Chief Executive’s Statement I am pleased to welcome you to our Quality Accounts 2015. Now in their sixth year, Quality Accounts continue to provide a truly objective metric for us, and others, to gauge the quality of our 59 hospitals and the services they provide against a broad range of criteria. The past year has seen another step change in the way healthcare providers are externally challenged on the quality they provide. Following a spate of high profile controversies around patient safety, the Care Quality Commission, the UK’s health regulator, has introduced a new inspection regime designed to raise standards. No healthcare provider can afford to be complacent and whilst I believe BMI’s hospitals provide safe and effective care, we should always be striving for improvement. To this end we recently introduced a new Quality Strategy, which articulates how we will provide the best possible care and strive for continual improvement, and live up to our brand promise to be “serious about health, passionate about care”. Its four core themes – safety, clinical effectiveness, patient experience and quality assurance – provide our staff with the platform to consistently deliver the care patients, their insurers, and commissioners expect and deserve. BMI hospitals have been enthusiastic participants in the pilot programme of the new CQC inspection regime for private providers, and to ensure our facilities are prepared we have developed a selfassessment tool to enable hospitals to compare their perceptions of themselves with those of the external inspectors. The rigorous inspection process itself also underpins the sharing of best practice between hospitals which further drives improvement and consistency. BMI Healthcare strives to provide the best care but the ultimate arbiters of whether we succeed are our patients. We are committed to monitoring every aspect of the care we provide, and the results of the detailed questionnaires we ask patients to complete inform improvement. We aim to provide a consistent, high quality patient experience and an environment that empowers our consultants to excel. Providing a dependably high quality of care requires constant focus on improvement; the most recent independent research conducted for BMI shows that over 98% of our patients rate their care as excellent or very good. The information available here has been reviewed by the Clinical Governance Board and I declare that as far as I am aware the information contained in these reports is accurate. Finally I would like to thank all the staff whose application, professionalism and ceaseless commitment to improvement is recognized here and in the positive experiences of the patients we care for. Since I joined BMI late last year, I have witnessed this firsthand on my many visits to our hospitals and I am committed to ensuring we build on that success. Jill Watts, Group Chief Executive 1 Hospital Information BMI The Huddersfield Hospital has 29 beds with all rooms offering the privacy and comfort of en-suite facilities, TV and telephone. The hospital has 2 theatres. These facilities combined with the latest in technology and on-site support services; enable our consultants to undertake a wide range of procedures from routine investigations to complex surgery. This specialist expertise is supported by caring and professional medical staff, with dedicated nursing teams and Resident Medical Officers on duty 24 hours a day, providing care within a friendly and comfortable environment. The hospital sees a mixture of NHS and Private Patients on an outpatient, inpatient and day case basis. Patients can access a wide range of services at BMI Huddersfield Hospital through the NHS choose and book scheme ,in addition to the Choose and Book scheme, the hospital has performed spot purchase work from the local trusts in the area. Year 2014-2015 the hospital treated 3247 patients 75.8% of these patients being NHS patients and 24.2% private patients. In 2014 -15 work has been completed to repair windows that will provide improved insulation,, and added security on the ground floor. The main stair case in the hospital has recently been refurbished. There is an ongoing commitment to ensure that theatre equipment is being replaced when required to ensure that Consultants have the most up to date and reliable equipment available to them. 2 A new ultrasound room has been created and decorated to complement the ultrasound machine which was purchased in 2013-14 in the imaging department. BMI Huddersfield Hospital offers the following specialties and services: Acupuncture Imaging Allergy testing - Mammography Anaesthetics - MRI scanning - Ultrasound Cardiology - X-ray Chest medicine Colorectal surgery Neurology Colposcopy Ophthalmology Cosmetic surgery Optometry Dermatology Oral/maxillofacial surgery Endocrinology Orthopedic surgery Endoscopy Physiotherapy ENT surgery Plastic and reconstructive surgery Erectile dysfunction Pre-admission clinic Family Planning Psychiatry Gastroenterology