Quality
Account
2012- 13
Professional Care, Exceptional Quality
QUALITY ACCOUNT 2012-2013
Contents
Page
Part One
Statement on quality from the Chief Executive of the Trust
3
Part Two
Priorities for improvement and statements of assurance from the Board
6
Patient Safety
Patient Experience
Clinical Effectiveness
7
11
14
Mandatory declarations and assurances
Review of services
Participation in clinical audits
Participation in National Confidential Enquiries
Local initiatives in clinical audit
Participation in clinical research
Goals agreed with the Commissioners
26
26
28
31
33
35
36
What others say about us:
The Care Quality Commission (CQC)
The National Health Service Litigation Authority (NHSLA)
38
41
Data Quality
Information Governance Toolkit attainment level
Clinical Coding error rate
Department of Health Core Quality Indicators
41
41
42
42
Part Three
Other information
How we performed on Quality in 2012/13
51
Safety and Efficiency
Midwifery Award
Improved Clinical Effectiveness – Endobronchial Ultrasound
Patient Dignity
Service Improvement
Falls
Complaints
NICE Standards compliance
Workforce
‘Our Behaviours’
Annexes
Statements from other organisations
51
51
52
53
53
54
55
57
58
61
62
Dartford Gravesham and Swanley Clinical Commissioning Group
Medway Healthwatch
Kent County Council Overview and Scrutiny Committee (HOSC)
Trust response to comments from other organisations.
2) Statement of directors’ responsibilities in respect of the Quality Account
65
3) Independent auditors opinion
66
How you can comment on this Quality Account
By email – glyn.oakley@dvh.nhs.uk
By letter – Susan Acott, Chief Executive, Darent Valley Hospital, Dartford, Kent DA2 8DA
2
Part One
Statement on quality from the Chief Executive of the Trust
I am pleased to be writing the introduction to the 2012/13 Trust Quality Account which gives me an opportunity to
tell you how we have concluded the year with strong performance in all Trust key areas of responsibilities.
•
•
•
•
•
•
The Trust has finished with a small surplus of £361k.
The key deliverables on 18 weeks and the A&E target have been met.
The cancer trajectory has returned to target following detailed demand and capacity work earlier in
the year
The very demanding target on MRSA bacteraemia has been met; our clostridium difficile numbers
continue to decline although we just missed the target.
The nursing strategy is embedded and key workforce targets are in good shape.
Crude mortality rates have continued their downward trend.
Given the operational pressure faced by the Trust, this is a huge achievement. The tight control and effective
management of our resources has given us a stable financial position from which we have been able invest in
many new staff, services and equipment.
The quality of patient care has developed further during the year, notably illustrated by a continuing fall in our
mortality figures. This has been achieved through a focus on critically ill and deteriorating patients; a focus on
the rapid treatment of sepsis; a focus on patients with a hip fracture; and improving the handover of patients
between medical teams.
Patient experience has been targeted through the launch of the Nursing & Midwifery strategy in February and
the ‘Our Behaviours’ strategy which has become a touchstone for all staff. The impact has been significant. We
have had an enormous number of letters and emails from patients wanting to tell us how thoughtful and
compassionate their care has been.
The NHS has been the focus of much public and media attention recently with the publication of the Francis
report into care at the Mid Staffordshire Foundation Trust. It is absolutely right that there should be scrutiny and
the conclusions of the Francis report will change the way in which the NHS delivers care.
I have been asked whether, as Chief Executive, I could be 100% certain that I didn’t have a ‘Mid Staffs’
occurring. I replied that I was 100% certain because – firstly, our values and principles as an organisation show
through in all our staff. Secondly, we have an experienced Board which scrutinise all of the information available
to it and effectively holds the Executive Team to account on quality and delivery. Lastly, we have an open culture
which means staff are not afraid to tell their senior colleagues what is occurring and never afraid to raise
concerns or issues, if necessary with me, the Executive Team or the Chairman. I am absolutely confident that
the overall quality of care here at Darent Valley is high and delivered by staff who are committed to the care of
patients and to the organisation.
It is my hope and expectation that this Quality Account will provide the evidence needed by you, the reader, to
give you the assurance necessary about the safety, quality and priorities of this Trust.
The Trust Board takes a direct interest in the experiences of patients who use out services. Every other month a
patient now comes to the Board and tells us how, as a hospital, we have treated them and how they feel about
that. These patient stories are both good and bad, and I believe we can learn just as much from both.
One lady, accompanied by her husband, told us her story. She had suffered a second heart attack and was very
frightened as a result. Listening to her, it was clear that everyone she had come into contact with had treated her
with respect, dignity, and consideration. The kindness she and her family were shown in their hours of fear and
need, stayed with them. The cups of tea offered, the gentle words from the nursing staff who always used their
names, the junior doctor who had all the time in the world to explain and explain again, the catering staff who
served good food. The fact that her husband was kept informed and not isolated from her. The cardiac
rehabilitation team who were always on the end of the phone.
This lady mentioned everyone from medical staff to the cleaning staff. All had touched her and she had good
memories of her whole experience as a result. She was very grateful and very confident in the hospital and its
staff and I was very proud to hear her story. This and other stories we have heard have served to emphasise the
3
emotional connection the hospital and its staff must have with their patients if we are to offer continuous high
quality care over the long term.
In part two of this Quality Account you will see in more detail what we will do in the year ahead to further improve
quality and safety. We have kept the focus on Patient Safety, Patient Experience and Clinical Effectiveness. The
Trust Board has set three priorities in each area. For Patient Safety these are; Harm Free Care as measured by
the NHS Safety Thermometer; a continued focus on reducing mortality and, in Radiology, improving reporting
times in CT and MRI scanning.
The priorities for Patient Experience will be to reduce the number of Outpatient appointments cancelled by the
Trust; to improve the experience of patients using the Emergency Department and thirdly to improve the patient
experience when people are discharged from the hospital.
Clinical Effectiveness is another priority for us. Specifically, we will work on improving care for the many frail
elderly people who are admitted to our hospital. This means ensuring patients are admitted straightaway to the
right ward; for example, to the Stroke Ward, or started promptly on the hip fracture pathway. In Maternity care we
will focus on the Midwife to birth ratio, the induction of labour rate and the Caesarian section rate. The third
priority area for Clinical Effectiveness will be to improve aspects of the Paediatric service.
Also in part two you will find the mandatory sections of the Quality Account that all Trusts must publish. We have
indicated in the text where these occur.
We have also reported on the outcomes and achievements of the last year, in particular the priorities we set
ourselves for 2012/13. We have ensured that 95% of inpatients, over the age of 16, have been assessed for
their risk of developing a blood clot.
The prevention and control of infection has been continued as a priority and we have achieved the target for
meticillin resistant staphylococcus aureus (MRSA) bacteraemias. However, the Trust missed the C-difficile target
by four cases and an action plan has been put in place to maintain pressure on this challenging target.
The Dementia Buddy scheme has been a big part of our work on the priority to improve the care of patients with
dementia in our hospital. Inspired by Ann Aldous-Dunn, a Public Governor, the project includes a fresh look at
the ward environment as well as recruiting volunteers to provide support for patients admitted who have
dementia.
There have been several new developments in patient care this year. In December 2012 the new Level 1 unit
opened on Laurel Ward. This unit provides care which is a step down from Intensive Care but more specialised
than the general ward.
The Evergreen Unit provides a specialist, one stop service for older patients presenting in the Emergency
Department or referred from their GP. This comprehensive assessment service is Consultant led with
multidisciplinary input available.
This year at Darent Valley we became the first hospital in Kent to introduce an Endobronchial Ultrasound
(EBUS) service. This is a new technique that helps with the diagnosis of lung cancer and other non-malignant
(non cancerous) and infective conditions. Our patients no longer need to travel to London but can have the
examination provided locally.
Key successes have also been the improvements in nutrition and meal delivery. In terms of challenges,
producing hundreds of meals every day is not one most of us would accept. However, that is what Alan Hinds;
our Catering Manager has to do. Hospital food is generally not known for hitting the mark. However, Alan,
working with our dieticians, has improved the menu for our patients and in an attempt to get more feedback and
greater awareness, took his meal service to the front entrance foyer. Visitors and patients were able to sample to
food and give their feedback. This was a well received and useful experiment.
We recognise that some health services are required seven days a week and so this year we have reviewed the
work patterns for many staff groups. Surgeons, Anaesthetists, Physicians, Radiologists, Matrons, Therapists and
senior managers have all changed their patterns of work. Consultant colleagues have moved to six or seven day
working, both to improve patient safety and assist in the flow of patient activity.
In May 2012, as Radiology replaced its aging MRI scanner with the very latest digital broadband MR scanner
with wide bore technology, the Trust received a Caspe Healthcare Knowledge Systems (CHKS) top hospitals
award. These awards are based on an evaluation of the key indicators of safety, clinical effectiveness, efficiency,
patient experience, quality of care and health outcomes.
4
The achievements of our staff have also been recognised externally this year. I am proud to be able to say that
one of our midwives, Sharon Hurst, won a top prize for excellence at the Royal College of Midwives annual
awards for her work supporting bereaved parents. Her prize will enable the Trust to provide counselling skills
training for other midwives.
In addition, the Trust was a finalist in the prestigious HSJ Patient Safety Award for improving the management of
deteriorating patients and dramatically reducing cardiac arrest, thus reducing hospital mortality.
We held another Quality Showcase event this year where a number of our staff gave oral presentations or
poster presentations on the quality of services they are providing and developing.
As winter approached, we opened new capacity and given the expansion in nursing staff this required, we
recruited nurses from Portugal to help boost our numbers. They have adapted very well and colleagues have
found them to be highly skilled and compassionate professionals.
You will also find in this Quality Account the results of the annual NHS national staff survey published by the
Care Quality Commission in March 2012. The results show that, despite moving through a period of significant
change, staff engagement and motivation were above average levels scoring within the top 20% in the country,
with “staff feeling they have the ability to contribute at work”.
Our staff are very proud of working in a Trust which is delivering all of its key targets, which is working hard to
improve quality and patient safety, and which is looking to expand services for the benefits of the growing
numbers of patients we serve.
Our staff have a hugely beneficial impact on patients clinically, socially and emotionally. I would like to thank all
the Trust’s staff, whichever role they fulfil, for delivering care to more patients than ever, with skill, kindness,
intellect and compassion. At the same time we have hit our required targets and delivered a stable financial
position. Not bad for a years’ work.
To the best of my knowledge the information in this report is accurate.
Susan Acott
Chief Executive
Dartford and Gravesham NHS Trust
5
Part Two
Priorities for improvement and statements of assurance from the Trust Board for the
2012/13 Quality Account
In the previous Quality Account the priorities were set for 2012/13 on the basis of feedback
from staff, Governors, patients and commissioners.
The themes decided by the Board were:
•
•
•
Patient safety
Patient experience
Clinical effectiveness
These were linked to the Commissioning for Quality and Innovation (CQUIN) payment
framework and other contractual quality mechanisms the priority being to ensure that no
patient suffers avoidable harm or complications whilst in our care.
For 2012/13, the Trust agreed an overarching quality strategy, which aimed to capture the
emotional connection for staff with the work that they do: ‘Quality – it’s personal’
This means that we needed to be more ambitious, to ensure that patients consistently
received the ‘professional care and exceptional quality’ that is our aspiration. We have
worked to deliver quality proactively, rather than reacting to events.
The strategy for improving services had four key strands:
•
Listening:
o Listening to patients’ experiences, both good and bad, seeing the care we provide
from their perspective – putting ourselves in their shoes.
o Listening to patients and relatives when they tell us about their symptoms and
histories, respecting their knowledge and expertise about their condition.
•
Getting the basics right: doing the essential things well, every time.
o Proper clinical examinations.
o Good documentation.
o Following national and local guidance.
o Showing empathy when dealing with patients.
•
Leadership:
o Using the ‘12 pillars of quality’ agreed at the Clinical Directors’ away-day.
o Implementing the agreed Trust ‘Our Behaviours’ at management level.
•
Pride:
o Instilling pride where things go well.
o Having sufficient pride in our standards, so that we tackle poor care when it
occurs.
6
An action plan was developed which encompassed all the agreed improvement and
development work required to achieve the aims of the Quality Strategy. This plan has been
regularly monitored and reported through the Quality and Safety Committee to the Trust
Board. The completed plan was presented to the April 2013 meeting of the Quality & Safety
Committee.
At year end a review of the Action Plan reveals that of the twenty six elements, under the four
headings, five are partially achieved and the remainder have all been achieved and in some
instances exceeded. To achieve this has required focus and support from colleagues from all
clinical & managerial disciplines to achieve:
• Changes to long held patterns of working.
• Innovation supported by Quality, Innovation, Productivity and Prevention (QIPP) plans.
• Incorporation of Commissioning for Quality and Improvement (CQUIN) priorities
/targets & cross organisation co-operation.
• Planning and implementation.
As lead for this piece of work the Director of Nursing would wish to express her thanks for the
support which has been so freely given.
Results and achievements for the 2012/13 Quality Account priorities
A) PATIENT SAFETY
Priority 1: To improve the percentage of admitted patients, over the age of 16 years,
who have a risk assessment for Venous Thromboembolism (VTE). This priority has
been monitored by the Quality and Safety Committee and is reported to the PCT in the
framework of the quarterly quality monitoring meetings.
Priority 1: achieved.
There are 25,000 preventable deaths that occur in UK hospitals every year due to venous
thrombosis (clot in a vein) or pulmonary embolism (clot in the lung). Each patient, over the
age of 16, admitted for care in our hospital will have an assessment to determine their risk of
developing a blood clot and, if necessary, will be given preventative treatment to minimise this
risk. This will be monitored externally by the Department of Health and NHS Kent and
Medway.
Risk assessment rates for Venous Thromboembolism (VTE) in 2012/13
Indicator
% Adults
VTE Risk
Assessed
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
FYTD
RAG
95%
95%
94%
94%
95%
96%
95%
95%
96%
96%
95%
96%
95%
G
Source – Dept of Health, Venous Thromboembolism (VTE) Risk Assessment data and locally validated data.
7
In the year 2012-2013 the requirement was as follows: - April to August 90% and from
September to March 95% of adult inpatients to be assessed for VTE risk. This priority was
achieved.
This indicator is measured in the data published by the Department of Health and in locally
validated information and is part of the NHS Outcomes Framework – Domain 5 ‘Treating and
caring for people in a safe environment and protecting them from avoidable harm’.
The Trust Executive lead for VTE is Ms Annette Schreiner, Medical Director.
Priority 2: To ensure that our patients are protected from hospital acquired infections
and to meet the targets for the number of Clostridium difficile (C-difficile) cases and
meticillin resistant staphylococcus aureus (MRSA) bacteraemias in 2012-2013 which
are hospital acquired. This priority has been monitored by the Infection Control
Committee and is reported to the PCT in the framework of the quarterly quality
monitoring meetings.
Priority 2: achieved except for C-difficile.
A bacteraemia is a bloodstream infection. The Trust was set a maximum of three cases of
meticillin resistant staphylococcus aureus (MRSA) bacteraemias and 20 cases of C-Difficile in
the year April 2012 to March 2013 before breaching the expected trajectory.
The following table shows internal Trust data on the number of cases of C-Difficile in
inpatients from April 2012- March 2013.
Year
2012-13
2011-12
Apr
2
1
Table to show cases of C-difficile in 2012-13 and 2011-12
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
1
2
3
0
7
0
1
1
1
3
3
0
1
1
2
2
5
1
6
2
5
2
FYTD
24
28
RAG
R
R
Source – Trust locally validated data Apr 2011 – Mar 2013
The Trust has been proactive throughout the year with a robust C-difficile action plan in place.
