BMI Goring Hall Hospital Quality Account 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 Today that work has been superseded by the Private Hospitals Information Network which is working towards publishing data that will allow patients and commissioners to make informed choices - a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 Goring Hall Hospital Quality Account April 2013 to March 2014 BMI Goring Hall Hospital has 24 private inpatient rooms, all with en suite bathrooms and a 4 bedded High Dependency Unit. Day case patients are accommodated in a 12 bedded surgical day care unit. This accommodation is allocated to ensure that all patients are treated in a “same gender” area. Medical day care patients are treated in the Mulberry Suite which can accommodate 4 day care patients at any one time. The Hospital has a wide range of inpatient and outpatient services covering many specialties, such as Orthopaedics, Gynaecology, Urology, Gastroenterology, General Surgery, General Medicine, Cardiology, chronic pain management and ENT. Physiotherapy and rehabilitation services are managed by our specialist therapists. The hospital benefits from a full range of diagnostic facilities including CT, MRI, Ultrasound, Digital Mammography and X-ray. The hospital treats patients with various funding routes, the majority of which are privately funded. The hospital has successfully bid for NHS commission care delivery and in 2013/14 NHS cases accounted for 44% of total case load. BMI Healthcare is registered as a provider with the Care Quality Commission (CQC) under the Health & Social Care Act 2008. BMI Goring Hall Hospital is registered as a location for the following regulated services: § § § Treatment of disease, disorder and injury Surgical procedures Diagnostic and screening The CQC carried out an unannounced inspection on 7th January 2014 when five standards were assessed. The hospital has demonstrated compliance to all these standards. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 BMI Goring Hall 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 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. The following developments have taken place: · Regional Water Safety Committee · Endoscopy Best Practice Group · Regional Health & Safety Committee · Forums to share learning from incidents at other hospitals · Regional Quality and Risk Committee At corporate level the Clinical Governance Board has an overview and provides the strategic leadership for corporate learning and quality improvement. There has been ongoing focus on robust reporting of all incidents, near misses and outcomes. Data quality has been improved by ongoing training and database improvements. New reporting modules have increased the speed at which reports are available and the range of fields for analysis. This ensures the availability of information for effective clinical governance with implementation of appropriate actions to prevent recurrences in order to improve quality and safety for patients, visitors and staff. At present we provide full, standardised information to the NHS, including coding of procedures, diagnoses and co-morbidities and PROMs for NHS patients.There are additional external reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers. BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where we produce a data set of all patient episodes approaching HES-equivalency and submit this to PHIN for publication. The data is made available to common standards for inclusion in comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website gives patients information to help them choose or find out more about an independent hospital including the ability to search by location and procedure. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 1. Safety 1.1 Infection prevention and control The focus on infection prevention and control continues under the leadership of the Group Director of Infection Prevention and Control and Group Head of Infection Prevention and Control, in liaison with the Infection Prevention and Control Lead BMI Goring Hall Hospital. We have had: · Zero cases of MRSA bacteraemia in the last year (NHS 1.17cases/100,000 bed days) · Zero MSSA bacteraemia cases /100,000 bed days · Zero 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 for Orthopaedic surgical procedures. Our rates of infection are o Hips 0.3% o Knees 1.7% Environmental audits are routinely completed in all clinical departments this enables the hospital to improve and continually monitor infection prevention controls. The clinical teams also audit the service using nationally recognised tools from the Infection Prevention Society (IPS). Department % compliance Actions Ilex Ward 93% Hand washing sink replaced Day Care Unit 96% Hand washing sink & surround replaced Oncology 94% Cleaning regimen reviewed and signage improved Consulting Suite 89% Refurbishment of two consulting rooms Theatre Suite 95% Theatre department repainted, worn equipment replaced and scrub areas upgraded Pharmacy 96% Broken tiles replaced Imaging Department 93% Department refurbished Physiotherapy 95% External window to be replaced BMI Goring Hall Hospital Quality Account April 2013 to March 2014 These audits have highlighted areas for improvement: • • • Hand washing: A programme is in place to ensure that all clinical hand washing basins are compliant with current guidance. All staff receive annual