Radiology General medicine Respiratory medicine General surgery Rheumatology Geriatric medicine Sports injury clinic Gynecology Urology Vascular surgery 3 BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the Health & Social Care Act 2008. BMI Huddersfield is registered as a location for the following regulated services:• • • Treatment of disease, disorder and injury Surgical procedures Diagnostic and screening The CQC carried out an unannounced inspection on 10/12/13 and found compliance with the following standards: Huddersfield Hospital has a local framework through which clinical effectiveness, clinical incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to continuously improve the quality of care. This is through the work of a multidisciplinary group and the Medical Advisory Committee. Regional Clinical Quality Assurance Groups monitor and analyze trends and ensure that the quality improvements are operationalised. There has been development of At corporate level the Clinical Governance Board has an overview and provides the strategic leadership for corporate learning and quality improvement. There has been ongoing focus on robust reporting of all incidents, near misses and outcomes. Data quality has been improved by ongoing training and database improvements. New reporting modules have increased the speed at which reports are available and the range of fields for analysis. This ensures the availability of information for effective clinical governance with implementation of appropriate actions to prevent recurrences in order to improve quality and safety for patients, visitors and staff. 4 At present we provide full, standardised information to the NHS, including coding of procedures, diagnoses and co-morbidities and PROMs for NHS patients.There are additional external reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where we produce a data set of all patient episodes approaching HES-equivalency and submit this to PHIN for publication. The data is made available to common standards for inclusion in comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website gives patients information to help them choose or find out more about an independent hospital including the ability to search by location and procedure. 1. Safety 1.1 Infection prevention and control The focus on infection prevention and control continues under the leadership of the Group Head of Infection Prevention and Control, in liaison with the link nurse in Huddersfield The focus on infection prevention and control continues under the leadership of the Group Director of Infection Prevention and Control and Group Head of Infection Prevention and Control, in liaison with the Infection Prevention and Control Lead Huddersfield. We have had: • Zero MRSA bacteraemia cases/100,000 bed days • Zero MSSA bacteraemia cases /100,000 bed days • Zero E.coli bacteraemia cases/ 100,000 bed days • Zero of hospital apportioned Clostridium difficile in the last 12 months. • SSI data is also collected and submitted to Public Health England for Orthopaedic surgical procedures. Our rates of infection are; o Zero Hips o Zero Knees 5 As per DH recommendations BMI Huddersfield Hospital has appointed a Director of Infection Prevention and Control (DIPC) at each Hospital site, who is supported by a Consultant Microbiologist, Infection Prevention Nurse (IPN) and link workers. The site Infection Prevention team meets quarterly to discuss all matters relating to IPC including water safety, decontamination, infection issues and Root Cause Analyses (RCA) and surveillance, and full Committee meetings being held three times per year. Full environmental audits have been undertaken in the last year on the ward, theatre and in the Consulting Rooms. Action plans were completed which have been followed up by the respective link practitioners and Heads of Department, and IPN. Audit results and action plans are discussed at both hospital and Committee meetings. The hospital has completed its PLACE audit. Hand hygiene audits are scheduled to take place in all clinical departments on a monthly basis. IPC is included in the mandatory training requirements for all clinical and non-clinical staff and incorporates e-learning, face-to-face interactive presentations and practical assessments. The hospital team has implemented the peripheral cannula, surgical site infection (SSI) and indwelling catheter care bundles and a high level of consistent practice was demonstrated in the audit results. Environmental cleanliness is also an important factor in infection prevention and our patients rate the cleanliness of our facilities highly. 6 1.2 Patient Led Assessment of the Care Environment (PLACE) We believe a patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient environment, replacing the old Patient Environment Action Team (PEAT) inspections. The assessments involve patients and staff who assess the hospital and how the environment supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or how well staff are doing their job. The results will show how hospitals are performing nationally and locally. The below shows the results of the 2014 and 2015 audits and improvement in all areas. 