BMI Carrick Glen Hospital Quality Accounts
April 2013 to March 2014
Chief Executive’s Statement
Welcome to our Quality Accounts 2014, the fifth year we have
published this data. The information presented here on a broad range
of quality measures continues to grow in importance and usefulness for
patients and commissioners. Quality accounts already provide a key
metric for people to assess the strength of our 66 hospitals and clinics
against other facilities - NHS and independent - from which they might
receive their care.
For BMI Healthcare and every other private provider the importance of
comparable quality data was recently reinforced by the conclusions of
the Competition Commission’s market investigation into private
healthcare. From the outset of the inquiry BMI Healthcare supported the
principle that competition in the sector would be enhanced if private
hospitals produced comparable quality data, and that competition
amongst hospitals would drive up service standards. We were therefore
fully supportive when the Commission announced in April that it is mandating the provision of
greater information on the performance of hospital operators and consultants. We
wholeheartedly agree when the Commission says that “a more transparent market with patients
actively making choices will drive hospital operators to compete on the things that matter to
patients”.
Whilst we are yet to see how the Commission will ensure that this is enacted, the private sector
continues to take its own steps. Five years ago BMI Healthcare was at the forefront of the
sector’s efforts to be more open about sharing comparable quality and pricing data when we
sponsored the launch of the Hellenic Project. Today that work has been superseded by the
Private Hospitals Information Network which is working towards publishing data that will allow
patients and commissioners to make informed choices - a challenge that the sector must now
rise to. We at BMI Healthcare will continue to play our part in these important developments,
which we believe can have a significant role in driving higher quality standards.
I remain proud, but certainly not complacent, about the quality of care our hospitals provide.
Last year BMI Healthcare invested £40m in our hospitals, supporting our committed staff and
consultants to meet the challenge of providing consistently safe, high quality care. We
constantly measure our patients’ experience, and I am pleased to note that in the three months
to the end of March 2014, 97.3% of patients independently surveyed expressed satisfaction with
their care and 97.9% said they would recommend us to others. There is however always room
for improvement, and publication of comparable quality data across the independent sector can
only help.
The information available in these quality accounts has been reviewed by the Clinical
Governance Board and I declare that as far as I am aware the information contained in these
reports is accurate. I thank all the staff whose energy and devotion to improvement is
represented here and, more importantly, in the experiences of every patient who steps across
our threshold.
Stephen Collier
Chief Executive Officer
BMI Carrick Glen Hospital is part of BMI healthcare, the largest independent healthcare provider
in the UK.
Located in Ayrshire, the hospital has 18 bedrooms offering privacy and comfort with en-suite
facilities, TV, telephone and Wi-Fi.
The hospital has one operating theatre with laminar flow, six consulting rooms as well as
imaging and physiotherapy departments.
Carrick Glen provides a wide range of Consultant specialist practice, supported by an
experienced team of professionals, offering everything from routine investigations to complex
surgery. This specialist expertise is supported by caring and professional medical staff with
dedicated nursing teams and a Resident Medical Officer on duty 24 hours a day, providing care
within a friendly and comfortable environment.
Nerve conduction studies and hand therapy clinics are two of the new services that we have
introduced at Carrick Glen in the last year.
There has been an ongoing programme of refurbishment within Carrick Glen which is near
completion. New hand washing sinks have been put in which comply with the Scottish Infection
Prevention and Control Regulations.
NHS activity
We engage with both Ayrshire & Arran and Dumfries & Galloway NHS boards. We have a
Service Led Agreement with A&A which includes the usage of their pathology, pharmacy and
CDU services.
Health Improvement Scotland (HIS)
BMI Healthcare are registered as a provider with Health Improvement Scotland (HIS) under the
Health & Social Care Act 2008. BMI Carrick Glen is registered as a location for the following
regulated services:•
•
•
Treatment of disease, disorder and injury
Surgical procedures
Diagnostic and screening
HIS carried out an unannounced inspection on 13th and 14th May 2014. The inspectors from
Healthcare Improvement Scotland check independent healthcare services regularly to make
sure that they are complying with necessary standards and regulations. They inspected on the 5
Quality themes with the following results
Quality Theme 0 – Quality of information: 5 - Very good
Quality Theme 1 – Quality of care and support: 5 - Very good
Quality Theme 2 – Quality of environment: 5 - Very good
Quality Theme 3 – Quality of staffing: 5 - Very good
Quality Theme 4 – Quality of management and leadership: 5 - Very good
BMI Carrick Glen Hospital has a local framework through which clinical effectiveness, clinical
incidents and clinical quality are monitored and analysed. Where appropriate, action is taken to
continuously improve the quality of care. This is through the work of a multidisciplinary group
and the Medical Advisory Committee.
Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the
quality improvements are operationalised.
At corporate level the Clinical Governance Board has an overview and provides the strategic
leadership for corporate learning and quality improvement. There is an appropriate structure of
reporting and escalation in place to enhance effectiveness of this group.
There has been ongoing focus on robust reporting of all incidents, near misses and outcomes.
Data quality has been improved by ongoing training and database improvements. New reporting
modules have increased the speed at which reports are available and the range of fields for
analysis. This ensures the availability of information for effective clinical governance with
implementation of appropriate actions to prevent recurrences in order to improve quality and
safety for patients, visitors and staff.
There are external reporting requirements for HIS, NHS boards and Insurers.
BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where
we produce a data set of all patient episodes approaching HES-equivalency and submit this to
PHIN for publication. The data is made available to common standards for inclusion in
comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website
gives patients information to help them choose or find out more about an independent hospital
including the ability to search by location and procedure.
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control (IPC) continues
under the leadership of the Group Head of Infection Prevention
and Control, in liaison with the IPC lead at BMI Ross Hall
hospital and our own lead in Carrick Glen.
BMI Carrick Glen Hospital has had: • Zero cases of MRSA bacteraemia in the last year (NHS
1.17cases/100,000 bed days).
• Zero cases of MSSA bacteraemia cases /100,000 bed
days
• Zero cases of E.coli bacteraemia cases/ 100,000 bed days
• Zero cases of hospital apportioned Clostridium difficile in the last 12 months.
• SSI data is also collected and submitted to Health Protection Scotland for orthopaedic
surgical procedures. Our rates of infection are zero.
We have carried out our annual infection prevention control environmental audit. An action list
has been created from this and the progress is discussed at our monthly clinical governance
meetings
Monthly care bundles for peripheral cannulation and hand hygiene are ongoing. These are
audited and where appropriate action plans are completed with follow up review to ensure all
actions have been implemented.
We have an ongoing mattress and pillow audit
A programme of education related to Aseptic Non-Touch Technique ANTT is currently
underway in BMI and our Infection Control Lead Nurse is due to attend training for this in June
2014 so this can be cascaded throughout the clinical departments.
An annual sharps audit takes place annually by an external company.
Carrick Glen submits its monthly infection control statistics to the BMI IPC lead for submission to
HEI Scotland.
Both the recent HIS inspection and our recent Provider visit commented on the high standard of
cleanliness within the hospital. There has been a rolling programme over the past year with
regards to interior painting Environmental cleanliness is also an important factor in infection
prevention and our patients rate the cleanliness of our facilities highly.
1.2 Venous Thrombo-embolism (VTE)
BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its
whole network of hospitals including, Carrick Glen. BMI Healthcare was awarded the Best VTE
Education Initiative Award category by Lifeblood in February 2013 and were the Runners up in
the Best VTE Patient Information category.
We see this as an important initiative to further assure patient safety and care. We audit our
compliance every three months with our requirement to VTE risk assessment every patient who
is admitted to our facility and the results of our audit shows that we achieve 100% compliance
on a regular basis.
Carrick Glen reports the incidence of Venous Thromboembolism (VTE) through the corporate
clinical incident system. It is acknowledged that the challenge is receiving information for
patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE
post discharge from the Hospital. As such we may not be made aware of them. We continue to
work with our Consultants and referrers in order to ensure that we have as much data as
possible. .
We have had 2 incidences of VTE between 1st January 2013 and 31st December 2013. A root
cause analysis was completed, both showed that all precautions had taken place and one on
assessment by a Radiologist was suggested it was a VT of chronic, long standing origin and
unrelated to recent surgery.