Work has focussed on prompt and accurate assessment and screening of patients; staff
training; regular cleanliness and compliance audits and a review of the cleaning policies. For
most of the year these measures have been effective in managing the C-difficile target
however in August 2012 the Trust had seven cases and the total for the year breached the
target.
Table to show Health Protection Agency data on the number of cases of MRSA in
inpatients from April 2012- March 2013
Year
2012-13
2011-12
Trust apportioned MRSA cases inpatients in 2012-13 and 2011-12
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
0
0
0
0
0
0
0
0
0
0
2
1
0
1
0
0
0
0
1
0
0
0
0
0
Source – Health Protection Agency, Mandatory surveillance of MRSA, NHS Acute trust Apr 2011- Mar 2013
8
FYTD
3
2
RAG
G
G
In 2012/13 there were three MRSA cases and this target was achieved.
This indicator is measured by data published by the Health Protection Agency and, month by
month, in locally validated Trust data and is part of the NHS Outcomes Framework – Domain
5 ‘Treating and caring for people in a safe environment and protecting them from avoidable
harm’.
The Trust Executive lead for Infection Control is Ms Annette Schreiner, Medical Director.
Priority 3: To record and report the rate of patient safety incidents and percentage
resulting in severe harm or death to the National Reporting and Learning System. This
will be measured by the number of incidents reported and published in National
Reporting and Learning System reports. This priority has been monitored by the
Quality and Safety Committee and is reported to the National Patient Safety Agency.
Priority 3: achieved.
The Trust reports incidents resulting in harm or death to the National Patient Safety Agency
for inclusion in the National Reporting and Learning System (NRLS). A report on the incident
types the Trust has reported is published twice yearly.
During the reporting period April to September 2012 the Trust reported 2,115 incidents to the
National Reporting and Learning System (NRLS), compared to 1,788 incidents in the same
period in 2011. Dartford and Gravesham NHS Trust is average in terms of the number of
incidents reported for this period with a reporting rate of 6.9 incidents reported per 100
admissions (which is comparable with the reporting rate for small acute trusts). The figures
reported for the previous four reporting periods can be seen on page 50.
Table to show incidents reported to the NPSA in 2012 and 2011
Trust reporting of incidents 2012 and 2011
Incidents reported
Reporting rate per 100
admissions
Apr-Sep 2012
2,115
6.9
Apr-Sep 2011
1,788
6.5
Understanding harm
Nationally, 67 per cent of incidents are reported as ‘no harm’, and just less than one per cent
as ‘severe harm’ or ‘death’. It is the actual harm to patients that is recorded rather than the
potential degree of harm.
Organisations that report more incidents usually have a better and more effective safety
culture. The Trust reported incidents to the NRLS in six out of the six months between April
2012 and September 2012 and is compliant with the requirement that incident reports should
be submitted to the NRLS each month.
9
For all small trusts fifty percent of all incidents were submitted to the NRLS more than 30 days
after the incident had occurred. In Dartford and Gravesham NHS Trust fifty percent of
incidents were submitted more than 16 days after the incident occurred. It is important that
incidents are reported promptly so that lessons can be learned and action taken to prevent
harm to others.
Table to show reporting rates for small acute trusts to the National Reporting and
Learning System (NRLS) in 2012/13
Source: National Recording and Learning System (NRLS)
Table to show incidents reported to the NRLS Apr –Sept 2012
Source - NHS Organisation Patient Safety Incident Reports (NRLS), Sept 2012.
10
Table to show degree of harm of reported patient safety incidents
Source - NHS Organisation Patient Safety Incident Reports (NRLS), Sept 2012.
This indicator is part of the NHS Outcomes Framework – Domain 5 ‘Treating and caring for
people in a safe environment and protecting them from avoidable harm’.
The Trust Executive lead for incident reporting is Ms Annette Schreiner, Medical Director.
B) PATIENT EXPERIENCE
Priority 1: To improve care for patients with dementia in our hospital. This priority has
been monitored by the Quality and Safety Committee.
Priority 1: achieved.
In 2012 the Trust launched the Dementia Buddy Project based on Ebony Ward where 60 –
75% of patients at any given time will have either a primary or secondary diagnosis of
dementia.
The key areas for action have been:
1) Environment
Clutter on the ward is kept to a minimum. The ward has been newly painted with each bay
and area of the ward painted a different colour to aid recognition of different locations. In
addition there are tables in each bay by the windows.
2) Culture
Staff maintain an atmosphere that is calm and positive whilst being professional and caring.
The ward routine is well structured and the Dementia Buddies help support a patient-centred
approach.
3) Communication
Nursing and medical staff are encouraged to take time to explain their actions and decisions
to patients and to answer questions. The Dementia Buddies promote different methods of
communication and can assist ward staff in explaining and answering questions regarding
care with patients and carers. They are also able to direct patients and their carers to support
services and information. This improved communication has received positive patient/carer
experience feedback.
4) Cognitive Stimulation
Previously patients with dementia might have been left to doze or stare into space and some
may become agitated. The Dementia Buddies carry out interactive activities with patients, for
example, looking at pictures and books, reading newspapers and chatting to patients. They
11
are able to act as escorts to patients who wander and provide company for patients who are
less mobile.
5) Meal times
Meal times are protected on the ward meaning that clinical interventions are discouraged
unless urgent. The ward uses the red tray and red jug lid system to indicate to staff and
buddies patients who will need help with eating and drinking so that meals can be presented
when the food is hot and appetising. The Dementia Buddies encourage patients to sit and eat
at dining tables and assist patients who need help with feeding.
The measurable outcomes are:
• Staff knowledge and awareness of dementia care improved.
• Positive Patient/carer experience feedback.
• Reduction in readmissions.
• Increase in discharges to own home.
• Reduction in length of stay for patients with dementia.
• Reduction in use of ‘specials’ (extra nursing staff).
• Additional assistance provided at meal times to support staff.
The impact of the Dementia Buddy project has been audited using an observational audit tool.
The baseline audit was carried out in May 2012 and a 6 month audit completed in December
2012 focussed on the four areas described above.
The results of the audit was presented to the Trust Quality and Safety Committee in February
2013.
The Trust Executive lead for dementia is Mrs Kate King, Interim Director of Nursing and from
April to October 2012 was Ms Jenny Kay.
Priority 2: To increase the percentage of staff who would recommend the Trust as a
provider to friends or family needing care. This priority has been monitored by the
Quality and Safety Committee and is reported in the NHS Staff Survey results.
Priority 2: achieved.
Within the NHS Staff Survey the indicator for staff recommending their workplace as a place
to receive treatment is included in questions about the organisation (Q12d). The Trust score
in 2012 indicated that 70% of staff said if a friend or relative needed treatment they would be
happy with the standard of care provided by this Trust*. This score was higher than the
previous year when it was 66%, and is above the national average of 60%.
Question 12d
% staff in
2012
Average for acute
trusts
% staff in
2011
70
60
66
"If a friend or relative needed treatment, I would
be happy with the standard of care provided by
this organisation"
*Source – 2012 National NHS staff survey, NHS Coordination Centre – tenth annual survey.
12
This indicator is measured in the outcomes from the 2012 National Staff Survey and is part of
the NHS Outcomes Framework - Domain 4: ‘Ensuring that people have a positive experience
of care’.
The Trust Executive lead for the staff survey is Mrs Jane Burr, Interim Director of Human
Resources.
Priority 3: To achieve a reduction in the number of Outpatient appointments that are
cancelled or rescheduled by the Trust. This priority has been monitored by the Quality
and Safety Committee.
Priority 3: achieved.
The cancellation or alteration of an outpatient appointment has been shown to be a source of
frustration and inconvenience for the people who use our services. The Trust has established
a baseline and has made it a priority for the Trust improvement team to work to reduce the
number of appointments which are changed by the Trust. The progress against the baseline
has been measured and recorded using the Trust’s data collection system and reported to the
Patient Experience Committee and the Quality and Safety Committee.
The table below shows total number of appointments cancelled by the Trust, across all
outpatient areas.
Table to show Outpatient appointments cancelled by the Trust in 2012/13
Month
Cancelled
Outpatient appointments cancelled or rescheduled by the Trust April 2012-March 2013
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
2380
2136
2044
2213
2147
2098
2290
2172
1923
2429 2236
% of total
9.44%
7.21%
8.57%
8.16%
8.16%
8.13%
7.78%
7.78%
8.40%
8.26%
8.74%
Source – Trust locally validated data Apr 2012 – Mar 2013
In 2011/12 the average cancellation rate over the year was 9.2% of appointments each
month. In 2012/13 the average cancellation rate had fallen to 8.27%
This indicator is measured using the monthly cancellation data submitted to the Trust
information system and is part of the NHS Outcomes Framework - Domain 4: ‘Ensuring that
people have a positive experience of care’.
The Trust Executive lead for patient experience is Mrs Kate King, Interim Director of Nursing
and from April to October 2012 was Ms Jenny Kay.
13
Mar
2261
8.65%
C) CLINICAL EFFECTIVENESS
Priority 1: To demonstrate a positive trend as measured by the Summary HospitalLevel Mortality Indicator (SHMI) and the Trust crude mortality rate. This priority has
been monitored by the Quality and Safety Committee and is reported to the PCT in the
framework of the quarterly quality monitoring meetings.
Priority 1: achieved.
Crude Mortality
This is the absolute mortality and is measured as the mortality rate as a percentage of
inpatients. The mortality rate is shown as a percentage and Caspe Healthcare Knowledge
Systems (CHKS) data enables a comparison with a peer group of similar trusts.
The mortality trend shows a stable mortality rate that is now lower than peer.
2011-12
2012-13
Trust Crude mortality 2011-13 compared to peer group
Deaths
Crude mortality %
1001
1.73
960
1.56
Peer %
1.71
1.70
Source: Caspe Healthcare Knowledge Systems
Summary Hospital-level Mortality Indicator (SHMI)
SHMI is a hospital-level indicator which reports mortality at trust level across the NHS in
England using standard and transparent methodology. This indicator is being produced and
published quarterly by the Health and Social Care Information Centre. Following the
recommendations of the Hospital Standardised Mortality Ratios (HSMR) Review, the
Department of Health committed to implementing the SHMI as the single hospital-level
indicator for the NHS.
An “average” hospital will have a SHMI of around 100. A SHMI of greater than 100 implies
more deaths occurred than predicted by the model.
SHMI Value and Banding
The SHMI is the ratio between the actual number of patients who die following a treatment at
a trust and the number that would be expected to die on the basis of average England
figures. It covers all deaths reported of patients who were admitted to acute, non-specialist
trusts in England and either die while in hospital or within 30 days of discharge.
SHMI = Actual Deaths / Expected Deaths
See also pages 21 and 43
14
For Dartford and Gravesham NHS Trust
Period
Spells
Actual
Deaths
Expected
Deaths
SHMI
Lower
Limit
Upper
Limit
Band
10/2010-09/2011
42269
1457
1316.114
1.107
0.876
1.142
2
01/2011-12/2011
45197
1445
1346.872
1.072
0.883
1.133
2
04/2011-03/2012
48128
1453
1412.685
1.029
0.887
1.127
2
07/2011-06/2012
50379
1458
1460.468
0.998
0.887
1.127
2
10/2011-09/2012
51074
1432
1486.233
0.964
0.889
1.124
2
Source - Summary Hospital - level Mortality Indicator (SHMI). NHS Health and Social Care Information Centre
The SHMI values are categorised into one of the following three bandings (i.e. SHMI value in
relation to Lower Limit and Upper Limit):
Band 1 – Where the trust’s mortality rate is ‘higher than expected’
Band 2 – Where the trust’s mortality rate is ‘as expected’
Band 3 – Where the trust’s mortality rate is ‘lower than expected’
It can be seen from the table above that Dartford and Gravesham NHS Trust SHMI banding is
Band 2 – ‘as expected’.
This indicator is measured by data published quarterly by the Health and Social Care
Information Centre and is part of the NHS Outcomes Framework - Domain 1: ‘Preventing
people from dying prematurely’.
The Trust Executive lead for clinical effectiveness is Ms Annette Schreiner, Medical Director.
Priority 2: Through the Enhancing Quality (EQ) Programme the Trust will continue to
improve care outcomes for patients in the established workstreams. The Trust will
participate in EQ new pathway initiatives and patient experience measures. This
priority has been monitored by the Quality and Safety Committee.
Priority 2: achieved.
The Enhancing Quality (EQ) Programme works by measuring evidence-based process
measures, using validated data and engaging clinicians in quality improvements.
It is a clinically-led programme which reduces variation and rapidly spreads innovation in the
adoption of NICE Quality Standards and Guidance. The result is streamlined care and
improved documentation making the care provided more consistent and reliable for every
patient, every time. This, in turn, improves outcomes such as mortality, length of stay,
complications and re-admissions. Results are benchmarked at organisational level and are
also available at ward level and individual consultant level.
15
The EQ Programme began data analysis with patients discharged from hospital in July 2010
and the programme is now reporting on the third year of activity. There are eleven trusts
participating in the EQ Programme in the South East Coast area.
The clinical conditions currently measured in EQ are:
• Heart Failure.
• Hip and Knee replacement surgery.
• Pneumonia.
• Dementia
• Acute Kidney Injury
• Patient Experience
EQ Pathways
Heart Failure
Hip and Knee
Community
acquired
Pneumonia
Dementia
RAG Rating
Green
Green
Green
Green
EQ Pathway improvements 2012/2013
A new heart failure specialist nurse was recruited at the
beginning of the year. This has resulted in better discharge
information being provided to patients. In January 2012 40% of
heart failure patients were receiving the appropriate discharge
information. In January 2013 this figured had improved to 93%
of patients.
The heart failure nurse provides an advice line for patient who
feel unwell or who have a worsening of their symptoms. The
advice given is effective in preventing inappropriate
admissions and aiding symptom management for patients.
The 30 day readmission rate has shown a reduction in the last
year.
An audit has commenced to review the mortality rate in
patients with heart failure and this audit will also consider the
support available to patients in the community.
In 2011 an internal audit of medication management for
elective orthopaedic patients identified an anomaly in the
documentation of times recorded for administration of drugs.
The development of the new drug chart (June 2012) and the
review of the national antibiotics guidelines has resulted in an
improvement in prescribing and administering antibiotics and
therefore in patient care.
All respiratory patients attending the Emergency Department
(ED) have a CURB-65* test (see below) completed and this
enables patients to be started on appropriate antibiotics
promptly. In January 2012 27% patients had their CURB-65
done which has improved to 75% completed in January 2013.
Joint working between the respiratory team and the ED staff
has improved the way the patients with community acquired
pneumonia are treated. Blood cultures are routinely taken
prior to antibiotics and antibiotics given within the first 6 hours.
Smoking cessation questions are also being asked regularly
and scores for this measure improved from 9% in January
2012 to 100% in January 2013. This has been matched by an
increase in the number of smoking cessation referrals made.
The Dementia Screening assessment is mandatory and a
national target. There has been a lot of collaborative working
between IT staff and clinical staff to achieve this. Written
discharge information is provided for all patients and 75% of
patients have an appointment to review their antipsychotic
medication by either the Consultant or their GP compared to
0% in Jan 2012.
16
Acute Kidney Injury
(AKI)
Patient satisfaction
Green
Green
A pharmacy checklist has been introduced to ensure the right
medication is being prescribed with appropriate reviews
planned. This follows the EQ agreed best practice targets.
Currently in the pilot phase, since September 2012; the Trust
is one of 5 trusts able to identify patients with acute kidney
injury. Currently the data collated for EQ has demonstrated
that only 23% of patents have a Consultant review, and none
of the patients that are part of this pilot have had renal imaging
(Ultrasound, CT or MRI scan) completed. Since these results
the Trust has introduced and implemented an AKI Alert system
for high risk patients. This report is provided to a senior
Nephrologist daily, who checks with the medical teams about
appropriate patient management.