7 .1.3 Venous Thrombo-embolism (VTE) BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its whole network of hospitals including, Huddersfield BMI Healthcare was awarded the Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the Runners up in the Best VTE Patient Information category. We see this as an important initiative to further assure patient safety and care. We audit our compliance with our requirement to VTE risk assessment every patient who is admitted to our facility and the results of our audit on this has shown BMI The Huddersfield hospital has had a 0% incidence of VTE in this reporting year. Huddersfield Hospital reports the incidence of Venous Thromboembolism (VTE) through the corporate clinical incident system. It is acknowledged that the challenge is receiving information for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE post discharge from the Hospital. As such we may not be made aware of them. We continue to work with our Consultants and referrers in order to ensure that we have as much data as possible. . 8 The hospital now has a dedicated VTE link nurse who is working closely with consultants to ensure that hospital policies and procedures are in line with current best practice guidelines and a clear process is followed to ensure all patients are appropriately risk assessed prior to theatre. 2. Effectiveness 2.1 Patient reported Outcomes (PROMS) Patient Reported Outcome Measures (PROMs) are a means of collecting information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves. PROMs is a Department of Health led program. Latest results can be found by going on the online SOLAR system provided to you by Quality Health For the current reporting period, the tables below demonstrate that the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing hip replacement and knee replacement at BMI The Huddersfield Hospital. The results for both hip and knee PROMS are higher than the national average and for knees the results are significantly higher. The consistently high results are a result of excellent patient experience and our team approach to care from the initial consultant appointment to consultant delivered surgery through to physiotherapist led discharge. April 14 – September 14 BMI Huddersfield England Oxford Hip Score average Health gain between reporting Q1 Q2 periods No data No data 18.16 40.081 21.922 Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved. April 14 – September 14 BMI Huddersfield England Oxford Hip Score average Health gain between reporting Q1 Q2 periods 15.7 23.3 39 18.16 40.081 21.922 Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved. 9 2.2 Enhanced Recovery Programme (ERP) The ERP is about improving patient outcomes and speeding up a patient’s recovery after surgery. ERP focuses on making sure patients are active participants in their own recovery and always receive evidence based care at the right time. It is often referred to as rapid recovery, is a new, evidence-based model of care that creates fitter patients who recover faster from major surgery. It is the modern way for treating patients where day surgery is not appropriate. ERP is based on the following principles:1. All Patients are on a pathway of care a. Following best practice models of evidenced based care b. Reduced length of stay 2. Patient Preparation a. Pre Admission assessment undertaken b. Group Education sessions c. Optimizing the patient prior to admission – i.e HB optimisation, control comorbidities, medication assessment – stopping medication plan. d. Commencement of discharge planning 3. Proactive patient management a. Maintaining good pre-operative hydration b. Minimising the risk of post-operative nausea and vomiting c. Maintaining normothermia pre and post operatively d. Early mobilisation 4. Encouraging patients have an active role in their recovery a. Participate in the decision making process prior to surgery b. Education of patient and family c. Setting own goals daily d. Participate in their discharge planning BMI Huddersfield Hospital has a multidisciplinary team of professionals who deliver a successful ERP pathway of care to patients. There is a dedicated Pre Assessment team who manage patient expectation regarding length of stay and commence the discharge process before patients are admitted, ensuring all their home care needs are met and any intervention required post discharge is pre- planned. We have a team of physiotherapists who work closely with the Consultants to promote early and continued mobilization of patients post operatively. Our current statistics show our average length of stay, year to date for knee replacements is 2.33 days 10 2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre. Unplanned readmissions and unplanned returns to theatre are normally due to a clinical complication related to the original surgery. 