BMI Fernbrae 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 Today that work has been superseded by the Private Hospitals Information Network which is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 Fernbrae Hospital is located in the west end of Dundee, in one of the city’s conservation areas. A
partially listed building, it has an enviable view over the River Tay and the banks of north-east Fife. The
hospital serves the people of Tayside, Angus, Perthshire and Fife, is easily accessible and parking is
available at the front and rear of the building.
The building has been a health care establishment for over 90 years and is now part of BMI Healthcare,
the largest independent healthcare provider in the UK.
A wide range of surgical procedures are carried out from routine investigations to complex surgery
including major joint replacements. Approximately 100 consultants have Practicing Privileges and they
receive support from a Resident Medical Officer.
The hospital has 15 en-suite patient bedrooms which are fitted with a remote controlled flat screen
television. We have recently had Wi-Fi installed into each ward area which serves each patient bedroom.
The hospital has one operating theatre with laminar airflow to assist in the prevention of infection.
In addition the hospital also offers the following•
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Outpatient Service
Bariatric Service
Cardiology Service
Clinical Psychology Service
Cosmetic Service
Dermatology Service
Ear, Nose & Throat Service
Endoscopy Service
Health Screening Service
Pharmacy Service
Physiotherapy Service including Complementary Therapy and Hand Therapy
Radiology Service including MRI
The hospital has recently upgraded our endoscopy procedure and decontamination rooms to a very high
standard, including our new Endoscopy Washer Disinfector for the disinfection of endoscopes.
The hospital’s mission statement “To be Tayside’s Independent Healthcare Provider of first choice,
positively contributing to the health of the community we serve” encompasses the very positive motivation
of the team at BMI Fernbrae Hospital.
All the staff at BMI Fernbrae Hospital are committed to ensuring that you are confident and comfortable
with every aspect of your visit. Our Director of Clinical Services is available to address any concerns you
may have and there is a Resident Medical Officer available 24 hours a day.
NHS Activity
BMI Fernbrae Hospital are currently not involved in NHS activity.
Healthcare Improvement Scotland (HIS)
BMI Healthcare, Fernbrae Hospital are registered as a provider with Healthcare Improvement Scotland
(HIS) under the Health & Social Care Act 2008. BMI Fernbrae Hospital is registered as a location for the
range of services described above.
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HIS carried out an unannounced inspection on 7 November 2013 and measured outcomes related to the
following themes •
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Quality of Information
Quality of Care & Support
Quality of Environment
Quality of Staffing
Quality of Care Staff
Quality of Management and Leadership
All recommendations related to the above themes have been actioned and implemented, leading to an
increased level of quality patient care.
BMI Fernbrae Hospital are currently carrying out a review and rationalisation of the National Care
Standards (Independent Hospitals) and how we apply these to the patient journey. This will be fully
completed by December 2014 and reported in the 2015 Quality Accounts.
BMI Fernbrae Hospital has a local framework through which clinical effectiveness, clinical incidents and
clinical quality is monitored and analysed. Where appropriate, action is taken to continuously improve the
quality of care. This is through the work of the multidisciplinary group and the Medical Advisory
Committee.
Regional Quality Assurance Board monitor and analyse trends and ensure that the quality improvements
are operationalised.
At corporate level the Quality Assurance 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 the 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.
Fernbrae are currently undergoing an ongoing programme of refurbishment which includes the following
upgrades and replacementsNew Handwashing sinks throughout (Compliant with Scottish Infection Prevention and Control
Regulation)
En-suite wetroom facilities in patient bedrooms
Development of improved nursing preparation rooms
Replacement of nursing station in Strathtay ward
Replacement of Medical Equipment in all departments
BMI Fernbrae Hospital’s clinical team liaise with the local NHS trust specialists groups in relation to the
transfusion, recording and traceability of blood and blood products and infection control.
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control continues under the
leadership of the Group Head of Infection Prevention and Control.
There is a Director of Infection Control in the hospital who is
accountable for the implementation of Infection Control Policies and
other IPC requirements. The Infection Prevention and Control Lead
and Link nurses in BMI Fernbrae Hospital are responsible to ensure
these are implemented appropriately.