The Trust is also commencing a review of the current
documentation with a potential to develop a checklist to aid
clinical decision making within this patient group.
The pilot patient satisfaction survey has commenced for Heart
Failure and Elective Hip/Knee patients with suppport from the
audit department. The aim is to have a return rate of 25% for
both initiatives.
* CURB-65 = is a clinical prediction rule that has been validated for predicting mortality in community-acquired
pneumonia and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.
The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum
score of 5:
• Confusion of new onset
• Urea
• Respiratory rate
• Blood pressure
• aged 65 or older
Improvement in EQ is measured by the quality of data entry and by ensuring that patients
admitted with one of the above conditions receive all of the care measures in the care bundle
for that clinical pathway.
The data is collected by the Trust for each patient and entered into an on-line tool. The results
are published independently by the South East Enhancing Quality Programme.
This indicator is part of the NHS Outcomes Framework - Domain 3: ‘Helping people to recover
from episodes of ill health or following injury’.
The Trust Executive lead for EQ is Mrs Kate King, Interim Director of Nursing and from April
to October 2012 was Ms Jenny Kay.
Priority 3: To reduce the number of emergency re-admissions to hospital within 28
days of discharge. We will target specific clinical areas where emergency re-admission
rates are higher than average. This priority has been monitored by the Quality and
Safety Committee.
Priority 3: not achieved.
The NHS monitors success in avoiding (or reducing to a minimum) emergency re-admissions
following discharge from hospital.
Not all re-admissions are likely to be part of the originally planned treatment and some may
17
be potentially avoidable. The NHS collects statistics for emergency re-admissions to hospitals
in England occurring within 28 days of the last, previous discharge from hospital. The table
below shows the figures collected for Dartford and Gravesham NHS Trust in 2012/13
compared to the previous year 2011/12.
Table to show total re-admissions to Darent Valley Hospital from April 2011 to March 2013
2012-13
2011-12
28 day re-admissions (all ages and genders)
Admissions
Re-admissions
Trust Rate
61,424
5,221
8.5%
57,878
4,442
7.7%
Peer Rate
8.5%
6.9%
Source - Caspe Healthcare Knowledge Systems (CHKS)
It is useful to compare the performance with that of a peer group of similar type acute
hospitals using the information collated and produced by Caspe Healthcare Knowledge
Systems (CHKS), the Trust’s partner for data analysis. Note that the re-admission rate, within
28 days, for the peer group has shown an increase that is greater than the Trust.
This priority has not been achieved and further analysis of the figures shows the different
pressures in Directorates.
Period
2012-13
28 day re-admissions (all ages and genders)
Admissions Re-admissions
Trust Rate
Surgical
17,231
896
5.2%
Medical
28,215
3,019
10.7%
Women’s Services*
9,940
497
5.0%
Paediatric
6,223
809
13.0%
Total
61,424
5,221
8.5%
Peer Rate
5.0%
7.9%
2.6%
11.1%
8.5%
Source - Caspe Healthcare Knowledge Systems (CHKS)
*The figure recorded for women’s services requires further explanation. The Trust has
recently introduced an Emergency Gynaecology Assessment unit. The clinic accepts referrals
from different sources and regularly women may attend on one day and be given an
appointment for the one-stop clinic a few days later. In the statistics this has been recorded as
‘re-admission’ because it happens within 28 days. Data submissions are currently not
sufficiently sensitive to separate these cases.
This indicator is part of the NHS Outcomes Framework - . Domain 5: ‘Treating and caring for
people in a safe environment and protecting them from avoidable harm’.
The Trust Executive lead for clinical effectiveness is Ms Annette Schreiner, Medical Director.
18
The next section describes our priorities for quality improvement in the coming year
2013/14 and provides the required statements of assurance from the Board with regard
to services, clinical audit, research, clinical quality goals, CQC registration and data
quality.
These priorities have been agreed by the Trust Board and each priority has an identified
Executive Director lead. Progress towards achieving these priorities will be recorded in the
Trust internal data management systems and submitted to the external reporting bodies e.g.
The Health Protection Agency, the National Patient Safety Agency and the NHS and Social
Care Information Centre as per the reporting schedule. Progress and interim results will be
reported to the Trust Patient Safety Committee and the Trust Quality and Safety Committee,
the latter being a sub-committee of the Trust Board. The minutes of the Trust Board are
published on the Trust website.
Some of the schemes presented here also form part of the Commissioning for Quality
Improvement (CQUIN) programme, agreed with our local lead commissioners, Dartford
Gravesham and Swanley Clinical Commissioning Group (CCG).
Trust Quality Improvement Priorities for 2013-14
A) PATIENT SAFETY
Priority 1: We will continue to use Safety Thermometer to support Harm Free Care
which measures the incidence of falls, pressure ulcers, urinary tract infections and
appropriate medical assessment for venous thromboembolism (VTE).
This priority was selected by the Trust Board
having reviewed information from incidents
reported by staff, letters and complaints from
patients and/or their carers, comments placed by
service users on the NHS Choices website and
other social media and internal audit outcomes.
Background
The NHS Safety Thermometer (ST) has been designed to be used by frontline healthcare
professionals. It measures a snapshot of harms once a month from pressure ulcers, falls,
urinary infection in patients with catheters and treatments for VTE.
The NHS Safety Thermometer provides a ‘temperature check’ on harm and can be used
alongside other measures of harm to measure local and system progress. In April 2012, the
Safety Thermometer became a monthly tool under the National Operating Framework.
19
The tool was designed to measure local improvement over time and should not be used to
compare organisations. Important considerations are:
• Demographics and case mix of patients surveyed.
• Not all harm is avoidable.
• Operational definitions can be interpreted by data collectors.
• Causation can occur both in and out of hospital.
Baseline: Current levels reported as of September 2012 as shown in the table below.
Safety Thermometer data September 2012
Month
September 2012
Harm Free (%)
89.17
Old Harms (%)
8.31
New Harms (%)
2.77
Source: NHS Safety Thermometer database
Total harm free care for July 2012 was 87.95%; August 2012 was 89.06% and September
2012 was 89.17%. The national standard is 95% by end 2013.
Measurement: Progress to achieve this priority will be monitored by monthly submissions to
the NHS Safety Thermometer database, the NHS Commissioning Board Authority (NHS CBA)
and measured progress reported to the Trust Quality and Safety Committee in the quarterly
report on the Quality Account priorities.
Priority 2: To continue to improve the Trust Standardised Hospital Mortality Index
(SHMI)
This priority was selected by the Trust Board having reviewed information from data published
by the Health and Social Care Information Centre and taking into consideration the high
profile of mortality rates and interest from the public, NHS staff and the media following the
publication of the Francis Report into care at the Mid-Staffordshire Foundation Trust.
SHMI is a hospital-level indicator which reports mortality at trust level across the NHS in
England using standard and transparent methodology. This indicator is being produced and
published quarterly by the Health and Social Care Information Centre. The Department of
Health committed to implementing the SHMI as the single hospital-level indicator for the NHS.
An “average” hospital will have a SHMI of around 100. A SHMI of greater than 100 implies
more deaths occurred than predicted by the model.
SHMI Value and Banding
The SHMI is the ratio between the actual number of patients who die following a treatment at
a trust and the number that would be expected to die on the basis of average England
figures. It covers all deaths reported of patients who were admitted to acute, non-specialist
trusts in England and either die while in hospital or within 30 days of discharge.
SHMI = Actual Deaths / Expected Deaths
20
The Baseline for Dartford and Gravesham NHS Trust: is the current SHMI as shown in the
table below. See also pages 14 and 43.
Standardised Hospital Mortality Index (SHMI) Dartford and Gravesham NHS Trust
published April 2013
Period
10/2011-09/2012
Spells
51074
Actual
Deaths
1432
Expected
Deaths
1486.233
SHMI
0.9635
Lower
Limit
0.8895
Upper
Limit
Band
1.1242
2
Source - Summary Hospital - level Mortality Indicator (SHMI). Health and Social Care Information Centre.
The SHMI values are categorised into one of the following three bandings (i.e. SHMI value in
relation to Lower Limit and Upper Limit):
Band 1 – Where the trust’s mortality rate is ‘higher than expected’
Band 2 – Where the trust’s mortality rate is ‘as expected’
Band 3 – Where the trust’s mortality rate is ‘lower than expected’
It can be seen from the table above that Dartford and Gravesham NHS Trust SHMI banding is
Band 2 – ‘as expected’.
Measurement: Progress to achieve this priority will be monitored by from data published by
the Health and Social Care Information Centre and measured progress reported to the Trust
Quality and Safety Committee and Trust Board.
Priority 3: To improve access and reporting in Radiology. We will review current
working patterns to improve reporting turnaround times for CT and MRI investigations
to achieve a standard for outpatients of no more than one week.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and internal audit
outcomes.
The planned service improvements are;
• Recruitment of additional Consultant Radiologists to support the increased workload.
• The service will maintain a Consultant presence on site in the evening and at
weekends to support reporting of inpatient scans.
• Agreed changes to working patterns will result in a reduction in number of Consultants
on leave at any one time. This will be supported by adherence to Trust protocols for
booking annual and study leave.
• Other changes agreed will alter the Consultant rota of to ensure that CT and MRI
reporting is covered as core business.
Baseline: Current reporting times for Computerised Tomography (CT) and Magnetic
Resonance Imaging (MRI) as shown in the tables below.
21
Average computerised tomography (CT) scan reporting time for inpatients and
outpatients
Inpatients
Outpatients
CT scan average reporting times (days)
from scan completed to report available
2011/12
2012/13
0 days
0 days
10 days
13 days
Activity (number of scans requested)
2011/12
3,855
5,783
2012/13
4,187
5,958
Source: Trust information systems (Radiology Information System)
Average magnetic resonance imaging (MRI) scan reporting time for inpatients and
outpatients
Inpatients
Outpatients
MRI scan average reporting times (days)
from scan completed to report available
2011/12
2012/13
1 day
1 day
11 days
11 days
Activity (number of scans requested)
2011/12
741
4,968
2012/13
1,389
7,293
Source: Trust information systems (Radiology Information System)
Measurement: Progress to achieve this priority will be monitored and measured progress on
the Quality Account priorities and the number of CT and MRI scans carried out within one
week, including reporting of the investigation results, reported to the Trust Quality and Safety
Committee and Trust Board.
B) PATIENT EXPERIENCE
Priority 1: To improve patient experience in Outpatients by reducing the percentage of
short notice cancellations.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and internal audit
outcomes.
Baseline: The percentage of Outpatient appointments cancelled by the Trust in 2012/13 is,
on average, 8.27% of appointments per month.
Measurement: Progress to achieve this priority will be monitored and progress measured by
quarterly reports to the Trust Quality and Safety Committee on the Quality Account priorities
which will include data on the percentage of appointments cancelled per month by Trust as
reported by Trust information systems.
22
Priority 2: To improve patient experience in the Emergency Department (ED) by
expanding and refurbishing the ED waiting area and Reception.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and internal audit
outcomes.
Baseline: Current level of complaints about the waiting area and the attitude of staff as
shown in the table below.
Complaints received about staff attitude and the surroundings in the Emergency
Department
Complaints registered formally in the Complaints Department about patient and service
user experience in the Emergency Department.
2012/13
Complaints about the Emergency Department
2
waiting area and surroundings
Complaints about the attitude(s) and behaviour of
26
staff in the Emergency Department
Source: Trust information systems
Measurement: Progress to achieve this priority will be monitored and progress measured by
quarterly reports to the Trust Quality and Safety Committee on the Quality Account priorities
which will include the number and type of complaints received about the environment and the
attitude of staff as formally registered in the Trust Complaints Department.
Priority 3: To improve the experience for patients and their carers particularly in
relation to discharge planning, information provided about treatment and care; and
medication and pain relief.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and internal audit
outcomes.
Baseline: Current levels of complaints involving discharge planning, information provided
about treatment and care; and medication and pain relief as shown in the table below.
Complaints registered formally in the Complaints Department about discharge planning,
information provided about treatment and care; and medication and pain relief
2012/13
Complaints received about discharge planning
30
Complaints received about information given
25
about treatment and care
Complaints received about medication and pain
58
relief*
Source: Trust information systems
* These include complaints about pain relief provided whilst in the Emergency Department and during childbirth
23
Measurement: Progress to achieve this priority will be monitored and progress measured by
quarterly reports to the Trust Quality and Safety Committee on the Quality Account priorities
which will include the number of complaints about discharge, medication, late discharges and
lack of information.
C) CLINICAL EFFECTIVENESS
Priority 1: To improve aspects of care given to frail elderly patients admitted following
stroke and surgical emergency. We will ensure that 90% of patients admitted following
a stroke experience direct admission to the Stroke Unit and ensure a swallow
assessment is completed within 24 hours of admission. We will have 80% of stroke
patients assessed by at least one therapist within the first 24 hours. In addition a frail
elderly surgical admissions care pathway will be in place by 31st March 2014.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and results of the
Sentinel Stroke National Audit Programme (SSNAP).
Baseline: Current data on achievement of stroke survey indicators as shown in the table
below and on status of introduction of an emergency frail elderly surgical care pathway.
Improvement target for patients admitted following stroke 2013/14
Current level April 2013
Trust target for 2013/14
Direct admissions to stroke unit
72%
90%
Swallow assessments in the first
81%
90%
24 hours
Assessment by at least one
75%
80%
therapist within first 24 hours
Source: Internal Trust data
Measurement: Progress to achieve this priority will be monitored and measured in quarterly
reports to the Trust Quality and Safety Committee on the Quality Account priorities which will
include, when published, the results of the National Sentinel Stroke Audit and, when
complete, the launch of the emergency frail elderly surgical care pathway.
Priority 2: To improve aspects of care in Maternity, specifically; maintaining/improving
the Midwife to birth ratio; reducing the number of induced labours and reducing
emergency caesarean section rates.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and the audit outcomes
published by the Royal College of Obstetricians and Gynaecologists.
24
Baseline:
• Midwife to birth ratio is 1:34 in March 2013.
• Induction of labour rate = 26.5%
• Caesarean section rates = 15.6%
(Data from the Trust Maternity Dashboard – Mar 2013)
Measurement: Progress to achieve this priority will be monitored and measured in quarterly
reports to the Trust Quality and Safety Committee on the Quality Account priorities which will
include figures from the Trust Maternity Dashboard.
Priority 3: To improve aspects of care within Paediatrics by implementing a
Paediatrician of the week rota; and reducing drug related incidents in connection with
the use of antibiotics in the Special Care Baby Unit (SCBU), Aspen and Cedar wards.
This priority was selected by the Trust Board having reviewed information from incidents
reported by staff, letters and complaints from patients and/or their carers, comments placed
by service users on the NHS Choices website and other social media and internal audit
outcomes.
Baseline:
• Consultant cover provided by existing rota in March 2013 was 0900-1700 Mon - Fri
with on-call cover 1700-0900.
• Antibiotic incidents on SCBU, Aspen and Cedar wards – 11 antibiotic related incidents
were reported via the Datix incident reporting system in 2012/13.
Measurement: Progress to achieve this priority will be monitored and measured in quarterly
reports to the Trust Quality and Safety Committee on the Quality Account priorities which will
include the level of antibiotic incidents in SCBU each month.
25
Mandatory declarations and assurances
The information on the following pages contains mandatory text that all NHS trusts must
include in their Quality Account. We have added some explanations of key terms.
The requirement for all NHS trusts to produce Quality Accounts is included in Chapter 2 of the
Health Act 2009. Subsequent to the Act guidance may be issued annually by the Secretary of
State for Health relating to the content and form of trust Quality Accounts. Dartford and
Gravesham NHS Trust receives this guidance in notification by letter(s) issued by the
Department of Health and the implementation of the guidance is overseen by a designated
Executive Director.
Statements of assurance
Review of Services
During 2012/13 the Dartford and Gravesham NHS Trust provided and/or sub-contracted
twelve relevant health services.