11 There were 4 unplanned readmissions to The BMI Huddersfield. All such incidents are investigated and reported through the hospital’s governance structure and reviewed at the Governance Committee There was two unplanned return to theatre. At BMI Huddersfield there have been very few returns to theatre or re admissions within 31 days and the data shows a reduction in both cases over the last 12 months. 3. Patient experience 3.1 Patient satisfaction BMI Healthcare is committed to providing the highest levels of quality of care to all of our patients. We continually monitor how we are performing by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third party. The following 4 tables are examples of just some of the key questions within the survey and The BMI Huddersfield performance over a rolling 12 month period. The hospital discusses the 12 reports at the Operational Team and Hospital Governance meetings. Specific actions that might be required are agreed at either forum. 13 100% of the inpatients would recommend the the hospital and this has remained fairly stable throught the year 2014-2015 When considering both very good and excellent, the overall impression of nursing care has remained consistently around and above 80%. The ward has now a new ward manager and part of the managers objectives are to increase a higher standartd of nursing by looking at new ways of working 3.2 Complaints In addition to providing all patients with an opportunity to complete a satisfaction survey BMI Huddersfield actively encourages feedback both informally and formally. Patients are supported through a robust complaints procedure, operated over three stages: Stage 1: Hospital resolution Stage 2: Corporate resolution Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied with the outcome at the other 2 stages. There is a very clearly defined complaints procedure which ensures complaints are dealt with promptly and professionally. The hospital Executive Director personally responds to every customer who has a complaint. The hospital has a structured lessons learned process whereby the outcomes of complaints are communicated to staff to ensure correct policy and procedures are being followed at all times. 14 The data above shows that BMI Huddersfield Hospital experienced a decrease in last year but an increase in the number of written complaints. Although the data demonstrates that significantly less than one percent of admitted patients complain we do take all complaints seriously and treat each as an individual learning opportunity,the majority of complaints can be categorised into two trends. One administrative errors and the other nursing care. Our administration team is now fully recruited and new process have been put in place, a robust training induction and training package has also been undertaken to ensure consistent adherence to the administrative processes. A new ward manager is now in post, part of their objectives is to look at training and development needs for her nursing team and also how to improve on patient needs and care. 4. CQUINS 5. The key aim of the Commissioning for Quality and Innovation (CQUIN) framework for 2013/14 was to secure improvements in quality of services and better outcomes for patients. These remain the same for 2014/15 BMI Huddersfield Hospital work closely with the local Care Commissioning Group(CCG) to agree local targets that reflect the local patient demographic. Regular meetings are held with the CCG to monitor progress of agreed targets. This year’s local CQUIN measures included implementation of 48 hour post discharge call for day case patients and brief intervention for those patients identified as drinking more than the recommended weekly consumption of alcohol. The tables below give a summary of the CQUIN data for BMI Huddersfield Hospital during 2014/15. The first table gives a summary of the goals for the 2013/14 CQUINS followed by the results the hospital achieved. 15 Goal Name Friends and Family Test NHS Safety Thermometer Description of Goal To improve the experience in line with Domain 4 of the NHS Outcomes Framework Improve the collection of data in realtion to pressure ulcers, falls, urinary tract infections in those with a catheter and VTE Venous Thromboembolism To reduce avoidable death, disability and chronic health from venous thromboembolism (VTE) Contact with Day Case pts To improve the outcomes for patients undergoing day-case surgery through contacting them 48 hours post surgery Well being - alcohol To ensure that patients are given brief advice around alcohol consumption and/or sign-posted/referred to appropriate services 6. National Clinical Audits BMI Huddersfield Hospital was only eligible to participate in National Joint Registry audit and all joint replacements are submitted to this. The hospital shows good compliance with data input into the register with 100% of eligible patients giving consent for their data to be used in the register and 100% link-ability to the patients NHS number. Looking forward to the next 12 months the BMI Huddersfield Hospital will continually strive to to achieve 100% on the above areas together with further key aims to ensure continued compliance with data input into the National joint Registry; • To provide high quality and relevant data in line with the National Joint Registry’s mission statement 16 • To set up Key Performance Indicators in line with the key quality indicators of Compliance, Consent and Link-ability. • To respond to National Joint Registry’s requested information within the agreed timescales. • To improve performance in the key quality indicators in line with National averages 7. Research No NHS patients were recruited to take part in research. 