or high-impact users of emergency departments, reducing attendance rates and supporting users to seek appropriate healthcare and support. Following a pause due to COVID-19, our acute trusts have established project teams and the project launched in July 2020.

The project has really benefitted from the West of England AHSN approach. Their vast experience in Quality Improvement and project management has helped us to engage our colleagues in other trusts from the top down, and launch the roll out across five other Emergency Departments. We would never have made this progress as individuals.

Dr Becky Thorpe, Clinical Lead SHarED, Emergency Department Consultant, University Hospital Bristol and Weston NHS Foundation Trust

ReSPECT

Over the last year we have supported a more standardised process of emergency care planning across the West of England, taking a coordinated system-wide approach.

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a process to plan a person’s clinical care in the event of a future emergency when they might be unable to make or express choices, developed by the Resuscitation Council in collaboration with patients and their families.

The personalised plan is created through conversations between a person and one or more health professionals involved in their care, as well as family members. Decisions are recorded on a ReSPECT form. The resuscitation status of a person (DNACPR) is also documented but it is only one aspect of the overall plan for emergency care.

Through our Patient Safety Collaborative, we identified there were opportunities to improve care for people, particularly those in the last year of life or at risk of deterioration. Person-centred conversations often happen too late or in an emergency setting, and information to help in decision-making might not be easily available or shared effectively when patients transfer between settings.

Using a quality improvement collaborative approach working with all system partners and patient representatives, we enabled the ReSPECT process to go live in Gloucestershire and Bristol, North Somerset and South Gloucestershire (BNSSG) Sustainability and Transformation Partnerships (STPs) in October 2019.

We hosted four major events to bring our health and care community together. These focused on supporting health care professionals to have difficult conversations through workshops and role play. We also coordinated ‘task-and-finish’ groups focusing on cross-cutting themes, such as digital integration, data and measurement, training and education, communication and engagement. Working with our evaluation partner, NIHR Applied Research Collaborative (ARC) West, we identified research objectives to inform further adoption and spread.

We have had particular success in digitising the ReSPECT form in the region, and are sharing our learning with other parts of the country. A local GP designed and delivered an EMIS template so that healthcare professionals, including out-of-hours GP services, can access patients’ ReSPECT information on a laptop through Connecting Care.

We worked together with our system partners to meet the challenges of COVID-19. ReSPECT is also part of the RESTORE2 TM tool, which includes recognition of the soft signs of deterioration, measurement of the National Early Warning Score (NEWS2) and structured communication. We are rolling out this training in our care homes to further raise awareness of ReSPECT.

An estimated 3,000 patients in each STP have a ReSPECT form documented in their patient record, and we continue to measure and evaluate the impact of ReSPECT across our region.

PreciSSIon

PreciSSIon (Preventing Surgical Site Infection across a region) is a collaboration between all acute trusts in the West of England. It aims to reduce surgical site infection after elective colorectal surgery by 50% by March 2021.

Surgical site infection (SSI) constitutes a major healthcare burden accounting for 14.5% of all hospital acquired infections in the UK and an increase in associated costs. It is a significant cause of patient morbidity, including increased length of stay and readmission, and contributes to late complications such as incisional hernia.

The collaborative has measured baseline 30-day surgical site infection (SSI) using patient reported outcome measures, and the aim is to implement an evidence-based care bundle comprising four elements designed to reduce SSI:

  • 2% chlorhexidine skin preparation
  • antibacterial sutures for deep and superficial layers
  • use of wound protectors
  • second dose of antibiotics if operations last over four hours.

The early part of 2019 was spent meeting clinical leads from each trust, leading to a launch event in November. Due to COVID-19, our planned March event was held online and we are providing individual coaching for each trust.

Anne Pullyblank, the West of England AHSN’s Medical Director and Consultant Colorectal Surgeon at North Bristol Trust, said:

“Most hospitals had been trying to address SSI but the collaborative has given us the impetus we needed to make change happen. We are learning from each other and many of us are also looking at SSI after emergency surgery.”

So far, all trusts have collected baseline data and all have implemented the bundle. Trusts are currently auditing implementation of the bundle and early results suggest we are starting to reduce SSI.