BMI Fernbrae Hospital have had: • Zero cases of MRSA bacteraemia in the last 12
months (NHS 1.17cases/100,000 bed days).
• Zero cases of hospital apportioned Clostridium Difficile in the last 12 months.
• Zero cases of MSSA in the last 12 months.
• Zero cases of e-coli in the last 12 months.
BMI Fernbrae Hospital have an annual programme of infection control audits which cover each
department in the hospital. Where appropriate, action plans are completed with follow-up review to
ensure all actions have been implemented.
We also have recently completed two Standard Operating Procedures with Audit tools to measure the
effectiveness of two high impact care bundles (Intravenous Cannulation and Hand Hygiene). These are
due for audit in May 2014 and will be carried out thereafter at three monthly intervals. We plan to
progress with those related to pre-operative, peri-operative and post-operative care in 2014.
The patient mattresses in the hospital are audited on a three monthly basis and replacement is automatic
where any fault is established.
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.
Practical hand hygiene training is carried out annually and the process is audited on a three monthly
basis. We consistently have 100% compliance with this area of practice. Infection Prevention and
Control training is part of the BMI Fernbrae Hospital mandatory training programme. BMI Fernbrae
Hospital have also implemented an updated induction programme for new staff members.
Environmental cleanliness is also an important factor in Infection Prevention and Control 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 BMI Fernbrae Hospital. 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 assess every patient who is admitted to our facility
and the results of our audit has shown we achieve 100% compliance on a regular basis.
BMI Fernbrae Hospital reports the incidence of Venous Thromboembolism (VTE) through the corporate
clinical incident system. It is acknowledged that the challenge is receiving information for patients who
may return to their GPs or other hospitals for diagnosis and/or treatment of VTE post discharge from the
Hospital. As such we may not be made aware of them. We continue to work with our Consultants and
referrers in order to ensure that we have as much data as possible.
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We have had no incidence of VTE between 1 January 2013 and 31 December 2013.
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. The length of stay at BMI Fernbrae Hospital
averaged 2.5 days for hip replacement and 3.25 days for knee replacement at December 2013. BMI
Fernbrae Hospital carried out 41 hip replacement procedures and 27 knee replacement procedures over
the past 12 months and all patients were pre-assessed prior to admission. All replacement surgery
patients had an ASA score of zero placing the patient at low risk of complication and infection.
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. Optimizing the patient prior to admission – i.e HB optimisation, control co-morbidities,
medication assessment – stopping medication plan.
c. Commencement of discharge planning
3. Proactive patient management
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Maintaining good pre-operative hydration
Minimising the risk of post-operative nausea and vomiting
Maintaining normal temperature pre and post operatively
Early mobilisation
4. Encouraging patients have an active role in their recovery
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Participate in the decision making process prior to surgery
Education of patient and family
Setting own goals daily
Participate in their discharge planning
2.2 Unplanned Readmissions within 31 days and unplanned returns to theatre.
Fernbrae have had 1 unplanned readmission and 3 unplanned returns to theatre during 2013 that were
due to a clinical complication related to the original surgery. There are theatre staff available on an oncall system 24hrs a day to provide access to theatre and prompt treatment.
BMI Fernbrae Hospital had 4 unplanned transfers to Local NHS Trust Hospital during 2013 due to
complications related to the original surgery. Please see graph below showing unplanned transfers to
NHS facilities.
3. Patient experience
3.1 Patient satisfaction
BMI Healthcare is committed to providing the highest levels of quality of care to all of our patients. We
continually monitor how we are performing by asking patients to complete a patient satisfaction
questionnaire. Patient satisfaction surveys are administered by an independent third party.
The questionnaire also asks how the patients rated their overall quality of care (which takes into account
all areas of their care and treatment as outlined below). This is measured across two catagories; very
good and excellent.
During the period 1st January 2012 to 31st December 2012 BMI Fernbrae Hospital received 243
completed patient questionnaires. All our staff are dedicated to providing the best possible patient care
and patients are particularly appreciative of their efforts. We are pleased to report that 100% of
respondents rated their Overall Quality of Care as good, very good or excellent.
