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
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Hospital Information
Situated in the heart of Nottinghamshire, BMI The Park Hospital is the region’s largest private
hospital with 85 bedrooms, all offering the privacy and comfort of en-suite facilities, satellite TV
and telephone.
BMI The Park Hospital is committed to providing high standards of quality, care and value. By
combining highly experienced doctors, nurses and high quality medical care with a calming
environment and what we consider to be five-star hospitality, our patients will be more relaxed,
and have a better experience which we hope will aid their recovery.
To ensure we deliver the best possible care, we have made a significant investment in a new
suite of four operating theatres, fitted with state of the art digital technology, in addition to
endoscopy, recovery and anaesthetic facilities. Coupled with our new intensive care unit, our
theatres provide the perfect platform for our clinicians to carry out a wide range of procedures.
The Park Hospital also has a Cancer Centre, enabling the full cancer pathway from diagnosis,
treatment to end of life care to be undertaken. Investment into the imaging department has also
been undertaken in the past 12 months with a new wide bore MRI scanner. Within imaging we
also have CT, ultrasound, mammography and plain film modalities available.
NHS patients account for approximately 26% of the activity undertaken at The Park Hospital,
the majority of which is undertaken under the Choose and Book contract. Services offered
under Choose and Book include Ophthalmology (cataract), Orthopaedics (shoulder, hip, elbow,
knee, foot and ankle, hand and wrist), Gynaecology, Hernia repair, Urology (male and female
urology, including prostate surgery), Colorectal, Oral surgery, Podiatric surgery,
The Park Hospital has also worked closely during the year with local NHS Acute Trusts and the
Clinical Commissioning Groups to undertake additional work under the Generic Contract.
New services / developments between that have been undertaken in the previous 12 months
include:
•
Enhanced specialist nurse support for cancer patients and implementation of
complimentary therapies
2
•
•
Ongoing bedroom refurbishment
Refurbished imaging department.
The advantages of NHS patients receiving treatment at the Park Hospital include the service
being Consultant led, with fast access to diagnostics and physiotherapy. Further benefits
include very low infection rates, supported by the accommodation all being within single rooms.
BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the
Health & Social Care Act 2008. BMI The Park is registered as a location for the following
regulated services:Specialisms/services
•
Diagnostic and/or screening services
•
Family Planning services
•
Physical disabilities
•
Sensory impairments
•
Surgical procedures
•
Termination of pregnancy
•
Treatment of disease, disorder or injury
•
Caring for children (0 - 18yrs)
•
Caring for adults under 65 yrs
•
Caring for adults over 65 yrs
Future developments within the hospital include a new physiotherapy department and
refurbishment of the outpatient area.
The CQC carried out an unannounced inspection on 14th July 2014 and found to be fully
compliant. The report was published on 15th August 2014
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
BMI The Park 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 analyse trends and ensure that the
quality improvements are operationalised. At corporate level the Clinical Governance Board has
3
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.
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.
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 BMI The
Park.
We have had: • No MRSA bacteraemia cases/100,000 bed days
• No MSSA bacteraemia cases /100,000 bed days
• 13 E.coli bacteraemia cases/ 100,000 bed days
• 0 hospital apportioned Clostridium difficile /1,000 bed days.
4
• SSI data is also collected and submitted to Public Health England for Orthopaedic
surgical procedures. Our rates of infection are;
o Hips
there were no surgical site infections in hips replacements
o Knees
there was one surgical site infection in knee replacements which was
treated with the appropriate antibiotic and resolved
The hospital has undertaken audits across a number of different areas, specifically
focusing on:
• Hand hygiene
• Catheters
• Environmental
• Insertion of intravenous cannulas
Although we achieved high audit results, we continue to support our staff with focused
activities on hand hygiene, aseptic non touch technique and other infection prevention
activities.
Environmental cleanliness is also an important factor in infection prevention and our
patientsrate the cleanliness of our facilities highly.
The graph below details the patient satisfaction scores for 2014 – 2015 for room and
bathroom cleanliness scores of excellent and very good. There is a rolling programme for
refurbishment of the patient rooms/bathrooms.
1.2 Patient Led Assessment of the Care Environment (PLACE)
5
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 score for privacy and dignity is lower than anticipated due to the fact there are WC facilities
which have both male and female facilities within the same area, with mixed handwashing
facilities. This area is due to be refurbished, commencing June 15.