training on infection control procedures. Carpets in clinical area: Goring Hall Hospital converted 57% of inpatient rooms to vinyl flooring. The remaining rooms will be refurbished through a rolling programme. Mammography: Refurbishment completed of the mammography unit. Clinical practice is monitored quarterly to ensure that practice standards based on high impact interventions (Saving Lives Care Bundle) are consistently embedded in practice. These research based practice standards are designed to reduce surgical site and peripheral line infections. These standards are consistently applied in practice. · Pre-operative Interventions: MRSA screening, showering & hair removal · Intra-operative Interventions: Skin preparation, prophylactic antibiotics, 90 -100% incises drapes, supplementary oxygen, glucose contro. · Intravenous cannula interventions: Aseptic technique, hand hygiene, Skin preparation,dressing · Post-operative interventions: Hand hygiene, surgical dressing 50-100% 100% 100% Through these audits we have identified areas for improvement that are now consistently applied: • • The use of forced warm air for all patients having surgery longer than 45 minutes The use of improved skin for all surgery (unless patient has a sensitivity) The hospital promotes infection control incentives and standards through an Infection Prevention and Control team. The team is led by a Director of Infection Prevention and Control and supported by ICP lead practitioner, who is responsible for ensuring that standards are maintained throughout each hospital department. Each department has a designated IC&P link. The team audit practice and environment throughout the year according to an audit plan. 1.2 Patient Led Assessment of the Care Environment (PLACE) 20/4/2014 In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient environment, replacing the old Patient Environment Action Team (PEAT) inspections. The assessments involve patients and staff who assess the hospital and how the environment supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or how well staff are doing their job. We believe a patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 Results of this assessment will be published later in the year, interim results are detailed below: Area Condition / appearance Cleanliness Safety Privacy & Dignity Overall Impression External areas 75% - - - - Communal areas 100% 100% 100% 100% Very confident Ilex Ward 100% 100% 100% 100% Very confident Day Care Unit 100% 100% 100% 100% Very confident Consulting suite 79% 91% 100% 70% - Food 100% Further work will continue to improve the environment in the Consulting Suite and external areas. 1.3 Venous Thrombo-embolism (VTE) BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its whole network of hospitals including BMI Goring Hall Hospital. BMI Healthcare was awarded the Best VTE Education Initiative Award category by Lifeblood in February 2013 and was the runner 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 to VTE risk assessment by auditing every patient who is admitted to our facility and the results of our audit on this has shown 100% of patients have been assessed prior to admission. The hospital intends to maintain this result through the continued investment in a robust pre-assessment process. BMI Goring Hall Hopsital 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. VTE incident rates 2013/14 Pulmonary Emboli 0 / 100 cases DVT 0.06 / 100 cases BMI Goring Hall Hospital Quality Account April 2013 to March 2014 2. Effectiveness 2.1 Patient reported Outcomes (PROMS) Patient Reported Outcome Measures (PROMs) are a means of collecting information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves. PROMs is a Department of Health led programme. For the current reporting period, the tables below demonstrate the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing hip replacement and knee replacement at BMI Goring Hall Hospital. Oxford Hip Score average 12/2013 Organisation Average Pre-Op Q Score Average Post-Op Q Score Adjusted average Health Gain ENGLAND 17.612 38.975 21.363 19.416 39.472 20.885 22.433 40.716 20.342 NHS COASTAL WEST SUSSEX CCG (09G) BMI - GORING HALL HOSPITAL (NT417) Copyright © 2011 Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.' Oxford Knee Score average 12/2013 Organisation Average Pre-Op Q Score Average Post-Op Q Score Adjusted average Health Gain ENGLAND 18.531 34.945 16.414 NHS COASTAL WEST SUSSEX CCG (09G) 20.355 34.275 14.544 BMI - GORING HALL HOSPITAL (NT417) 20.881 35.463 15.042 Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved. BMI Goring Hall Hospital continues to innovate care for joint replacement surgery through an Enhanced Recovery Programme (ERP). 2.2 Enhanced Recovery Programme (ERP) The ERP is about improving patient outcomes and speeding up a patient’s recovery after surgery. ERP focuses on making sure patients are active participants in their own recovery and always receive evidence based care at the right time. It is often referred to as rapid recovery BMI Goring Hall Hospital Quality Account April 2013 to March 2014 and is a new, evidence-based model of care that creates fitter patients who recover faster from major surgery. It is the modern way for treating patients where day surgery is not appropriate. ERP is based on the following principles: 1. All Patients are on a pathway of care a. Following best practice models of evidenced based care b. Reduced length of stay 2. Patient Preparation a. Pre Admission assessment undertaken b. Optimising the patient prior to admission – i.e HB optimisation, control comorbidities, medication assessment – stopping medication plan c. 