8. Priorities for service development and improvement • • Following an initial review of the priorities for service development, over the last 12 months the BMI Huddersfield Hospital now has ongoing improvement, development and engagement with the Clinical Governance process and reporting tools at hospital and corporate level, capital investment has been made in equipment and instrument replacement, environmental and safety improvements have been made in clinical areas. These include: Operating Theatre improvements, patient bedroom upgrade/refurbishment, and Main staircase refurbishment. • A review is being carried out by the theatre manager and out patient’s manager of ambulatory care within the hospital and how this can be improved. This will require a review of environmental factors as well as the patient pathway. • A Minor Procedure Room in the hospital’s Consulting Rooms is being planned this offers a more comfortable and less stressful experience for patients in comparison to a full Operating Department pathway. • A development of a new spread sheet looking at the patients journey from their first visit to out patients to their discharge from the hospital, helping all who are involved in planning patient care. Continuing improvements to the way in which Safety, Health and the Environment (SHE) issues are reported through the implementation of sub groups and a wider understanding and implementation of audit. • • Intentional ward rounds will be carried out on the wards offering an improvement in patient care and better communication between patients and staff 17 • 9. Mandatory Quality Indicators 8.1 The value of the summary hospital-level mortality indicator (SHMI) for the (Huddersfield) for the reporting period. Unit 0% Reporting Periods (at least last two reporting periods) Oct 2012 – Jun 2014 National Average Highest National Score Lowest National Score 0.9987 1.1849 0.58345 8.2 The BMI Huddersfield patient reported outcome measures scores for (i) Groin hernia surgery Unit 0.127 Reporting Periods (at least last two reporting periods) Apr 14 – Sept 14 National Average Highest National Score Lowest National Score 0.0786 0.278 -0.112 The BMI Huddersfield considers that this data is as described for the following reasons The BMI Huddersfield score is above the national average. 18 (ii) Varicose vein surgery Unit No BMI Data Reporting Periods (at least last two reporting periods) Apr 14 – Sept 14 National Average Highest National Score Lowest National Score -7.395 -1.957 -12.571 There are no scores available for BMI Healthcare and therefore the BMI Huddersfield cannot be scored (iii) Hip replacement surgery Unit No Data Reporting Periods (at least last two reporting periods) Apr 14 – Sept 14 National Average Highest National Score Lowest National Score 21.542 28.6 9.714 The BMI Huddersfield considers that this data is as described as less than 30 patients went through the process and therefore cannot be scored. (iv) Knee replacement surgery during the reporting period. Unit 23.3 Reporting Periods (at least last two reporting periods) Apr 14 – Sept 14 National Average Highest National Score Lowest National Score 16.641 24.429 5.833 The BMI Huddersfield considers that this data is as described for the following reasons With an above national average score the enhanced recovery program at the hospital is contributing to good patient outcomes, this program will continue to be developed further. 8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital which forms part of the BMI Huddersfield within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period. Unit 0% Reporting Periods (at least last two reporting periods) Apr 11 - Mar 12 National Average Highest National Score Lowest National Score 11.45 14.35 7.96 The BMI Huddersfield considers that this data is as described for the following reasons. The BMI Huddersfield does not admit or treat any patients in this age group. 