•
Emergency Department (Accident and Emergency).
•
Acute inpatient care: medicine and surgery, both elective (planned) and emergency
(unplanned).
•
•
Critical care (Intensive Care) and Theatres.
Daycare.
•
•
Outpatient care.
Maternity services.
•
•
Gynaecology services.
Children’s services.
•
•
Therapy services.
Pathology, radiology and pharmacy services.
The Dartford and Gravesham NHS Trust has reviewed all the data available to them on the
quality of care in twelve of these relevant health services.
The income generated by the relevant health services reviewed in 2012/13 represents 93.3%
per cent of the total income generated from the provision of relevant health services by
Dartford and Gravesham NHS Trust for 2012/13.
The Trust receives the other 6.7% of its income for other aspects of work for example; training
and education, research and development, recharges of salaries and wages for staff working
at other organisations and other direct credit and miscellaneous income.
26
Each clinical directorate is led by a senior doctor, who is responsible for monitoring quality in
the directorate through the directorate’s governance processes and the directorate Quality
Laboratories (Q-Labs). For Q Labs the information is collated and produced by Caspe
Healthcare Knowledge Systems (CHKS), the Trust’s partner for data analysis and is a
significant element of this assurance process. The Q-Lab is a clinical meeting at which
multidisciplinary teams (doctors, nurses, therapists, midwives and managers) review detailed,
comparative clinical quality indicators and patient care data, mortality rates at speciality level,
with complications and re-admissions.
These services are managed through a clinical directorate structure
Chairman
Sarah Dunnett
Chief Executive
Susan Acott
Deputy Chief
Executive
Gerard Sammon
Radiology
Department
Clinical Director
Dr Paul Holder
Medical Director
Annette Schreiner
Surgical
Directorate Clinical
Director
Mr Andrew McIrvine
Director of Nursing
Kate King
Accident &
Emergency
Department
Clinical Lead
Dr Dylan Jenkins
Director of
Operations
Julie Hunt
Children's
Directorate Clinical
Director
Dr Selwyn D'Costa
Women's
Directorate Clinical
Director
Mr Rob McDermott
(from Dec 2012)
Dr Vincent Kika
Pathology
Directorate Clinical
Director
Maadh Aldouri
Medical Directorate
Clinical Director
Dr Philip Mairs
Theatres, ITU &
Critical Care
Directorate Clinical
Director
Dr Mike Protopapas
Orthopaedic
Directorate Clinical
Director
Mr Farid Moftah
Note: From April to October 2012 the Director of Nursing was Jenny Kay.
The clinical directorates each have individual governance meetings which report into the
Trust’s Quality and Safety Committee, which is a sub-committee of the Trust Board and
chaired by a Non Executive Director. Each month the Directorate Governance Committees
review complaints and compliments, incidents, compliance with national requirements and
standards and data from clinical audits. The agenda is centred on patient safety, patient
experience and clinical effectiveness.
The Q-Lab is our in-house system to compare ourselves against other providers. Sometimes
being an outlier just reflects a special service provision, for example; Gynaecology
readmissions where a case note review showed that the Gynaecology assessment unit,
which sees patients as ward attenders and otherwise treats patients as outpatients,
overstated the readmission rate. Sometimes, however the Q-Lab can reflect a real problem
27
which requires action, for example; in summer 2010 a Q-Lab identified a higher than average
mortality rate associated with the management of patients admitted with a fractured neck of
femur (broken hip). Following prompt and robust action it is now evident from on-going
monitoring that mortality is now within the normal range.
Board to Ward to Board
The Executive and Non-Executive Director members of the Board have ‘adopted’ a ward or
clinical department. This is very helpful in allowing Board members to understand the
successes and challenges of those areas. For example, the practical difficulties of maintaining
the provision of single sex accommodation. This creates a meaningful ‘Board to Ward to
Board’ relationship and dialogue. The relationship is equally valued by staff who have a direct
pathway to an Executive Director.
The Trust Board receives regular clinical presentations from nursing and/or medical staff as
part of the agenda each month which keeps them abreast of clinical initiatives.
Participation in National Clinical Audits and National Confidential Enquiries in 2012/13
The required wording has been used by the Trust in this section of the Quality Account.
Clinical audit aims to improve the quality of patient care by looking at current practice and
modifying it where necessary.
During 2012/13 Dartford and Gravesham NHS Trust participated in 36 national clinical audits
and 2 national confidential enquiries covered by relevant health services that Dartford and
Gravesham NHS Trust provides.
During 2012/13 Dartford and Gravesham NHS Trust participated in 89% of the national
clinical audits and 100% of the national confidential enquiries which it was eligible to
participate in.
The national clinical audits and national confidential enquiries that Dartford and Gravesham
NHS Trust was eligible to participate in during 2012/13 are listed in the table below.
The national clinical audits and national confidential enquiries that Dartford and Gravesham
NHS Trust participated in during 2012/13 are listed in the table below:
The national clinical audits and national confidential enquires that Dartford and Gravesham
NHS Trust participated in, and for which data collection was completed during 2012/13, are
listed in the table below alongside the number of cases submitted to each audit or enquiry as
a percentage of the number of registered cases required by the terms of that audit or enquiry.
28
Participation
Y, N or N/A
No. of
cases
submitted
% of
cases
submitted
Severe trauma (Trauma Audit & Research Network,
TARN)
N
-
-
Renal colic (College of Emergency Medicine)
Y
50
100%
National Joint Registry (NJR)
Y
622
97%
Adult critical care (Case Mix Programme – ICNARC
CMP)
Y
646
100%
Emergency use of oxygen (British Thoracic Society)
Y
20
100%
N
-
-
Audit Title
Acute Care
Adult community acquired pneumonia (British Thoracic
Society)
Non-invasive ventilation - adults (British Thoracic
Society)
Y
Data collection still in
progress
Blood & Transplant
Intra-thoracic transplantation (NHSBT UK Transplant
Registry)
N/A
National Comparative Audit of Blood Transfusion –
Blood Sample Labelling – part A all cases required,
part B minimum 50 to be reviewed
Y
284
23/50
100%
46%
Potential donor audit (NHS Blood & Transplant)
Y
76
100%
Y
140
100%
Y
130
100%
Y
50
100%
Heart failure (HF)
(subscription funded from April 2012)
Y
211
Data still
being
submitted
Coronary angioplasty
(NICOR)
Y
254
100%
Cardiac arrhythmia (HRM)
Y
148
70%
National Cardiac Arrest Audit (NCAA)
Y
138
75%
Acute coronary syndrome or Acute myocardial
infarction (MINAP)
(subscription funded from April 2012)
Y
404
Data still
being
submitted
Cancer
Head and neck oncology (DAHNO)
(subscription funded from April 2012)
Bowel cancer (NBOCAP)
(Subscription funded from April 2012)
Lung cancer (NLCA)
(subscription funded from April 2012)
Oesophago-gastric cancer (NAOGC)
(subscription funded from April 2012)
N/A
Heart
Adult cardiac surgery audit (ACS)
N/A
Congenital heart disease (Paediatric cardiac surgery)
(CHD)
National Vascular Registry (elements include CIA,
peripheral vascular surgery, VSGBI Vascular Surgery
Database, NVD)
Pulmonary hypertension (Pulmonary Hypertension
Audit)
N/A
N/A
N/A
29
Long term conditions
National Review of Asthma Deaths (NRAD)
Y
1
100%
Adult asthma (British Thoracic Society)
Y
13
61%
Bronchiectasis (British Thoracic Society)
Y
14
100%
Pain database
N
-
-
106
100%
Renal replacement therapy (Renal Registry)
N/A
Renal transplantation (NHSBT UK Transplant Registry)
N/A
Diabetes (Paediatric) (NPDA)
Y
Inflammatory bowel disease (IBD)
Includes: Paediatric Inflammatory Bowel Disease
Services
Y
Diabetes (Adult) ND(A), includes National Diabetes
Inpatient Audit (NADIA)
Y
Data collection still in
progress
1460
100%
Mental Health
National audit of psychological therapies (NAPT)
N/A
Prescribing Observatory for Mental Health (POMH)
(Prescribing in mental health services)
N/A
Older People
National audit of dementia (NAD)
Y
40
100%
Sentinel Stroke
National Audit Programme (SSNAP)
Y
50
100%
Hip fracture database (NHFD)
Y
346
100%
Carotid interventions audit (CIA)
Y
9
100%
Fractured neck of femur
Y
50
100%
Parkinson's disease (National Parkinson's Audit)
N
-
-
Y
709
78%
Paediatric fever (College of Emergency Medicine)
Y
48 (all
patients)
96%
Neonatal intensive and special care (NNAP)
Y
637
100%
Paediatric asthma (British Thoracic Society)
Y
10
71%
17
100%
Elective Surgery
Elective surgery (National PROMs Programme)*
Women’s and Children’s Health
Paediatric intensive care (PICANet)
N/A
Paediatric pneumonia (British Thoracic Society)
Y
Epilepsy 12 audit (Childhood Epilepsy)
Y
30
Data collection still in
progress
National Confidential Enquiries into Patient
Outcome and Death (NCEPOD)
Medical and Surgical programme: National Confidential
Enquiry into Patient Outcome and Death (NCEPOD)
-
Y
Y
Alcohol Related Liver Disease Study
Subarachnoid Haemorrhage Study
Mental Health programme: National Confidential Inquiry
into Suicide and Homicide for people with Mental
Illness (NCISH)
10
15
100%
100%
N/A
Source – Trust locally validated data Apr 2012 – Mar 2013
* PROMS cases submitted data is sent to the Trust each month from Quality Health – most recent figures shown, Mar 2012.
These audits are reviewed and managed by the Trust Clinical Audit Committee and reported
to the Quality and Safety Committee.
In addition Dartford and Gravesham NHS Trust was eligible to, but did not, participate in
these national clinical audits and national confidential enquiries.
Audit Title
Severe trauma (Trauma Audit & Research Network, TARN)
Adult community acquired pneumonia (British Thoracic Society)
Parkinson's disease (National Parkinson's Audit)
National Pain Database Audit: chronic pain services
Source – Trust locally validated data Apr 2012 – Mar 2013
Participation in National Confidential Enquiries into Patient Outcome and Death
A National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is an
investigation into an area of healthcare. When the enquiry is complete a report is produced
which details recommendations for improvement.
N
The NCEPOD documents have been discussed within the directorate and a report provided to
the Trust Quality and Safety Committee. The Quality and Safety Committee monitors and
advises the Trust Board on progress against the NCEPOD recommendations requesting
action plans as appropriate.
In addition there are 4 current NCEPOD studies:
National Confidential Enquiry into Patient
Outcome and Death
Participated in
2012/13
% of cases
submitted
Cardiac Arrest Procedures Study
Yes
On going
Bariatric Surgery Study
Yes*
On going
Alcohol Related Liver Disease Study
Yes
On going
Subarachnoid Haemorrhage Study
Yes
On going
* The Trust does not carry out any bariatric surgery but has completed the review questionnaire
31
Maternal and Perinatal Mortality Notification
The National Patient Safety Agency took over the monitoring of maternal and perinatal
mortality from the Centre for Maternal and Child Enquires (CEMACE) from April 2011.
Maternal and Perinatal Mortality Notification
Participated in
2012/13
% of cases
submitted
Maternal mortality surveillance i.e. mothers
Yes
100%
Perinatal mortality surveillance i.e. babies
Yes
100%
Source – Trust locally validated data
National Audits reviewed by the Trust in 2012/13
The reports of the four national clinical audits were reviewed by the provider in 2012/13 and
Dartford and Gravesham NHS Trust intends to take the following actions to improve the
quality of healthcare provided.
1. National Audit of Dementia
As a result of this audit, and because dementia has been selected as a particular area of
priority for Dartford and Gravesham NHS Trust, the following actions have been agreed:
• A new proforma has been developed to enhance the level of dementia specific
information available including readmissions, delayed discharges and falls.
• A Dementia Buddy scheme has been introduced to provide patients and their families
with care and support.
• We are introducing a blue wrist band system across the hospital for all inpatients with
Dementia. Called ‘Forget Me Not’ because of the blue colour it is an indicator to staff
that a patient may require help if they become lost or disorientated on the Trust
premises.
• Hospital signage is being reviewed in frequently used areas to make them as
informative and easy to understand as possible, using colour to help patients to identify
and find the way round their bed area.
• On elderly care wards, the six-bedded bays are being painted with different colours
matched to a corresponding flower to make it easier for patients to remember and locate
their bed.
• Memory boxes and picture books are being introduced to help diminish the risk of
further loss of memory while patients are in hospital.
2. National Lung Cancer Audit
Although the Trust’s results are broadly comparable to other organisations, one area was
identified where some improvement was required. As a result of this audit steps have been
taken to ensure that, when ward patients are to be given their diagnosis, the Lung Cancer
Nurse Specialist is contacted so she can be present to provide further support and
information to the patient and their family.
32
3. National Audit of Seizure Management in Hospitals
This audit showed that Dartford and Gravesham NHS Trust compares favourably with other
hospitals in most fields although it highlighted that priority should be given to establishing
policies for management of patients with first seizures, management of status (prolonged)
seizures and pathway for onward referrals. The following actions have been agreed as a
result of the audit:
• Training to ward and Emergency Department staff regarding neurological assessment,
appropriate investigations/clinical management and referral.
• Liaison with Kings College Hospital to share policies and to establish patient
information packs.
4. Epilepsy 12 Audit (Childhood Epilepsy)
The audit identified that the Trust fully met 6 and partially met 5 of the meaningful and
pragmatic measures of quality applied to the first 12 months of care after first paediatric
assessment. An action plan was agreed as a result of the audit and includes:
• Introduction of weekly epilepsy clinics and annual review clinics with dedicated nursing
input.
• Review clinics will have a check list based on NICE guidance.
• The introduction of a dedicated nurse to lead for children with epilepsy. He/She will act
as a port of contact for queries, organise annual review clinics, help in training parents
with rescue medication and maintain a database of patients.
• The Gravesend Epilepsy Network lead now provides support and counselling for
parents as well as teenagers suffering from epilepsy. Their contribution is extremely
valuable and we would formally like to thank them for their incredible service.
Local initiatives in Clinical Audit
The Trust uses a locally devised scoring system to indicate the priority that completed audits
have been given, known as the Implementation of Clinical Effectiveness (ICE) score; this
system has also been shared with a number of other organisations for their own use.
The score ranges from ICE 1 (indicating a high level of priority) to ICE 3 (low implications or
priority). Giving a score to an audit presents an effective way of managing the findings from
audit activity across the Trust. All ICE 1 audits are reported to the Trust Quality and Safety
Committee and the action plans are monitored at specialty audit meetings.
All local audits registered with the Trust’s Clinical Audit & Effectiveness Department are
required to be presented at directorate/specialty audit meetings where the findings and
implications are discussed, and the ICE score and action plan agreed. These action plans
are then monitored by the department and, once fully implemented, a re-audit is undertaken
to confirm changes in practice have been achieved.
33
The reports of the four local clinical audits were reviewed by the provider in 2012/13 and
Dartford and Gravesham NHS Trust intends to take the following actions to improve the
quality of healthcare provided.
1. The Management of Acute Kidney Injury (AKI) at Darent Valley Hospital (DVH)
Acute kidney injury (AKI), previously called acute renal failure (ARF) is a rapid loss of kidney
function; its causes are numerous and include exposure to substances harmful to the kidney,
and obstruction of the urinary tract. AKI is diagnosed on the basis of characteristic laboratory
findings, such as elevated blood urea, nitrogen and creatinine, or inability of the kidneys to
produce sufficient amounts of urine.