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, BMI The Park. BMI Healthcare was awarded the Best VTE
6
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 there was one patient who developed a
VTE following surgery and the RCA investigation showed that this was unavoidable, as
everything to prevent this from happening had been completed.
The Park 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.
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 programme.
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 The Park. Unfortunately we cannot compare our
7
results with the NHS as statistically there were not enough NHS patients who were treated at
The Park Hospital to make a comparison
April 14 – September 14
The Park
England
Oxford Hip Score average
Health gain between reporting
Q1
Q2
periods
No
score as
less
than 30
patients
No
score as
less
than 30
patients
No comparison can be made
18.16
40.081
21.922
Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved.
April 14 – September 14
The Park
England
Oxford Knee Score average
Health gain between reporting
Q1
Q2
periods
No
score as
less
than 30
patients
No
score as
less
than 30
patients
No comparison can be made
19.401
36.103
16.702
Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved.
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
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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
The Park Hospital has a hospital ERP Multidisciplinary team. This team has a lead
Orthopaedic Consultant Surgeon, Consultant Anaesthetist and includes representatives
from all relevant clinical depts.
The Park Hospital has previously implemented the following in relation to ERP:
• Best practice patient pathways
• ERP pain pathway
• Successful Carb loading pre-op implemented for THR/TKR for specific
surgeons, other key orthopaedic surgeons, colorectal surgeons
• Pre-operative Assessment Checklist issued to patient
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.
9
Unplanned Readmission within 31 days (Rate
per 100 Discharges)
0.450
0.4166
0.4112
0.400
0.3689
0.350
2009
0.300
2010
0.250
2011
0.200
2012
0.150
0.100
2013
0.0822
0.0495
0.050
2014
0.0381
0.0129
2015
2015
2014
2013
2012
2011
2010
2009
0.000
Both these categories of incidents tend to be when patients have returned with collections of
fluid or haematomas and need to have them drained.
For all other categories of incidents they are all subjected to in depth investigations, to ensure
that lesson can be learnt from them. These are discussed in all the governance forums from
ward to board to ensure improvement can be made.
10
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.
(There are no results from Sept 13 – Jan 14 as the Park Hospital participated in a postal pilot
and the results are not comparable)
Arrival Process
% of Excellent and Very Good
11
Nursing Care
% of Excellent and Very Good
Accommodation
% of Excellent and Very Good
12
Catering
% of Excellent and Very Good
Discharge Procedure
% of Excellent and Very Good
13
Quality of Care
% of Excellent and Very Good
% Met/Exceeded Expectations
14
3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI The
Park 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 have been 4 complaints from NHS patients this year, all of which have been resolved at
stage 1. There were no themes as the numbers were too small. The complaints related to the
following:
• the process of pre-operative assessment, and request to health care professional for
treatment prior to surgery.
• Access to appointments
• Advice on post op activity
• Surgery cancelled following advice from consultant anaesthetist, which the patient did
not agree with
The Park Hospital has reviewed all complaints received and has implemented
Areas that have been implemented to reduce complaints from other patients:
• ‘Intentional rounding’ has been implemented, to ensure that patients are getting
appropriate care as the hospital has all single rooms and some patient feel isolated.
• The rooms have been maintained under a programme of refurbishment.
15
•
•
•
A project to reduce the noise on the ward has recently commenced.
A falls strategy to reduce falls has been implemented with good effect.
Taped handover has been introduced to ensure that the ward staff time is used more
effectively at the bed side.
4. CQUINS
Agreed CQUINS for 2014/5 are as follows:
Indicators
Introduction of Friends and Family in OPD and
Day Case
Friends and Family Response Rate
Mental Capacity: % of patients > 75 years
asked the question
Performing nutritional risk assessments on all
patients
Falls: Identifying the number of patients who
had had falls in the past 12 months
Complaints: 12 complaints to be reviewed at
internal panel in Q2 and 3 at External panel in
Q3
Q1
Q2
Q3
Introduced
Q4
19.6
100
22.23
100
44.03
100
22.97
100
100
100
100
100
100
100
100
100
1
3
2
1
5. National Clinical Audits
The Park was only eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this.
Within the report dated 1st April 2014 - 6th March 2015. There are a total of 533 recorded
procedures:
•
•
•
•
54 in edit ie not fully submitted
326 with yes consent
146 with unknown consent
7 with declined consent.
The overall consent rate is 68% (326 yes consent/479 fully submitted records).