2. Effectiveness
2.1 Enhanced Recovery Programme (ERP)
The ERP is about improving patient outcomes and speeding up a patient’s recovery after
surgery. ERP focuses on making sure patients are active participants in their own recovery and
always receive evidence based care at the right time. It is often referred to as rapid recovery, is
a new, evidence-based model of care that creates fitter patients who recover faster from major
surgery. It is the modern way for treating patients where day surgery is not appropriate.
Last year BMI Carrick Glen Hospital carried out 41 total hip replacements and 30 total knee
replacements, all patients were pre-assessed prior to admission.
ERP is based on the following principles:1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care
b. Reduced length of stay
2. Patient Preparation
a. Pre Admission assessment undertaken
b. Group Education sessions
c. Optimizing the patient prior to admission – i.e HB optimisation, control comorbidities, medication assessment – stopping medication plan.
d. Commencement of discharge planning
3. Proactive patient management
a. Maintaining good pre-operative hydration
b. Minimising the risk of post-operative nausea and vomiting
c. Maintaining normothermia pre and post operatively
d. Early mobilisation
4. Encouraging patients have an active role in their recovery
a. Participate in the decision making process prior to surgery
b. Education of patient and family
c. Setting own goals daily
d. Participate in their discharge planning
Our physiotherapy department is in the process of setting up a lower limb rehabilitation group
for post-operative patients having had a total hip or knee replacement. They are presently
carrying out a trial of the programme and hope to be fully operative by July.
2.2 Unplanned Readmissions within 31 days and unplanned returns to theatre.
Unplanned readmissions and unplanned returns to theatre are normally due to a clinical
complication related to the original surgery.
The patients that were readmitted were individually assessed and no trend either by cause or
Consultant was identified therefore no improvement plan is necessary.
3. Patient experience
3.1 Patient satisfaction
BMI Healthcare is committed to providing the highest levels of quality of care to all of our
patients. We continually monitor how we are performing by asking patients to complete a patient
satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third
party.
At BMI Carrick Glen we take the feedback from patients very seriously. The patient satisfaction
survey results are discussed at our monthly Quality and Risk meetings. Any patient scoring any
aspect of their care lower than three are called by a member of staff to explore the reason they
rated their care suboptimally. This also provides an opportunity for the staff to learn and/or
change process.
During the period 1st January 2013 to 31st December 2013 for BMI Carrick Glen Hospital all
patients that returned a questionnaire scored at a level of excellent or very good at 100% for
the two categories – were they treated with respect and dignity and overall quality of care. And
96.8% of patients said that they would definitely recommend BMI Carrick Glen. to others.
3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
Carrick Glen actively encourages feedback both informally and formally. Patients are supported
through a robust complaints procedure, operated over three stages:
Stage 1: Hospital resolution
Stage 2: Corporate resolution
Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied
with the outcome at the other 2 stages.
Between January 2013 and December 2013 there were seven written complaints received by
the hospital –
Clinical
Administration
Financial
3
1
3
Six complaints were resolved at hospital level, one of the clinical complaints escalated to a level
two stage of resolution.
4. Research
Carrick Glen has for the previous two years been working in partnership with NHS A&A Multiple
Sclerosis unit to undertake MRI scanning for a small cohort of patient’s trialing a new drug.
5. Priorities for service development and improvement
The following are areas that we are focusing on with a view to growing and improving our
clinical services –
To continue to implement and develop the BMI Clinical Strategy. This is giving a focus for all
clinical areas to look at ways of improving and auditing effectiveness of practices.
To continue to develop, market and promote our services by working closely with the marketing
team and Primary Care Manager, hosting GP evenings to increase their awareness of services
that we provide.
Recruiting new Consultants to the Medical Society that are introducing new services to the
hospital.
Constantly monitoring the external environment to identify opportunities to expand existing
services
e.g. Physiotherapy – mid July we are setting up Pilates classes for post-operative patients
In August we will be starting a women’s health physiotherapy for pre/post
op patients
Carrick Glen’s senior clinical team meets monthly and ensures all corporate and regulatory
requirements are implemented and met to ensure the safety of the environment for our patients
and staff.