AKI complicates 7% of all hospital admissions and 30% of ITU admissions according to latest
NCEPOD report. It also found only 50% cases were appropriately managed and 43%
involved unacceptable delays in identifying AKI. The management of AKI at DVH was
previously audited in 2012 and highlighted that not all cases were managed optimally,
potentially leading to increased length of stay and increased cost. The purpose of this audit
was to re-assess the current management of acute kidney injury in emergency hospital
admissions.
Despite action plans being implemented from the previous audit, such as teaching sessions
for junior doctors, adopting London AKI Network (AKIN) guidelines and making them readily
available on the Trust intranet, the results highlighted further room for improvement.
One action implemented already was the setup of an ALERT system in March 2013 which
has enabled Nephrology consultants to review new cases of AKI3 on a daily basis, even prior
to a formal referral being made. Further actions put in place include the following:
• Education of staff about the findings of the audit and the importance of urine dip test,
Ultrasound scan (USS) and quick transfer to tertiary centres.
• Raise compliance with carrying out urine dip test in the Emergency Department.
• Compare audit data with the results of a national AKI audit pilot in which the Trust
participated during the year.
2. Foot Assessment for Diabetic Patients
Diabetes is known to cause ulceration of the feet due to its damaging effects on blood vessels
and nerves. Patients’ feet require regular assessment as recommended by NICE guidelines.
Patients with diabetes admitted to hospital are at a high risk of foot ulceration particularly
pressure ulcers on the heels. When a patient with diabetes is admitted to hospital, a foot
assessment should be undertaken within 24 hours and the risk for ulceration classified.
An audit of all inpatients with diabetes on a particular day was undertaken to see if their feet
had been examined and their risk of ulceration classified within 24 hours of their admission.
The actions to be taken as a result of this audit include:
• A separate page to be included in the Medical Admissions Pathway to prompt the foot
34
•
assessment as this is currently not automated.
Workshops to continue for medical staff covering foot assessments and other aspects
of diabetes inpatient care.
3. Re-audit of oxygen prescribing at Darent Valley Hospital
The National Patient Safety Agency (NPSA) Rapid Response Report states Trusts should
ensure that “Oxygen is prescribed in all situations in accordance with British Thoracic Society
(BTS) guidelines”. The following actions have been undertaken as a result of the audit of the
guidance:
• A Trust policy produced to help clarify responsibilities of each health care professional
involved in oxygen provision and to specify requirements as per NPSA and BTS.
• Pharmacists made more aware of requirements for oxygen prescribing and become
more involved in prompting prescribers and nurses to comply with required standards.
• Oxygen prescribing included in the medicines management training session at
registered nurses study days to help with raising awareness of requirements.
4. Quality of Information in Health Records
Accurate record keeping is essential in ensuring high quality patient care; the patient’s clinical
record should act as an accurate representation of their medical history and episode of care.
This continuous trust-wide audit is carried out to assess the standard and quality of record
keeping, showing compliance with NHSLA guidelines and the Trust’s Clinical Records Policy.
The audit highlighted a number of aspects of record keeping which had poor compliance
across various areas of the Trust and as a result, the Audit Department is working with
specialty audit leads to present the area specific results at individual audit meetings to raise
awareness of standards and agree local action plans. The continuous audit will now be
reported 6 monthly to identify any areas where further improvements are required.
These audits are reported via the Clinical Audit and Effectiveness Committee to the Quality
and Safety Committee (a Board sub-committee).
Participation in clinical research
Clinical research involves gathering information to help us understand the best treatments,
medication or procedures for patients. It also enables new treatments and medications to be
developed. Research involving patients must be approved by an ethics committee.
The number of patients receiving relevant health services provided or sub-contracted by
Dartford and Gravesham NHS Trust that were recruited during that period to participate in
research approved by a research ethics committee was 159.
Participation in clinical research demonstrates the Trust’s commitment to improving the quality
of the care we offer and to making our contribution to wider health improvement priorities.
35
Our clinical staff stay abreast of the latest possible treatments and actively engage in
participation in research.
Dartford and Gravesham NHS Trust was involved in conducting clinical research studies in
cancer, cardiology, diabetes, epilepsy, gastroenterology, infection control, intensive care,
paediatrics, respiratory, stroke and urology during 2012/13. There were 57 clinical staff
participating in research approved by a research ethics committee at Dartford and
Gravesham NHS Trust 2012/13. These staff participated in research covering 18 medical
specialties.
Goals agreed with Commissioners
Commissioning for Quality and Improvement (CQUIN) 2012/13, progress and
achievement
The Primary Care Trusts held the NHS budget for their area in 2012/13 and decided how
money was spent on hospitals and other health services. This is known as ‘commissioning’.
NHS Kent and Medway were the main commissioner of services at Dartford and Gravesham
NHS Trust. The PCT set performance targets based on quality and innovation.
A proportion of Dartford and Gravesham NHS Trust income in 2012/13 was conditional upon
achieving quality improvement and innovation goals agreed between Dartford and
Gravesham NHS Trust and any person or body they entered into a contract, agreement or
arrangement with for the provision of relevant health services, through the Commissioning for
Quality and Innovation payment framework.
Further details of the ‘Standards to support the data quality for the preparation of Quality
Reports’ are available at the following website http://www.monitornhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275
For 2012/13, the Trust had 10 CQUIN indicators to achieve representing 2.5% of total
income, approximately £3.6m. The Trust set itself a challenging goal of achieving 87%
delivery.
CQUIN 2012/13 progress and achievement
The following information gives details of the CQUIN goals and achievements for the year
2012/13.
There were two areas of CQUIN. To qualify for any payment in a quarter, all four Gateway
measures needed to be achieved. Assuming the Gateway was achieved, schemed targets
needed to be met for payment against the schemes.
CQUINs were divided into national, regional, cluster and local indicators as follows:
• National CQUIN indicators (Venous thromboembolism (VTE) assessment. Patient
experience survey, Safety thermometer, Dementia diagnosis).
36
•
•
•
Regional CQUIN indicators (Enhancing Quality EQ)
Cluster CQUIN indicators (VTE audit, Safe workforce tool, High impact innovations)
Local CQUIN indicators (Long term conditions, psychiatric liaison)
RAG - Red = Not Achieved, Amber = Partially Achieved, Green = Achieved in full.
CQUIN Gateways 2012/13
Gateway
1. National data collection requirements
Performance
RAG
rating
Met all requirements
Green
2. Five national performance measures:
Amber
a. A&E 4 hour wait > 95% across full year.
b. 18 week RTT
c. Cancer waiting times
d. MRSA objective– maximum of three
avoidable cases
e. CDiff objective– maximum of 20
avoidable cases
3. Workforce Plan
4. CQC conditions
Met the 4 hour A&E target.
Met 18 week RTT for all specialities
Waiting list backlog is increasing – recovery
plan in place.
3 MRSA cases – within objective
24 C-diff cases – objective breached
Within objective
th
Green
th
CQC inspection 4 and 5 October 2012
Positive report received
Green
CQUIN Indicators 2012/13
CQUIN Indicator
VTE assessment
Percentage of adult inpatients that have had a VTE risk
assessment on admission to hospital using the clinical
criteria of the national tool.
Objective agreed: 95% in quarter 4.
Patient experience –personal needs
Calculated from 5 survey questions “responsiveness to
personal needs of patients” conducted during summer
2012.
1. Involvement in decisions about treatment / care.
2. Hospital staff available to talk about worries / concerns
3. Privacy when discussing condition / treatment.
4. Being informed about side effects of medication.
5. Being informed who to contact if worried about
condition after leaving hospital.
Objective agreed: 64.8% to be achieved.
Safety Thermometer
Monthly surveys of all appropriate patients (as defined in
the guidance) to collect data on four metrics (pressure
ulcers, falls, urinary tract infection in patients with
catheters and venous thromboembolism assessment
completed ).
Objective agreed: 100% in quarter 4
37
Value
Achievement
RAG
rating
173K
National
indicator
95%
objective
achieved
Green
173K
National
indicator
Percentage
achieved
63.6%
Amber
173K
National
indicator
objective
achieved - all
submissions at
100% in
quarter 4
Green
Improving diagnosis of dementia
1. Percentage of all patients aged 75 and over who have
been screened following admission to hospital, using the
agreed dementia screening question tool.
2. Percentage of all patients aged 75 and over, who have
been screened as at risk of dementia, which have had a
dementia risk assessment within 72 hours of admission to
hospital, using the hospital dementia risk assessment tool.
3. Percentage of all patients aged 75 and over, identified
as at risk of having dementia that are referred for
specialist diagnosis.
The above 3 metrics apply to emergency admissions aged
75 and above including those with dementia admitted for
more than 72 hrs.
Target: 90% for each target each month for three
consecutive months in year 1.
Enhancing Quality Programme. Percentage
achievement of the ‘Enhancing Quality’ programme
improvement metrics (EQ is a quality improvement
programme in five clinical areas: heart failure, acute
kidney injury, pneumonia, hip and knee surgery and
dementia).
Reduction in incidence of VTE
Quarterly notes audit of patients who are identified at risk
from VTE to determine whether the appropriate
prophylaxis as per NICE guidance was prescribed.
Safe Workforce – use of safe tool
1. Demonstrate completion of a staffing review for all adult
wards within the last 6 months with action plan for deficits
and improvements required.
2. Implementation of action plan.
3. Full implementation of plan and delivery of targets by
end of quarter 4.
4. Development of a ward dashboard of workforce and
quality indicators and rollout of coverage during 12/13.
Objective: 1. Plan and implement. 2. Q1: 25% of wards;
Q2: 50%; Q3: 75%; Q4: 100%
Implementation of the Innovation, Health & Wealth
High Impact Innovations
The identification, planning and implementation of a
programme to develop the relevant high impact
innovations ready for the CQUIN gateway in 2013/14
(Relevant innovations are: assistive technologies and
digital by default)
38
173K
National
indicator
Jan 13 - 92%
Feb 13 - 91%
Mar 13 - 91%
700K
Regional
indicator
Objective
achieved
Green
576K
Cluster
indicator
Objective
achieved
Green
288K
Cluster
indicator
Objective
achieved
Green
461K
Cluster
indicator
Objective
achieved
Green
Green
Long Term Conditions – whole system CQUIN
1. Reduction in unplanned bed days for patients with
long term conditions.
2. Participation in the 2 regional events:
a. Integrated team working – April 2012
b. Using technology for supporting self-care – July
2012
3. Active participation in integrated team working:
th
Following 25 April event agree action plan with
CCGs stating priority actions for integrated team
working and milestones for achievement. 4 key areas:
a. Diabetes
b. COPD / Asthma
c. Dementia
d. Heart Failure
4. Participation in locally agreed CCG projects related to
the long term conditions programme.
Psychiatric Liaison
Service to be provided by Kent and Medway Partnership
Trust.
1. Reducing A&E attendance in West Kent
2. Raise Mental Health awareness across all workforce
providers & improve timely access to mental health
assessment for identified groups.
432K
Local
indicator
Part 1 may be
reliant on
partner Trusts
Amber
432K
Local
indicator
Objective
achieved
Green
Source – Trust data management and recording system.
What others say about the provider:
The Care Quality Commission (CQC).
The Care Quality Commission (CQC) regulates and inspects health organisations.
Dartford and Gravesham NHS Trust is required to register with the Care Quality Commission
(CQC) and its current registration status is ‘registered’. Dartford and Gravesham NHS Trust
has no conditions on the status of its registration as of 31st March 2013.
The Care Quality Commission has not taken enforcement action against Dartford and
Gravesham NHS Trust during 2012/13.
Dartford and Gravesham NHS Trust has participated in special reviews or investigations by
the Care Quality Commission relating to the following areas during 2012/13:
•
Routine Review of Compliance.
Dartford and Gravesham NHS Trust intends to take the following action to address the
conclusions or requirements reported by the Care Quality Commission. Dartford and
Gravesham NHS Trust has made the following progress by 31 March 2013 in taking such
action.
No actions arising from the CQC review of compliance are required.
1. CQC Review of Compliance – 4/5th Oct 2012.
The Review of Compliance was part of a routine schedule of planned reviews by the Care
39
Quality Commission. The review assessed the Trust’s level of compliance against a total of 7
outcomes. The Trust was found to be meeting all of these essential standards.
The CQC report mentions that inspectors spoke with patients, relatives of people who used
the service and also to staff. They found that significant progress had been made in the four
outcome areas that required improvement at the last inspection. Patients and their relatives
said they had been involved in making decisions about their care and treatment and their
privacy and dignity was respected. Staff said that they felt well supported. They said that they
liked working at the hospital and had the training and information they needed.
Dartford and Gravesham NHS Trust took the following action to address the conclusions or
requirements reported by the Care Quality Commission.
No actions arising from the CQC report are required.
The National Inpatient Survey results 2012
The Trust also reports on the results of the annual National Inpatient Survey conducted by the
Care Quality Commission.
People are asked what they thought about different aspects of the care and treatment they
received. Each NHS trust receives scores out of 10, based on the responses given by their
patients. A higher score is better. The results take into account the age, gender and method
of admission (emergency or elective) of respondents for each trust. The survey information is
collected anonymously, and all responses are confidential.
Table to show national inpatient survey results 2012 and 2011
Q32
Q34
Q36
Q56
Q62
Adult inpatient survey questions 2012 and 2011
Question
2012 score (out of 10)
Were you involved as much as you
wanted to be in decisions
7.0
about your care and treatment?
Did you find someone on the hospital
staff to talk to about your
5.1
worries and fears?
Were you given enough privacy when
discussing your condition or
8.4
treatment?
Did a member of staff tell you about
medication side effects to
4.2
watch for when you went home?
Did hospital staff tell you who to contact if
you were worried about
7.8
your condition or treatment after you left
hospital?
2011 score (out of 10)
6.5
4.7
7.7
4.1
7.4
Source – Care Quality Commission, 2011 and 2012
The questionnaire was sent to 850 inpatients that had been treated at Dartford and
Gravesham NHS Trust in June 2012 and responses were received from 406 patients. The
five questions shown above (the survey includes over 70 questions) were included in an
overall ‘patient responsiveness’ score in 2011 and have been matched to the same questions
in the 2012 survey.
40
The National Health Service Litigation Authority (NHSLA)
The NHSLA handles all negligence claims against NHS trusts and makes payment on their
behalf. All NHS Trusts pay into the NHSLA scheme with the premium based on levels of
activity, history of claims and attitude to risk management. A key function for the NHSLA is to
contribute to reducing the number of negligent or preventable incidents. This is achieved
through their risk management programme consisting of standards and assessments
developed to reflect issues which arise in the negligence claims reported to the NHSLA. The
Standards are divided into three “levels”: one, two and three. Trusts receive a 10% discount
of their NHSLA premium with a successful level one assessment and 20% discount for a
successful level 2 assessment.
Dartford and Gravesham NHS Trust has been successful in achieving level two assessment
scoring particularly well on Standard 1 which is concerned with governance and risk
management.
Quality of Data
This measure of data quality refers to whether the Trust recorded patients’ NHS and GP
numbers in their clinical notes.
Dartford and Gravesham NHS Trust submitted records during 2012/13 to the Secondary Uses
Service (SUS) for inclusion in the Hospital Episode Statistics (HES) which are included in the
latest published data. The percentage of records in the published data which included the
patient’s valid NHS number was:
99.4% for admitted patient care;
99.7% for outpatient care; and
97.7% for accident and emergency care.
The percentage of records which included the patient’s valid General Medical Practice Code
was:
100.0% for admitted patient care;
100.0% for outpatient care; and
100.0% for accident and emergency care
Information Governance Toolkit attainment levels
Information governance means keeping information about patients and staff safe. The
Information Governance Toolkit is an annual assessment that all NHS organisations are
required to complete.
Dartford and Gravesham NHS Trust Information Governance Assessment Report overall
score for 2012/13 was 71% and was graded red.