There was an internal meeting in relation to NJR on 19th December 2014 with the local NJR
representative. There has been a slight rise in the overall consent rate. The process for
recording the consent rate is being reviewed to improve the data
6. Research
No NHS patients were recruited to take part in research.
16
7. Priorities for service development and improvement
The Park Hospital is currently developing its Nurse Specialist Team and currently has the
following Nurse Specialists:
• Palliative Care
• Breast
• Colo-rectal (also covers breast and gynaecology)
The Park Hospital has also undertaken/is undertaking the following service developments:
• Continued development of MRI
• Enhanced complementary services within Oncology, including art therapy,
physiotherapy, aromatherapy
• Refurbishment of ward areas
• Development of new physiotherapy unit
• Refurbishment of outpatients/cardiology
• Development of dedicated ambulatory care area
• Development of pre-operative assessment team
8. Mandatory Quality Indicators
8.1 The value of the summary hospital-level mortality indicator (SHMI) for The Park Hospital 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
The Park Hospital considers that this data is as described for the following reasons:
There have been no unexpected deaths of patients in the year 14/15. There have been a
number of expected deaths from end of life disease, none of whom were NHS patients.
8.2 The Park’s patient reported outcome measures scores for
(i) Groin hernia surgery
Unit
Unable
to report
as there
were
fewer
than 30
NHS
patients
during
the year
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
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(ii) Varicose vein surgery
Unit
Please
note that
the data
provided
by
HSCIC
did not
give any
data in
terms of
Varicose
Veins
and
therefore
none can
be
reported.
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
National
Average
Highest National
Score
Lowest National
Score
21.542
28.6
9.714
(iii) Hip replacement surgery
Unit
Unable
to report
as there
were
fewer
than 30
NHS
patients
during
the year
Reporting Periods
(at least last two
reporting periods)
Apr 14 – Sept 14
18
(iv) Knee replacement surgery during the reporting period.
Unit
Unable
to report
as there
were
fewer
than 30
NHS
patients
during
the year
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
8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital which forms part of the
The Park Hospital within 28 days of being discharged from a hospital which forms part of the
hospital during the reporting period. NB: The Park does not offer NHS paediatric services
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
.
8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of
the Park Hospital within 28 days of being discharged from a hospital which forms part of the
hospital during the reporting period.
Unit
1
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 Park Hospital considers that this data is as described for the following reasons:
• the patient needed to have a collection of fluid drained to prevent infection
8.4 The Park Hospital’s responsiveness to the personal needs of its patients during the
reporting period.
Unit
97.8%
Reporting Periods
(at least last two
reporting periods)
2013-2014
National
Average
Highest National
Score
Lowest National
Score
68.7
85
54.4
19
The Park Hospital considers that this data is as described for the following reasons
The Park Hospital has taken the following actions to improve this response rate and so the
quality of its services, by ensuring that the patients have more opportunity to complete a
response form. The patient is encouraged to complete a form before they are discharged as
most patients do not follow up on their visit once they have left the hospital.
8.5 The percentage of patients who were admitted to The Park Hospital 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 Park considers that this data is as described for the following reasons, The patient are all
assessed at pre-operative assessment and again on the ward when they are admitted, unless
they fit the category of not being applicable.
8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the Park
Hospital 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
There have not been any C. Difficile hospital apportioned cases to report.
8.7 The number and, where available, rate of patient safety incidents reported within the Park
Hospital, 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
67
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
1.384
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
20
Number of patient safety incidents that resulted in severe harm or death
Unit
2
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)
Unit
0.17
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 Park Hospital considers that this data is as described for the following reasons:
• One patient fell out of bed and opened the newly operated knee joint.
• One patient was transferred out to the local NHS and suffered a cardiac arrest and
passed away.
The Park Hospital has written and implemented a falls strategy to reduce the numbers fall that
result in harm to the patient. There have not been any further serious falls since the
implementation.
The patient who passed away did not have any post operative complications and according to
the post mortem report, died of natural causes.
8.8 The percentage of staff employed by the The Park Hospital during the reporting period, who
would recommend the The Park Hospital as a provider of care to their family or friends.
Unit
79%
Reporting Periods
(at least last two
reporting periods)
2014
National
Average
Highest National
Score
Lowest National
Score
64.58
96.43
33.73
9.0 Non-Mandatory Quality Indicators
9.1 The percentage of patients who received care as inpatients during the reporting period, who
would recommend the Park as a provider of care to their family or friends.
Unit
83.92
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
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