On other key issues the patient ratings for the hospital were as follows (all % good, very good or
excellent):
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Overall impression of the arrival process
Overall nursing care:
Consultant Surgeon / Physician :
Diagnostic Imaging (XǦray):
97.2%
Physiotherapists:
Pharmacy:
Consultant Anaesthetist:
Theatre staff:
Accommodation:
Catering:
Discharge Procedure
99.1%
99.6%
100.0%
100.0%
100.0%
100.0%
100.0%
96.3%
99.6%
99.1%
We asked patients to tell us if they were treated with respect and dignity at all times and 98.8% said ‘Yes,
always’ and finally we are proud to report that 99.6% of patients said that we either met or exceeded their
expectations, and 90.1% of our patients would definitely recommend BMI Fernbrae Hospital.
During the period 1st January 2013 to 31st December 2013 BMI Fernbrae Hospital received 689
completed patient questionnaires. All our staff are dedicated to providing the best possible patient care
and patients are particularly appreciative of their efforts. We are pleased to report that 98.4% of
respondents rated their Overall Quality of Care as good, very good or excellent. On other key issues the
patient ratings for this hospital were as follows (all percentages were good, very good or excellent):
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Overall impression of the arrival process
Overall nursing care:
Consultant Surgeon / Physician
Diagnostic Imaging (XǦray):
98.1%
Physiotherapists:
Pharmacy:
Consultant Anaesthetist:
Theatre staff:
Accommodation:
Catering:
Discharge Procedure
98.8%
98.4%
98.6%
97.0%
96.2%
98.6%
100.0%
88.6%
90.6%
95.5%
We asked patients to tell us if they were treated with respect and dignity at all times and 98.8% said ‘Yes,
always’ and finally we are proud to report that 99.6% of patients said that we met or exceeded their
expectations, and 90.1% of our patients would definitely recommend BMI Fernbrae Hospital.
3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI Fernbrae
Hospital 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
outcome at the other 2 stages.
with the
Between January 2013 and December 2013 there were 21 written complaints received by the hospital.
• Clinical
• Non-Clinical (Patient Involved)
• Non-Clinical (No Patient Involved)
3
18
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We ensure that all patients are given the information via the “Please Tell Us” leaflet which outlines the
complaints procedure. The majority of the above complaints was in relation to financial queries and was
all resolved at hospital level. We have met face to face with the complainant on two occasions during the
above two years’ period. We ensure our complaints are readily available for HIS inspection as required.
Only 6% of the above complaints were not fully resolved within the 20 working day requirement and we
continue to make every effort to make the necessary adjustments to fulfill that responsibility.
4. National Clinical Audits
BMI Fernbrae Hospital participates in a local audit with NHS Tayside for Hip and Knee replacement
surgery.
5. Research
No NHS patients were recruited to take part in research.
6. Priorities for service development and improvement
The following are our priorities from a clinical perspective –
• To continue with the development of the Enhanced Recovery Programme (ERP) and
it’s positive outcomes for patient care. The patients on this programme have access
to a multi-disciplinary team including the Registered Nurse, Physiotherapist,
Consultant, Registered Medical Officer, Radiographer and Pharmacist.
• To continue to implement and develop the BMI Clinical Strategy which was produced
in 2014 and launched during the early part of 2014. This is a multi-disciplinary
strategy involving all clinicians and non-clinicians in the hospital environment.
• To continue to develop, market and promote our services by working closely with our
marketing team, hosting GP evenings and promote private medical insurance with GP
practices in the area.
• To continue auditing our clinical practice and compliance with patient safety tools to
improve the quality of service to our patients. Patient safety is the uppermost priority
of BMI Fernbrae Hospital
• BMI Fernbrae Hospital have implemented a daily clinical communications meeting to
assist with the quality of communications between departments in the hospital. This is
a multi-disciplinary initiative.
• To continue to review and rationalize the National Care Standards for Independent
hospitals to help enhance the quality of care delivered to our patients.
• To review and develop the Quality Improvement Scotland (QIS) Standards for Hospital
Acquired Infections (HIA’s) as part of our Infection Control Programme.
• To continue to ensure that our theatre medical equipment is continually reviewed and
upgraded as necessary.