41
The Trust’s overall score remained the same 71% as for 2011/12, and the Trust remained
categorised as ‘Not Satisfactory’ as we were unable to achieve the expected ‘level 2’ score on
all requirements. Specifically, the Trust was unable to achieve the expected level in relation to
information governance training and contractual clauses. An action plan to address these
points will be overseen by the Trust’s Information Governance Committee during 2013/14.
Clinical Coding Error rate
Clinical codes are a way of recording patient diagnosis and treatment. NHS hospitals are paid
different amounts for different groups of codes. This system is called Payment by Results.
Dartford and Gravesham NHS Trust was not subject to the Payment by Results clinical coding
audit by the Audit Commission during the reporting period.
Statement on relevance of data quality
Dartford and Gravesham NHS Trust will be taking the following actions to improve data
quality:
•
•
•
•
•
Maintaining full compliance with the recommendations in the previous Audit
Commission report on Payment by Results for the Trust’s outpatient data.
Working with primary care clinicians to resolve differences in data collected.
Continue the on-going collaboration between clinicians and clinical coders which
supports the accuracy and consistency of coding.
Embedding the use of real time bed management and order communications across
the organisation; this increased use of information technology in direct patient care
leads to an improvement in overall data quality.
Developing enhanced data quality reporting to allow errors to be detected earlier in the
data submission cycle.
Department of Health Core Quality Indicators
In 2012/13, for the first time, the Trust is required by the Department of Health to include
reporting on a core set of indicators in the Quality Account.
Some of these indicators have already been adopted by the Trust as priorities in previous
years and this means there is a measure of duplication in this 2012/13 Quality Account. The
Department of Health guidance on wording and presentation is prescriptive and there is no
latitude. For convenience and clarity we have labelled these core indicators (A) to (H).
A) Summary hospital mortality indicator (SHMI)
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to:
a) The value and banding of the summary hospital-level mortality indicator (SHMI) for the
trust for the reporting period; and
42
b) The percentage of patient deaths with palliative care coded at either diagnosis or
specialty level for the trust for the reporting period.
The Dartford and Gravesham NHS Trust considers that this data is as described for the
following reasons: the Trust has made regular and timely data submissions to the Health and
Social Care Information Centre and the figures are consistent with those produced by Caspe
Healthcare Knowledge Systems (CHKS), the Trust’s information partner
The Dartford and Gravesham NHS Trust intends to take the following actions to improve the
indicator and percentage in (a) and (b), and so the quality of its services, by:
• Mortality indices will continue to be an agenda item at Directorate Governance
meetings and featured at Q-labs.
• Outliers identified will be subject to scrutiny and review.
• The Trust Quality and Safety Committee will receive a report on mortality quarterly to
enable assurance to be given to the Trust Board.
In the table below are the scores for the last four reporting periods.
Table to show SHMI, trust banding and percentage palliative care coding
Period
Trust
SHMI
Banding
Average
SHMI
all trusts
Highest
SHMI
all trusts
Lowest
SHMI
all trusts
%Deaths with
Palliative Coding at
DVH
04/2010 – 03/2011
109.45
2
100.37
124.73
69.01
11.40%
04/2011 - 03/2012
102.85
2
100.23
124.75
71.02
27%
07/2011 - 06/2012
99.83
2
100.22
121.59
71.08
31%
10/2011 - 09/2012
96.35
2
100.05
121.07
68.49
31%
Source: Health and Social Care Information Centre
B) Patient reported outcome measures (PROMS)
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to the trust’s patient reported outcome
measures scores for:
I. Groin hernia surgery,
II. Varicose vein surgery,
III. Hip replacement surgery, and
IV. Knee replacement surgery, during the reporting period
The Dartford and Gravesham NHS Trust considers that the outcome scores are as described
for the following reason: the Trust has made regular and timely data submissions to the
Health and Social Care Information Centre.
.
The Dartford and Gravesham NHS Trust intends to take the following actions to improve
these outcome scores, and so the quality of its services, by:
43
•
Continuing to make timely PROMS data submissions and maintaining a review of the
PROMS data at the Trust Quality and Safety Committee.
The health gain index used in PROMS
PROMS uses a standardised instrument for use as a measure of health outcome. It is
applicable to a wide range of health conditions and treatments and provides a simple
descriptive profile and a single index value for health status.
The health gain index is primarily designed for self-completion by respondents and is ideally
suited for use in postal surveys, in clinics and face-to-face interviews. It is cognitively simple,
taking only a few minutes to complete. Instructions to respondents are included in the
questionnaire.
In the table below are the scores for the last two reporting periods. The data for the remainder
of 2012 is not yet available.
Table (a) PROMs for groin hernia
Period
2010/11
2011/12
Groin Hernia
Health gain
Average
(DVH)
0.119
0.094
0.083
0.087
Largest
Smallest
0.137
0.155
-0.037
-0.043
Source: Health and Social Care Information Centre
The adjusted average health gain for groin hernia surgery, see table (a), indicates a small
improvement above the average improvement in health status of those patients surveyed.
Table (b) PROMS for varicose veins
Period
2010/11
2011/12
Varicose Veins
Health gain
Average
(DVH)
*
*
0.092
0.094
Largest
Smallest
0.165
0.199
0.017
-0.105
Source: Health and Social Care Information Centre
The adjusted average health gain for varicose vein surgery, see table (b), is incomplete as the
Trust does not carry out this type of surgery in sufficient numbers to submit enough data to
quantify for PROMs
44
Table (c) PROMS for hip replacement
Period
2010/11
2011/12
Hip Replacement
Health gain
Average
(DVH)
0.397
0.452
0.401
0.411
Largest
Smallest
0.467
0.508
0.247
0.310
Source: Health and Social Care Information Centre
The adjusted average health gain for hip replacement surgery, see table (c), indicates a small
improvement above the average improvement in health status of those patients surveyed in
2011/12.
Table (d) PROMS for knee replacement
Period
2010/11
2011/12
Knee Replacement
Health gain
Average Largest
(DVH)
0.317
0.263
0.295
0.299
0.379
0.399
Smallest
0.142
0.132
Source: Health and Social Care Information Centre
The adjusted average health gain for knee replacement surgery, see table (d), does not
indicate an improvement above the average improvement in health status of those patients
surveyed in 2011/12.
C) 28 day readmissions
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre (HSCIC) with regard to the percentage of patients
aged:
(i)
0 to 14 (recorded as <16 on the HSCIC system)
(ii)
15 or over (recorded as >16 on the HSCIC system)
Readmitted to a hospital which forms part of the trust within 28 days of being discharged from
a hospital which forms part of the trust during the reporting period.
The Dartford and Gravesham NHS Trust considers that these percentages are as described
for the following reasons: the Trust has made regular and timely data submissions to the
Health and Social Care Information Centre and the figures are consistent with those produced
by Caspe Healthcare Knowledge Systems (CHKS), the Trust’s information partner.
The Dartford and Gravesham NHS Trust has taken the following actions to improve these
percentages, and so the quality of its services, by:
•
•
Increasing numbers of Elderly Care Consultants
Development of Evergreen unit – Elderly care assessment unit working to prevent
avoidable admission and readmission.
45
•
Progression and development of dementia services – this work has been recognised
by the Care Quality Commission, and has resulted in better discharge arrangements
for this vulnerable patient group.
In the table below are the percentages for the reporting periods available on the HSCIC
system.
Table to show 28 day readmissions under 16 years
28 day readmissions Age <16
04/2010-03/2011
04/2011-03/2012
04/2012-03/2013
Trust
9.45%
-
Average
8.20%
-
Highest
14.34%
-
Lowest
0.00%
-
Average
Highest
Lowest
10.51%
-
14.09%
-
Source: Health and Social Care Information Centre
Table to show 28 day readmissions over 16 years
28 day readmissions Age 16+
Trust
04/2010-03/2011
04/2011-03/2012
04/2012-03/2013
10.80%
-
0.00%
-
Source: Health and Social Care Information Centre
D) Responsiveness to needs of patients
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to the trust’s responsiveness to the
personal needs of its patients during the reporting period.
The figures are an average score from a selection of questions from the National Inpatient
Survey measuring patient experience. The score is out of 100 and data is available up to
2011-12.
The Dartford and Gravesham NHS Trust considers that this data is as described for the
following reason: the Trust has made participated in the national Care Quality Commission
(CQC) inpatient survey which provides the data used for the Health and Social Care
Information Centre figures.
The Dartford and Gravesham NHS Trust has taken and intends to take the following actions
to improve this data, and so the quality of its services, by:
• The Trust has implemented a nutrition action plan in 2012/13 as a result of a
Governor’s Enquiry into hospital food.
• The Trust carried out a Dignity and Respect survey of patients attending the Outpatient
and Fracture Clinics. The outcomes from this survey will form part of an action plan to
improve the experience of patients attending outpatient clinics.
• Redesign of the patient waiting area in the Emergency Department.
46
In the table below are the figures for the last three reporting periods.
Responsiveness to needs of patients indicator score
Year
DVH Trust average
score
National Average (all
trusts)
Highest
Lowest
2009-10
72.7
75.6
86.0
68.6
2010-11
73.0
75.7
87.3
68.2
2011-12
70.1
75.6
87.8
67.4
Source: Health and Social Care Information Centre
E) Staff recommendation to family or friends
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre (HSCIC) with regard to the number of staff
employed by, or under contract to, the Trust during the reporting period who would
recommend the trust as a provider of care to their family or friends.
The HSCIC links to data produced in the Department of Health NHS Staff Survey. The
highest and lowest scores are unavailable for this question however the average for acute
trusts is included below.
The Dartford and Gravesham NHS Trust considers that these percentages are as
described for the following reason: the figure is taken from the National NHS Staff Surveys
2011 and 2012 published by the Department of Health. This annual survey is a poll of a
percentage of randomly selected Trust staff each year.
The Dartford and Gravesham NHS Trust has taken the following actions to improve this
percentage, and so the quality of its services, by:
• The Trust has introduced a level of 85% staff with current appraisal at Directorate level.
• The 2012/3 nurse recruitment initiative for Portuguese nurses was successful and
these colleagues have integrated well resulting in improved staffing levels on wards.
In the table below are the figures for the last two reporting periods.
Staff recommendation of the Trust as in the National Staff Survey Results for 2011 and
2012
Staff who would be happy to recommend the Trust “If a
friend or relative needed treatment, I would be happy
with the standard of care provided by this organisation”
Source: Department of Health annual staff survey.
47
Trust score
2012
70%
Trust score
2011
66%
Average for acute
trusts
60%
F) Assessment for venous thromboembolism (VTE)
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to the percentage of patients who were
admitted to hospital and who were risk assessed for venous thromboembolism during the
reporting period.
The Dartford and Gravesham NHS Trust considers that this percentage is as described for the
following reasons: the Trust has made regular and timely data submissions to the Health and
Social Care Information Centre and the figures are consistent with those produced by the
Trust internal information systems.
The Dartford and Gravesham NHS Trust has taken the following actions to improve this
percentage, and so the quality of its services, by:
•
•
In June 2012 a new patient drug chart was introduced. This includes a section for
documentation of VTE assessment and prescribed prophylaxis.
Hospital acquired VTE are reviewed by the Consultant led VTE monitoring group and
reported to the Trust Patient Safety Committee. For each case in 2012/13 an RCA
summary has been forwarded to the Primary Care Trust.
In the table below are the percentages for the last three reporting periods. Results are given
monthly so providing Average, Highest and Lowest would give a very large table and has not
been included. It should be noted that the 95% level is a target and not a score.
Percentage of adult inpatients (over 16 years) assessed for risk of developing VTE
Year
Quarter
Number of
VTEassessed
Admissions
2011-12
Q1
9,652
11,936
Percentage
of admitted
patients
risk
assessed
for VTE
80.9%
2011-12
Q2
10,412
11,790
2011-12
Q3
11,973
2011-12
Q4
2011-12
Total
Admissions
Highest
Lowest
All Trusts
100%
15.7%
84.1%
88.3%
100%
20.4%
88.2%
13,065
91.6%
100%
32.4%
90.7%
12,889
13,971
92.3%
100%
69.8%
92.5%
Q1-Q4
44,926
50,762
88.5%
100%
15.7%
88.9%
2012-13
Q1
12,641
13,636
92.7%
100%
80.8%
93.4%
2012-13
Q2
12,746
13,457
94.7%
100%
80.9%
93.8%
2012-13
Q3
12,184
12,783
95.3%
100%
84.6%
94.1%
2012-13
Q4
13,015
13,545
96.1%
100%
87.9%
94.2%
2012-13
Q1-Q4
50,586
53,421
94.7%
100%
80.8%
93.9%
Source: Health and Social Care Information Centre
48
G) Hospital acquired C-difficile infections
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to the rate per 100,000 bed days of
cases of C-difficile infection reported within the trust amongst patients aged 2 or over during
the reporting period.
The Dartford and Gravesham NHS Trust considers that this rate is as described for the
following reasons: the Trust has made regular and timely data submissions to the Health and
Social Care Information Centre and the figures are consistent with those produced by the
Trust internal data systems
The Dartford and Gravesham NHS Trust has taken the following actions to improve this rate,
and so the quality of its services, by:
•
•
•
•
•
Training and education of ward and department staff on the risk assessment
process/isolation /and stool specimen collection.
C-difficile /Bowel risk assessment training to be undertaken by key staff identified by
Matrons.
Enhanced measures undertaken following each case of post 72 hour C-difficile.
Audits of C-difficile risk assessment compliance, of patient management for all Cdifficile cases, of hand hygiene and of commode cleanliness.
Review of cleaning processes following discharge of infected patients and on a daily
basis.
In the table below are the percentages for the last three reporting periods.
Post 72 hour C-difficile cases per 100,000 bed days
Period
DVH C-difficile
cases
Rate (per 100,000 bed
days)
04/2010-03/2011
21
13.4
04/2011-03/2012
28
18.4
04/2012-03/2013
24
15.0
Average rate for
acute trusts
29.6
21.8
-
Source: Health and Social Care Information Centre
H) Patient safety incidents resulting in severe harm or death
The data made available to the National Health Service trust or NHS foundation trust by the
Health and Social Care Information Centre with regard to the number and, where available,
rate of patient safety incidents reported within the trust during the reporting period, and the
number and percentage of such patient safety incidents that resulted in severe harm or death.
The Dartford and Gravesham NHS Trust considers that this number and/or rate is as
49
described for the following reasons: the Trust has made regular and timely data submissions
to the National Recording and Learning System (NRLS) which provides the data used for the
Health and Social Care Information Centre figures. See also page 40.
The Dartford and Gravesham NHS Trust has taken the following actions to
improve this number and/or rate, and so the quality of its services, by:
•
•
•
Timely monthly data submissions to the National Recording and Learning System for
incidents report in the Trust.
From October 2012 implementation of the electronic Datix web system of incident
reporting to all areas of the Trust.
Training, individual and group, of staff in use of the new Datix web system.
In the table below are the figures for the last four reporting periods.
Patient Safety Incidents resulting in severe harm and death as reported to the National
Recording and Learning System
D&G
National
Average
Highest
Trust
Lowest Trust
2011/12 Q1/Q2
0% (0)
1.2% (20)
7% (62)
0% (0)
2011/12 Q3/Q4
0% (0)
1.0% (17)
3.5% (64)
2012/13 Q1/Q2
0.1% (3)
0.9% (16.5)
2.4% (38)
0% (0)
0.1%(2)
2012/13 Q3/Q4
0.7% (14)**
-
-
-
Small Acute Trust
Source: National Recording and Learning System (NRLS)
In the table above the percentage is the proportion of patient safety incidents resulting in
severe harm or death; and the number in brackets is the absolute number of cases.
**Note: the figures provided for 2012/13 Q3/Q4 are from unvalidated, internal Trust data since
the NRLS report is not due for publication until September 2014. No figures are available for
national average, highest or lowest trust, and the Trust value shown may change.
