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 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 8 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 17 (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 21