19 8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of the BMI Huddersfield within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period. Unit 0.25% Reporting Periods (at least last two reporting periods) Apr 11 – Mar 12 National Average Highest National Score Lowest National Score 10.01 14.51 5.54 The BMI Huddersfield considers that this data is as described for the following reasons. Good pre assessment screening and post anaesthetic care results in a low readmission rate. 8.4 The BMI Huddersfield responsiveness to the personal needs of its patients during the reporting period. Unit 97.2% Reporting Periods (at least last two reporting periods) 2013-2014 National Average Highest National Score Lowest National Score 68.7 85 54.4 The BMI H considers that this data is as described for the following reasons this t reflects the overall satisfaction of our patients. A focus on providing a high standard of customer care to all our patients results in high levels of patient satisfaction. 8.5 The percentage of patients who were admitted to The BMI Huddersfield and who were risk assessed for venous thromboembolism during the reporting period. Unit 100% Reporting Periods (at least last two reporting periods) Apr 14 – Jan 15 National Average Highest National Score Lowest National Score 95 100 87 The BMI Huddersfield considers that this data is as described for the following reasons A dedicated team of skilled nurses are receive regular training on the prevention of VTE following surgery and monthly audits are carried out to ensure continued compliance 20 8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the BMI Huddersfield amongst patients aged 2 or over during the reporting period. Unit 0 Reporting Periods (at least last two reporting periods) Apr 13 – Mar 14 National Average Highest National Score Lowest National Score 14.7 37.1 0 The BMI Huddersfield considers that this data is as described for the following reasons There is a dedicated infection control nurse who delivers regular training throughout the hospital. The Patient bedrooms and bathrooms are single patients use and hand washing facilities are readily available with education on hand washing techniques displayed throughout the hospital. 8.7 The number and, where available, rate of patient safety incidents reported within the BMI Huddersfield during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. Number of patient safety incidents reported Unit 45 Reporting Periods (at least last two reporting periods) Oct 13 – Sep 14 National Average Highest National Score Lowest National Score 20 139 0 Rate of patient safety incidents reported (Incidents per 100 Bed Days) Unit 3.2636 Reporting Periods (at least last two reporting periods) Oct 13 – Sep 14 National Average Highest National Score Lowest National Score 3.589 7.496 0.0245 Number of patient safety incidents that resulted in severe harm or death Unit 0 Reporting Periods (at least last two reporting periods) Oct 13 – Sept 14 National Average Highest National Score Lowest National Score 40.2 97 0 Percentage of patient safety incidents that resulted in severe harm or death (Incidents per 100 Admissions) 21 Unit 0% Reporting Periods (at least last two reporting periods) Oct 13 – Sept 14 National Average Highest National Score Lowest National Score 0.3 2.4 0.0 The BMI Huddersfield that this data is as described for the following reasons. There is a robust process for the reporting and investigating of incidents. This includes the reporting of cancellations of surgery and day cases who stay overnight as clinical incidents. There have been no serious untoward incidents or never events. 8.8 The percentage of staff employed by the BMI Huddersfield during the reporting period, who would recommend the BMI Huddersfield as a provider of care to their family or friends. Unit 68% Reporting Periods (at least last two reporting periods) 2014 National Average Highest National Score Lowest National Score 64.58 96.43 33.73 The BMI Huddersfield considers that this data is as described for the following reasons The above data and below notes are taken from 2013 audit as no staff survey has taken place for 2014-2015 Although we are scoring above the national average BMI Huddersfield Hospital will be improving communications with our staff in a variety of ways including staff forums, departmental meetings and information sharing via email to ensure they are engaged with developments in the hospital. 10. Non-Mandatory Quality Indicators 9.1 The percentage of patients who received care as inpatients or discharged from A &E during the reporting period, who would recommend the BMI Huddersfield as a provider of care to their family or friends. Unit 78% Reporting Periods (at least last two reporting periods) Jun 13 – Jan 14 National Average Highest National Score Lowest National Score 66.23 94.38 35.63 The BMI Huddersfield considers that this data is as described for the following reasons Although we are scoring above the National average the BMI Huddersfield Hospital will continue to seek feedback from our patients in a variety of ways to ensure we are listening to concerns 22 and actions are taken if there are specific areas within the hospital that have a downward trend in patient satisfaction. The BMI Huddersfield hospital continually endeavor’s to retain and improve its score. 23