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Quality accounts and priorities

1. Improve sepsis screening and timely management 

Lead: Dr Sanjay Krishnamoorthy, Clinical Director of Emergency Services 

Why we have chosen this as a Quality Priority?

Sepsis is a life-threatening condition, with around 123,000 cases each year in England and an estimated 37,000 deaths associated with the condition. Sepsis also has long term impacts in morbidity and quality of life. The UK Sepsis Trust estimates that an improved management of sepsis could lead to a saving of £170 million, with savings of between £2,000 to £5,000 per sepsis case. Timely identification and appropriate antimicrobial therapy has been shown to be effective in reducing transition to septic shock and therefore reducing mortality.  

What we aim to achieve during 2021/22?

We will:

  • Improve early recognition of deteriorating patient in our emergency departments and inpatients so that at least 90% patients who meet the relevant criteria are screened for sepsis within 1 hour
  • Improve the timely commencement of appropriate antimicrobial therapy for patients found with suspected red flag sepsis so that at least 90% of patients receive IV antibiotics within 1 hour

2. Improve personalised cancer care at diagnosis 

Lead: Eamon O’Reilly, Lead Nurse

Why we have chosen this as a Quality Priority?

The Trust is actively involved in the existing Cancer Alliance ‘Improving Care Locally’ programme, which annually sets improvement priorities; The national priority to deliver personalised care for people who are newly diagnosed with cancer. Given the extensive changes to cancer services in 2020/21 due to the Covid19 pandemic, we want to focus on improvement in end to end cancer pathways – diagnosis and at end of treatment, to ensure quality by personalising care. 

What we aim to achieve during 2021/22?

We will:

  • Ensure >75% of patients whose treatment is managed by our Trust have a Holistic Needs Nurse Assessment (HNA) appointment after a diagnosis of cancer and a personalised cancer care plan
  • 10% increase per quarter in the number of patients who have end of treatment summaries     

3. Improving outcomes for inpatient diabetes patients

Lead: Phillip Lee, Clinical Director of Medical Specialities 

Why we have chosen this as a Quality Priority?

The National Inpatient Diabetes Audit (NADIA) between 2010 and 2019 showed that between 10-15 % of inpatients on the Chelsea site have diabetes, whilst at West Middlesex this is as high as 23%. The vast majority of these patients are not admitted directly because of their diabetes, and hence are not usually under the direct care of the diabetes team. (For example they may be admitted for surgery or with a different medical problem).

There is substantial evidence that patients with diabetes, regardless of the reason for admission, have a greater average length of stay than equivalent patients without diabetes. For example in our trust in 2019, emergency admission with diabetes had a mean LOS of 9.1 days compared to 6.6 without diabetes, In addition, nationally and locally there continue to be patients experiencing diabetes harms as inpatients, including hypoglycaemia, new foot ulcers and diabetic ketoacidosis. These are all reportable to the national diabetes audit.  National reports show that 11% of the inpatient budget is spent on diabetes care and modelling suggests that much of this could be saved by investing in inpatient diabetes care. 

The 2019 NADIA showed that whilst overall satisfaction of inpatients with their diabetes care on the Chelsea site was high, on the West Middlesex site it was below average.

There are now national recommendations from NHS England and Diabetes UK on how to provide diabetes care. Published data in hospitals of varying sizes show that inpatient diabetes teams can reduce length of stay for those with diabetes. This has now been reflected in the NW London Integrated Diabetes contract, which specifies a consultant led multidisciplinary diabetes inpatient team to improve quality of care and reduce costs.

What we aim to achieve during 2021/22?

We will:

  • Establish a method of identifying and reporting patients who have diabetes at point of admission
  • Increase the nurses and HCAs who receive 10-point training
  • Reduction in length of stay for diabetes patients across 3 elective pathways
  • Reduction in inpatient diabetes harms

4. Improve clinical handover     

Lead: Dr Kathleen Bonnici, Consultant Acute Medicine

Why we have chosen this as a Quality Priority?

  • Handover of patient care within hospitals traditionally consists of a brief conversation and brief notes at the end of shift or when a patient is being transferred to the care of another team; this approach raises risks relating to content and record keeping variability.
  • Effective handover between clinical teams is widely accepted as essential for patient safety. The British Medical Association together with the National Patient Safety Agency and NHS Modernisation Agency has produced clear guidance regarding the contents and setting for a safe and efficient handover. The Trust aims to engage our clinical teams to assess our handover processes in light of national best practice and to develop the necessary improvements that will support the safe and effective handover of patient care.

What we aim to achieve during 2021/22?

We will:

  • Embed a shared appreciation of the principles underpinning good clinical handover through the delivery of a training package; 50% of clinical staff to be trained in the principles of safe and effective clinical handover.
  • Introduce a standardised handover process based on national best practice;95% of all handovers to be attended by each medical downstream ward.
  • Introduce a standardised handover proforma / documentation within the Trust electronic medical records system (Cerner)

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