50
Part Three
How we performed on Quality in 2012/13
This section describes some of the 2012/13 highlights, awards and achievements of the last
year.
Safety and efficiency award
In May 2012 the Trust received a Caspe
Healthcare Knowledge Systems (CHKS)
top hospitals award.
These awards are based on an evaluation
of the key indicators of safety, clinical
effectiveness, efficiency, patient
experience, quality of care and health
outcomes. In addition the indicators
measure the Trust’s performance against
a similar peer group of hospitals.
Dartford midwife wins top UK midwifery award.
A midwife from Darent Valley Hospital has scooped one of the
UK’s top midwifery prizes at the Royal College of Midwives
(RCM) Annual Awards, for her work in bereavement care.
Sharon Hurst a midwife at Dartford and Gravesham NHS Trust
has won the National Maternity Support Foundation (NMSF)
Supporting Training and Rewarding Excellence in Bereavement
Award.
Sharon has been the driving force behind the Trust’s bereavement services. This supports
bereaved parents from the first moment of contact through to vital postnatal support. Her
efforts have led to increased funding for improvements to the physical spaces for
bereavement care within the maternity department.
The award will provide ‘Jake’s Scholarship’ funding to enable Sharon and her colleagues to
undergo further training to developing the teams counselling skills. The midwives will be
known as ‘Jake’s Midwives’ named after Jake Canter who was stillborn in 2005. Jake was the
son of NMSF founders Andrew and Rachel Canter.
Andrew Canter, Chairman of NMSF described Sharon’s work as an outstanding achievement
in this most challenging area of maternity care.
51
A trophy and giant cheque were presented to Sharon at the Royal College of Midwives
Annual Midwifery Awards ceremony on 24th January 2013 in London.
Health Service Journal (HSJ) Patient Safety award
The Trust was a finalist in the prestigious HSJ Patient Safety Awards for improving the
management of deteriorating patients and reducing hospital mortality. The nomination was for
the dramatic improvements in the recognition and prevention of cardiac arrest and decreasing
mortality. The cardiac arrest rate has reduced by more than 50% over the past 5 years from
6.27 to 1.72 per 1000 admissions between 2007 and 2012. This represents a reduction of
39% against the national average reduction of 22%. In line with the reduction of cardiac
arrests we have seen hospital mortality rates continue to fall in 2012.
Other Quality Initiatives in 2012/13
Endobronchial Ultrasound (EBUS)
Over the past 10 years, endobronchial
ultrasound (EBUS) has been
developed as a means to improving
the success rate and sensitivity of
biopsies.
This is a procedure that allows the
doctor to look into the lungs (similar to
a bronchoscopy) but then to take
samples of the glands in the centre of
the chest (mediastinum) using the aid
of an ultrasound scan, these glands lie
outside the normal breathing tubes
(bronchi).
A flexible tube (bronchoscope), which
is about the size of an adult little finger, is passed into the lungs via the mouth and a small
camera at the end of the bronchoscope enables the doctor to look directly into the windpipe
(trachea) and breathing tubes (bronchi). A small ultrasound probe on the end of the camera
allows the doctor to see the glands in the centre of the chest (mediastinum) and take samples
under direct vision
In Dartford and Gravesham, patients have not had access to a local EBUS service, and
doctors referred patients to London (St Thomas’ Hospital). It is estimated that about 50
patients a year are referred for an EBUS procedure.
Respiratory Consultants Dr Mushtaq and Dr Khan are trained to do the procedure and have
audited results of the first 13 cases done at Darent Valley Hospital. The introduction of the
52
EBUS service has increased treatment options and quality of care for patients and the Trust is
now attracting patients from other parts of South East England.
Dignity Champions
Ensuring dignity and respect for people using our services
is essential. 'Dignity Champions’ have been introduced to
help ensure that all patients are treated with dignity and
compassion at all times. Dignity Champions believe that it
is not enough that care services are efficient; care must be
delivered with compassion.
We believe that dignity should be a fundamental part of the
care that we give. We are always mindful that in a busy
hospital dignity should never be comprised or forgotten, not
only for the patients but for their loved ones too.
Dignity Champions come from various clinical staff groups. Many have spent time in our local
mental health unit to gain insight into behaviours as well as to learn from colleagues who care
for people with mental health problems, especially dementia.
Learning about what dignity really means and how it is being delivered is crucial to providing
our patients with the hospital experience that we would wish for them. We had our first Dignity
Study day in January; topics included living with a long-term condition and end of life care. A
carer spoke about his experiences and how he feels as a carer for his mother who has
Dementia. Every case is different and in many cases unique to each family.
February 1st was Dignity Action Day, a national event to highlight the need for dignified care in
care settings. A display in the main entrance and a patient survey in outpatients helped us to
ask people directly for their opinion about dignity and what it means to them. Many wards took
part in raising awareness about dignity in hospital including using dignity boards to highlight
good examples of care.
The A Team - Service Improvement
The Quality, Innovation, Productivity and Prevention (QIPP) programme
is a national Department of Health strategy involving all NHS staff,
patients, clinicians and the voluntary sector. It aims to improve the quality
and delivery of NHS care while reducing costs to make £20bn efficiency
savings by 2014/15.
Inspire
Innovate
Improve
The Trust introduced a dedicated service improvement team during the summer of 2012. The
aim of the team is to work with and support directorates in improving the experiences of
patients. One of the workstreams is:
53
Short notice cancellation of appointments
The Trust became aware from Outpatient surveys, complaints and internal audits that
unacceptably high numbers of patients were being inconvenienced by a significant proportion
of outpatient appointments being cancelled at short notice, i.e. less than 6 weeks.
As a result of this work there has been a reduction in the numbers of cancellations and this is
not just a shift to more timely notice. See also page 13. There has been1,090 fewer short
notice cancellations in 2012/13. As each short notice cancellation costs approx. £50 in staff
time this is not an inconsiderable sum saved and a significant improvement in the service
offered to patients.
Falls resulting in fracture occurring in hospital
In 2012/13 there have been 9 patients who fell whilst in hospital and sustained a fracture
compared to 16 patients in 2011/12. The Trust aspires to a target of zero avoidable falls
resulting in a fracture. The downward trend is positive and there is an action plan in place to
support this target.
Graph to show decline in falls resulting in a fracture over time, April 2009 – March 2013
In-patient Falls resulting in a fracture (Apr 09 - Mar 13)
Falls resulting in a fracture
Linear (Falls resulting in a fracture)
25
20
15
10
5
0
2008/09
2009/10
2010/11
2011/12
2012/13
Source – Trust data management and recording system.
All falls resulting in a fracture are investigated as a Serious Incident (SI) so that causes may
be identified. Of the 9 falls shown above 7 were deemed ‘unavoidable’ on investigation, two
were under investigation in April 2013.
54
Analysis of inpatient falls 2012-2013
Analysis of inpatient falls Apr 2012- Mar 2013
1200
1000
800
Num be r of falls
600
400
200
0
Total
Totals:
No Harm
1046
803
Low (Minimal Moderate (Short
Death (Caused
harm - requiring
term harm by the incident)
extra
requiring f urther
231
11
1
Source – Trust data management and recording system.
Comparison of falls 2011/12 and 2012/13
Analysis of inpatient falls 2011/12 and 2012/13
2011/12
2012/13
Total
admissions
Total
falls
No harm
Low harm
Falls resulting in a
fracture
57,878
1119
862
257
16
Total
falls
No harm
1046
803
61,424
*Low harm (requires
minimal additional
care due to fall)
231
*Moderate (short term
harm requiring further
intervention
*Death
(caused by
incident)
11
1
Source – Trust data management and recording system and CHKS.
The total number of falls has decreased despite a 6.1% increase in admissions.
*Note that the classification of harm has been changed this year as the Trust has moved to an
electronic incident reporting system, previously having been paper based
The overall falls rate to total elective and non-elective admissions is 2.6%
Responding to Complaints
There were 395 complaints received in the period 1st April 2012 to 31st March 2013
compared to 377 for the same period in 2011-12.
Within the time period 13 complaints were reopened. This is usually because the person who
has complained is not satisfied with the response and asks for additional clarification.
The Trust supported and facilitated 19 local resolution meetings (LRM). This is an opportunity
for the person who has made the complaints to meet with senior staff – usually the Consultant
and the Matron for the service, and to discuss any outstanding issues face to face. These
LRMs are documented and a transcript provided in addition to a formal response.
Four cases have been accepted for further investigation by the Parliamentary and Health
Service Ombudsman (PHSO). This is the next stage of the NHS Complaints Process if the
person with the complaint is dissatisfied with the Trust’s response.
55
Graph to show written complaints by month Apr 2012 to Mar 2013
Written complaints received by month
45
40
Number of complaints
35
30
25
Written complaints by month
20
15
10
5
0
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Month
Management of Complaints
Each new complaint is screened by a manager to determine the most appropriate means of
responding – this could be by a phone call, a face to face meeting, or by letter. The complaint
is then taken forward by the Complaints Officer working with the directorate. All complaints
are tracked to monitor deadlines and achieve timely responses.
All complaints result in action being taken to identify what went wrong, and to put systems in
place to avoid this happening in future.
Performance for acknowledgement of complaints within 3 days was 98% and issue of a final
response was 78%, which is outside the departmental monitoring target of 85%.
Prominent themes of Complaints
Complaints by theme 2012-13
35
30
25
20
Nursing care
Medical Care
Treatment and diagnosis
Attitude
Number
15
10
5
0
Q1 (apr, may, jun)
Q2 (jul, aug, sep)
Q3 (oct, nov, dec)
Q4 (jan, feb, mar)
Quarter
56
A review of nursing complaints in 2011-12 showed a significant improvement in complaints
about nursing. As can be seen in the graph below which details the more common themes of
complaints this reduction in nursing complaints has been maintained. This is especially
pleasing as it occurred when the wards and the A&E department have been particularly busy.
Complaint themes and trends are monitored by the Director of Nursing and reviewed each
month by the Trust Board. Any emerging themes or variation is scrutinised in detail with
further breakdown on the numbers to directorate and ward level.
Patient Safety Update
This bulletin provides feedback to staff on the work of the Patient Safety Committee.
Using real examples where appropriate the bulletin informs staff about current safety issues,
alerts and reports on incidents that have happened in the Trust. Recent reporting has
included ‘never events’, clinical documentation, pH testing related to nasogastric tubes, a
drug prescription error, and the introduction of the adult patients passport to safer use of
insulin.
NICE Standards compliance
The National Institute for Health and Clinical Excellence (NICE) guidance is designed to
promote good health and prevent ill health, is based on the best evidence and intended to
deliver good value for money, weighing up the cost and benefits of treatments.
New NICE guidance is received monthly and the Medical Director decides the appropriate
clinician to review the guidance to see that the Trust is compliant.
NICE Guidances received in 2012/13 and status as at March 31st 2013
50
40
50
30
24
20
10
16
15
8
0
1
Not
Awaiting Applicable
Fully
Partially
Not
applicable response
compliant compliant Compliant
(Source: Trust information systems)
57
NICE guidance is discussed at local meetings to ensure all clinicians are aware of the latest
guidance and are practising in accordance with the guidance. In the very rare situation that a
department or directorate decides not to adhere to the guidance there must be a formal
record of this decision made.
The Trust is not compliant in one case; the Director of Pharmacy has reviewed this guidance
and reported that the company who supply the product have been unable to set up a
workable Patient Access Scheme and this has delayed compliance with the standard.
Workforce – our quality resource
The Trust has a growing patient base and to ensure that we continue to deliver high quality
services to patients the hospital has seen areas redesigned and they way that we work
become more productive. This increase in quality and productivity will be essential to ensure
our continued success.
The 2012 staff survey showed an improved profile of results from the previous year. This
included improved rankings in 12 of the 16 below average scores in the 2011 survey.
The Department of Health highlights the five key findings with which the Trust compares most
favourably and least favourably with other acute trusts in England. These are shown below.
Five top ranking scores
Key factor
2012 Trust
score
Staff job satisfaction.
Percentage of staff reporting good communication
between senior management and staff.
Percentage of staff feeling pressure in last three months
to attend work when feeling unwell
Percentage of staff suffering from work related stress in
the last 12 months.
Percentage of staff reporting errors, near misses or
incidents witnessed in the last month.
3.64
2012 national
average
score
3.58
2011 Trust
score
32%
27%
25%
29%
22%
30%
37%
25%
94%
90%
98%
3.55
New
question
Bottom five ranking scores
Key factor
2012 Trust
score
Percentage of staff experiencing physical violence
from patients, relatives or the public in last 12 months
Percentage of staff having equality and diversity
training in last 12 months
Percentage of staff receiving health and safety training
in last 12 months
Percentage of staff saying hand washing materials are
always available
Percentage of staff receiving health and safety training
in last 12 months
58
2012 national
average score
2011 Trust
score
New
question
17%
15%
47%
55%
43%
67%
74%
77%
52%
60%
62%
67%
74%
77%
It should be noted that two of the bottom five rankings relate to training that is only provided to
staff on a two yearly basis and therefore is as expected for this Trust although it is lower than
the average it is only marginally so.
The two biggest changes the Trust has seen internally through the staff survey results are as
follows:
•
•
Percentage of staff having well structured appraisals in last 12 months has improved
from 30% - 40%
Staff recommendation of the trust as a place to work or receive treatment has improved
to 3.73 from 3.54.
Each Directorate has formulated an action plan based on the staff survey results for their
area.
Planning and developing the workforce
The Trust, in 2011, commissioned the Audit Commission to assess levels of ward based
nursing in the Trust. This showed a marked increase in nursing since the previous report in
2009. This report has informed changes to nursing levels in 2012/13. The Trust has also
considered the workforce implications of a number of invited third party reviews, for example,
Deanery visits regarding junior medical staff.
The Trust has an annual workforce plan, which is reviewed periodically in the context of
operational needs and service developments and is approved by the Board.
The Trust was re-accredited as an Investor in People for three years in 2012, demonstrating
good practice staff development. This demonstrates the Trust’s strong track record in the
investment of time and resource in its staff. This commitment to staff education and learning
is central to the deliver of quality services and ensures our workforce adapts to changing
ways of providing care.
The staff survey for 2012 shows that 85% were appraised in the previous year and that 81%
of staff received job-relevant training, learning or development in the previous 12 months.
Staff engagement and empowerment
The Chief Executive has held open sessions throughout the year to speak directly to staff,
and leads a monthly briefing session. The Trust has constructive discussions with staff
representatives through Joint Consultative Committee and Local Negotiating Committee.
Staff engagement was highlighted through the Quality Showcase Event where teams and
individuals from across the Trust participated in highlighting areas of good practice and
innovation. The staff survey results showed that the percentage of staff satisfied with the
quality of care they were able to deliver and agreeing that their role makes a difference to
patients were higher than the national average for acute trusts.
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Health and well-being
The Trust has continued to be one of the highest trusts for flu vaccination percentages in the
south east with 68% of staff receiving the vaccination. All staff have direct access to the Trust
Occupational Health Services as well as direct access to independent counselling services
and support from personal harassment contacts.
The Trust’s sickness absence rate of 3.3% is slightly below Trust target of 3.5%.
Table to show headcount; vacancy, turnover and sickness rates at 31st March 2013
Total staff
headcount (full-time
and part-time) as at
31 March 2013
Vacancy rate
as at 31
March 2013
Turnover rate
Sickness rate
Turnover = total number of
leavers over the period
divided by average number
employed as at 31 March
2013
Total number of days over the
period divided by the number of
sickness days for all employees
over the same period (averaged
over 2012/2013)
2134
8.87%
7.29%
3.61%
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Leadership
The Trust developed key corporate behaviours in 2011/12 – Our Behaviours. These are
applicable to all staff and were embedded in 2012/13 through development programmes,
recruitment, induction and appraisal.
The table above shows the behaviours which are expected of all staff working within
the Dartford and Gravesham NHS Trust
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Annex 1
Statements from other organisations
1) Dartford Gravesham and Swanley Clinical Commissioning Group comments on the
2012/13 Quality Account for Dartford and Gravesham NHS Trust (D&G).
The Trust’s draft Quality Accounts document was sent to Clinical Commissioning Groups
(CCGs) for consultation and comment. The CCGs have a responsibility to review the Quality
Accounts of the Trust each year, using the Department of Health’s Quality Accounts checklist
tool to ascertain whether all of the required elements are included within the document.
The CCG has now completed its review and is pleased to that the necessary data
requirements have been included and that the account contains accurate information in
relation to the NHS Services provided or sub contracted.
The Quality Account is well structured, clear and concise and follows a consistent format
throughout the whole of the report. The Trust has personalised the report by acknowledging
that its successes are due to the involvement of its staff at all levels. The Trust has outlined its
successes during 2012/13 and acknowledges areas where further improvements are
required.
The Trust has identified three key areas which they will focus on making improvements during
2013/14. These include projects within the themes of Patient Safety, Patient Experience and
Clinical Effectiveness, which the CCG endorses. It is reassuring that these areas are high on
the Trust’s agenda as they link well with identified themes within the published Francis Report
Recommendations.
Mortality remains a key area in which the Trust is committed to improving further. A detailed
outline of the planned service improvements has been included which identifies how they aim
to achieve this. Throughout the report patient opinion and feedback has been taken into
consideration when making decisions on where and how to improve services.
In conclusion, the CCG can see that the Trust puts quality at the forefront of its service
provision and that it is central to its operations. The CCG thanks the Trust for the opportunity
to comment on this document. The past year has presented many challenges due to the
changing NHS infrastructure and the transition which has been required from the old Primary
Care Trusts to the new Clinical Commissioning Groups. The CCG looks forward to building
stronger relationships with the Trust through closer joint working in the future.
62
2) Healthwatch Medway commentary on Dartford and Gravesham NHS Trust Quality
Account.
Healthwatch Medway has been invited to comment on the Trust Quality Account. The
consultation period is 30 days; to date a response has not been received for inclusion in this
document.
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3) Kent County Council Health Overview and Scrutiny Committee (HOSC)
The following has been received by letter dated 25th May 2012:
‘In recent weeks the HOSC has received a number of draft Quality Accounts from Trusts
providing services in Kent, and may continue to receive more. I would like to take this
opportunity to explain to your Trust the position of the Committee this year.
Given the large number of Trusts which will be looking at the HOSC at Kent County Council
for a response, and the standard window of 30 days generally allowed for responses, the
Committee does not intend to submit a statement for inclusion in any Quality Account this
year.
Through the regular work programme of HOSC, and the activities of individual Members, we
hope that the scrutiny process continues to add value to the development of effective
healthcare across Kent and the decision not to submit a comment should not be interpreted
as a negative comment in any way.
As part of its ongoing overview function, the Committee would appreciate receiving a copy of
your finalised Quality Account for this year and hopes to be able to become more fully
engaged in next year’s process’.
Kind regards
Robert Brookbank
Chairman
Health Overview and Scrutiny Committee
Kent Count Council
Dartford and Gravesham NHS Trust response to the comments received from other
organisations.
We would like to thank all the above organisations for their comments on this Quality Account.
These will be helpful in further developing the document for the Quality Account 2014-15.
Following receipt of these comments no amendments have been made to the Quality Account
2012-13.
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Annex 2
STATEMENT OF DIRECTORS' RESPONSIBILITIES IN RESPECT OF THE QUALITY
ACCOUNT
The directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of
annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009
and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the
National Health Service (Quality Accounts) Amendment Regulations 2011 and the National
Health Service (Quality Accounts) Amendment Regulations 2012)).
In preparing the Quality Account, directors are required to take steps to satisfy themselves
that:
•
•
•
•
•
The Quality Account presents a balanced picture of the Trust’s performance over the
period covered.
The performance information reported in the Quality Account is reliable and accurate.
There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review
to confirm that they are working effectively in practice.
The data underpinning the measures of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, and is subject to appropriate scrutiny and review; and
The Quality Account has been prepared in accordance with Department of Health
guidance.
The Directors confirm to the best of their knowledge and belief they have complied with the
above requirements in preparing the Quality Account.
By order of the Board
Date: 26th June 2013
Chief Executive
Date: 26th June 2013
Chair
65
Annex 3
Independent auditors opinion
INDEPENDENT AUDITOR’S LIMITED ASSURANCE REPORT TO THE
DIRECTORS OF DARTFORD AND GRAVESHAM NHS TRUST ON
THE ANNUAL QUALITY ACCOUNT
We are engaged by the Audit Commission to perform an independent assurance engagement
in respect of Dartford and Gravesham NHS Trust’s Quality Account for the year ended 31
March 2013 (“the Quality Account”) and certain performance indicators contained therein as
part of our work under section 5(1)(e) of the Audit Commission Act 1998 (“the Act”). NHS
trusts are required by section 8 of the Health Act 2009 to publish a quality account which must
include prescribed information set out in The National Health Service (Quality Account)
Regulations 2010, the National Health Service (Quality Account) Amendment Regulations
2011 and the National Health Service (Quality Account) Amendment Regulations 2012 (“the
Regulations”).
Scope and subject matter
The indicators for the year ended 31 March 2013 subject to limited assurance consist of the
following indicators:
• Percentage of patient safety incidents that resulted in severe harm or death; and
•
Hospital acquired C-difficile infections
We refer to these two indicators collectively as “the specified indicators”.
Respective responsibilities of Directors and auditors
The Directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of
annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009
and the Regulations).
In preparing the Quality Account, the Directors are required to take steps to satisfy
themselves that:
•
the Quality Account presents a balanced picture of the Trust’s performance over the
period covered;
•
the performance information reported in the Quality Account is reliable and accurate;
•
there are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review
to confirm that they are working effectively in practice;
•
the data underpinning the measures of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, and is subject to appropriate scrutiny and review; and
•
the Quality Account has been prepared in accordance with Department of Health
guidance.
The Directors are required to confirm compliance with these requirements in a statement of
directors’ responsibilities within the Quality Account.
Our responsibility is to form a conclusion, based on limited assurance procedures, on whether
anything has come to our attention that causes us to believe that:
66
•
the Quality Account is not prepared in all material respects in line with the information
requirements prescribed in the Schedule referred to in Section four of the Regulations
(“the Schedule”);
•
the Quality Account is not consistent in all material respects with the sources specified
below; and
•
the specified indicators in the Quality Account identified as having been the subject of
limited assurance in the Quality Account have not been prepared in all material
respects in accordance with Section 10c of the NHS (Quality Accounts) Amendment
Regulations 2012 and the six dimensions of data quality set out in the NHS Quality
Accounts - Auditor Guidance 2012/13 issued by the Audit Commission in April 2013
(“the Guidance”).
We read the Quality Account and conclude whether it is consistent with the requirements of
the Regulations and to consider the implications for our report if we become aware of any
material omissions.
We read the other information contained in the Quality Account and consider whether it is
materially inconsistent with:
•
Board minutes for the period April 2012 to May 2013;
•
papers relating to the Quality Account reported to the Board over the period April 2012
to May 2013;
•
feedback from the Commissioners North Kent CCGs dated 26/06/2013
•
the Trust’s complaints report published under regulation 18 of the Local Authority,
Social Services and NHS Complaints (England) Regulations 2009, dated March 2013
•
the latest national patient survey dated 2012;
•
the latest national staff survey dated 2012;
•
the Head of Internal Audit’s annual opinion over the Trust’s control environment dated
08/05/2013;
•
the annual governance statement dated 04/06/2013;
•
Care Quality Commission quality and risk profiles dated March 2013; and
•
the results of the Payment by Results coding review dated May 2013.
We consider the implications for our report if we become aware of any apparent
misstatements or material inconsistencies with these documents (collectively the
“documents”). Our responsibilities do not extend to any other information.
This report, including the conclusion, is made solely to the Board of Directors of Dartford &
Gravesham NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for
no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors
and Audited Bodies published by the Audit Commission in March 2010. We permit the
disclosure of this report to enable the Board of Directors to demonstrate that they have
discharged their governance responsibilities by commissioning an independent assurance
report in connection with the indicators. To the fullest extent permissible by law, we do not
accept or assume responsibility to anyone other than the Board of Directors as a body and
Dartford and Gravesham NHS Trust for our work or this report save where terms are
expressly agreed and with our prior consent in writing.
67
Assurance work performed
We conducted this limited assurance engagement in accordance with the Guidance. Our
limited assurance procedures included:
•
evaluating the design and implementation of the key processes and controls for
managing and reporting the indicators;
•
making enquiries of management;
•
limited testing, on a selective basis, of the data used to calculate the indicator back to
supporting documentation;
•
comparing the content of the Quality Account to the requirements of the Regulations;
and
•
reading the documents.
A limited assurance engagement is narrower in scope than a reasonable assurance
engagement. The nature, timing and extent of procedures for gathering sufficient appropriate
evidence are deliberately limited relative to a reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent limitations than financial
information, given the characteristics of the subject matter and the methods used for
determining such information.
The absence of a significant body of established practice on which to draw allows for the
selection of different but acceptable measurement techniques which can result in materially
different measurements and can impact comparability. The precision of different
measurement techniques may also vary. Furthermore, the nature and methods used to
determine such information, as well as the measurement criteria and the precision thereof,
may change over time. It is important to read the Quality Account in the context of the
Schedule set out in the Regulations.
The nature, form and content required of Quality Accounts are determined by the Department
of Health. This may result in the omission of information relevant to other users, for example
for the purpose of comparing the results of different NHS organisations.
In addition, the scope of our assurance work has not included governance over quality or nonmandated indicators which have been determined locally by Dartford and Gravesham NHS
Trust.
Basis for Adverse Conclusion – Percentage of patient safety incidents that resulted in
severe harm or death
This indicator requires Trusts to report all patient safety incidents that result in severe harm or
death as a percentage of the total number of incidents. Our testing identified that the total
number of incidents reported by Dartford & Gravesham NHS Trust was overstated, and
consequently the reported percentage of safety incidents that resulted in severe harm or
death was understated.
Conclusion (including adverse conclusion on Percentage of patient safety incidents
that resulted in severe harm or death indicator)
In our opinion, because of the significance of the matters described in the Basis for Adverse
Conclusion paragraph, the percentage of patient safety incidents that resulted in severe harm
68
or death indicator has not been prepared in all material respects in accordance with the
criteria.
Based on the results of our procedures, nothing has come to our attention that causes us to
believe that for the year ended 31 March 2013:
•
the Quality Account is not prepared in all material respects in line with the requirements
of the Regulations and the prescribed information in the Schedule;
•
the Quality Account is not consistent in all material respects with the sources specified
above; and
•
the Hospital acquired C-difficile infections indicator has not been prepared in all
material respects in accordance with the Section 10c of the NHS (Quality Accounts)
Amendment Regulations 2012 and the six dimensions of data quality set out in the
Guidance.
……………………………………………….
PricewaterhouseCoopers LLP
Chartered Accountants
London
June 2013
69
Abbreviations and Acronyms
A&E
Accident and Emergency Department
ACS
Acute Coronary Syndrome
AKI
Acute Kidney Injury
AKIN
Acute Kidney Injury Network
AMI
Acute Myocardial Infarction
CAUTI
Catheter Associated Urinary Tract Infection
CCG
Clinical Commissioning Group
CD
Clinical Director
CDU
Clinical Decision Unit
CEA
Carotid Endarterectomy
CEMACE
Centre for Maternal and Child Enquiries
CHD
Coronary Heart Disease
CHKS
Caspe Healthcare Knowledge Systems
CNST
Clinical Negligence Scheme for Trusts
COPD
Chronic Obstructive Pulmonary Disease
CQC
Care Quality Commission
CQS
Composite Quality Score
CQUIN
Commissioning for Quality and Improvement
CT
Computerised Tomography
D&G
Dartford and Gravesham
DOLS
Deprivation of Liberty Safeguards
DVH
Darent Valley Hospital
EBUS
Endobronchial Ultrasound
ECIST
Emergency Care Intensive Support Team
ED
Emergency Department
EDN
Electronic Discharge Notification
EQ
Enhancing Quality
FYTD
Full Year To Date
70
GP
General Practitioner
GI
Gastrointestinal
HES
Hospital Episode Statistics
HF
Heart Failure
HOSC
Health Overview and Scrutiny Committee
HSJ
Health Service Journal
HSMR
Hospital Standardised Mortality Ratio
ICE score
Implementation of Clinical Effectiveness score
ICNARC
Intensive Care National Audit and Research Centre
IT
Information Technology
ITU
Intensive Therapy Unit
IG
Information Governance
KPI
Key Performance Indicator
LOS
Length of Stay
LRM
Local Resolution Meeting
MET
Medical Emergency Team
MINAP
Myocardial Ischaemia National Audit Project
MRSA
Meticillin Resistant Staphylococcus Aureus
MSSA
Meticillin Sensitive Staphylococcus Aureus
MUST
Malnutrition Universal Screening Tool
NBOCAP
National Bowel Cancer Audit Programme
NCDAH
National Care of the Dying Audit - Hospitals
NCEPOD
National Confidential Enquiry Into Patient Outcome and Death
NCAG
National Chemotherapy Advisory Group
NDA
National Diabetes Audit
NHFD
National Hip Fracture Database
NHS
National Health Service
NHSLA
National Health Service Litigation Authority
NICE
National Institute for Health and Clinical Excellence
71
NIV
Non Invasive Ventilation
NJR
National Joint Registry
NLCA
National Lung Cancer Audit
NNAP
National Neonatal Audit Programme
NPSA
National Patient Safety Agency
NRLS
National Reporting and Learning System
NSF
National Service Framework
ODP
Operating Department Practitioner
OSC
Overview and Scrutiny Committee
PAR score
Patient At Risk score
PAS
Patient Administration System
PCI
Primary Coronary Intervention
PCT
Primary Care Trust
PEAT
Patient Environment Action Team
PHSO
Parliamentary Health Service Ombudsman
PROMS
Patient Related Outcome Measures
PSC
Patient Safety Committee
Q Labs
Quality Laboratories
QIPP
Quality Innovation Productivity and Prevention
RAG
Red Amber Green
RTT
Referral To Treatment
SCBU
Special Care Baby Unit
SHA
Strategic Health Authority
SHMI
Standardised Hospital Mortality Indicator
SI
Serious Incident
SINAP
Stroke Improvement National Audit Programme
SSNAP
Sentinel Stroke National Audit Programme
SIRO
Senior Information Risk Owner
ST
Safety Thermometer
72
SUS
Secondary Uses Service
TARN
Trauma Audit and Research Network
TIA
Transient Ischaemic Attack
UK
United Kingdom
UNICEF
United Nations Children's Fund
UoG
University of Greenwich
UTI
Urinary Tract Infection
VTE
Venous Thromboembolism
WHO
World Health Organisation
How readers can comment on the Quality Account
By email –
glyn.oakley@dvh.nhs.uk
By letter –
Susan Acott, Chief Executive,
Darent Valley Hospital, Dartford,
Kent DA2 8DA
73
How readers can comment on the
Quality Account
By email – glyn.oakley@dvh.nhs.uk
By letter – Susan Acott, Chief Executive,
Darent Valley Hospital, Dartford,
Kent DA2 8DA
Dartford and Gravesham NHS Trust
Darent Valley Hospital
Darenth Wood Road
Dartford, Kent DA2 8DA
Tel: 01322 428100
www.dvh.nhs.uk
Quality Account 2012/13 compiled by Sue Craven, Assistant Director of Governance, Dartford and Gravesham
NHS Trust.
74