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 e. VTE prophylaxis f. Surgical techniques that reduce blood loss g. Adjuncts to pharmaceutical pain management such as cooling bandages 4. Encouraging patients to have an active role in their recovery a. Participate in the decision making process prior to surgery b. Education of patient and family c. Setting own goals daily d. Participate in their discharge planning The hospital has an ERP committee that meets throughout the year. During these meetings we review the patient complete journey from booking through to discharge, looking at the information and advice given to patients, the care they receive, and the engagement with patients, consultants and GP’s to ensure their help with delivering the complete enhanced recovery pathway. We have focused on patient education, early mobilization, carbohydrate loading, appropriate analgesia and planning discharge at the preadmission stage, reducing patient’s length of stay and getting them mobilizing earlier. This helps reduce the risk of VTE, infection and helps towards a smoother recovery. With these interventions the length of stay in the hospital for hip replacements is 3.5 nights and for knee replacement patients is 2.8 nights and this has reduced dramatically since commencement of this programme. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre. Unplanned readmissions and unplanned returns to theatre are normally due to a clinical complication related to the original surgery. The hospital has implemented a programme of post discharge follow-up calls. This means that further advice, support and changes to the discharge package can be made in a timely manner. Those patients requiring additional support can be identified earlier. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 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. Our teams review results regularly to ensure that the highest standards are maintained. BMI Goring Hall has improved and standardised patient information, patient room facilities, reviewed the discharge process, streamlined the admission and pre-assessment processes and improved access to parking by designating patient specific parking bays.These improvements are under continuos review through our Quality and Risk team to ensure that the highest standards are maintained. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 BMI Goring Hall Hospital Quality Account April 2013 to March 2014 3.2 Complaints In addition to providing all patients with an opportunity to complete a satisfaction survey BMI Goring Hall 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 with the outcome at the other 2 stages We encourage our clinical teams to be involved in responses to patient compliants, this promotes reflective practice. The main themes for patient complaints are detailed below with actions taken in response: Themes Breach of patient information Quality and style of customer service Appearance of safety of access to hospital Access to hospital for oncology patients Inaccurate internal and external signage Actions Change to working practice to promote patient confidentiality: use of patient identity labels controlled, use of patient voicemail for information controlled Customer care progamme relaunch to focus on dealing with complaints Courtyard upgraded to improve disabled access Designated oncology patient parking Internal and external signage improved BMI Goring Hall Hospital Quality Account April 2013 to March 2014 4. CQUINS Commissioning for QUality and INnovation is a national scheme where commissioners set both national and local improvement targets for providers of commissioned services. These targets are intended to stretch and challenge the providers to make sustainable improvements to their service. BMI Goring Hall entered into the full range of CQUINS and through various improvement projects it has achieved the recommended target for all measures. New CQUINS for 2013-2014 have been set for commissioned services and BMI Goring Hall Hospital intends to actively participate in all. CQUIN Measure 1.2 Friends and Family increased response rate - Achieved 2.1 Safety Thermometer Data Collection - Achieved 2.2 Reduced or Maintained rate of Pressure Ulcer - Achieved Target Result Comments Increase patient response rate to 20% 32% NHS friends and family survey Complete a point prevalence survey of incidents of Pressure Ulcer and 100% 100% Infection and data submitted to NHS IC Maintained zero incidence of hospital 0 0 acquired pressure ulcer 3.1 Dementia Find , Assess, Investigate & refer - Achieved 90% 100% Improve the identification of suspected dementia diagnosis 3.2 Dementia Clinical Leadership Achieved 100% 100% Improved dementia awareness 100% 100% Improved support for carers through linking with community services 95% 100% VTE risks identified prior to admission 100% 100% Any incidents of VTE investigated to identify the root cause 5.1 Local Follow up calls - Achieved 80% 81% 6.1 Local New to follow up ratio Achieved 2.14 1.84 3.3 Dementia Clinical Supporting carers - Achieved 4.1 VENOUSTHROMBOEMBOLISM (VTE) Risk assessment - Achieved 4.2 VENOUSTHROMBOEMBOLISM (VTE) RCA - Achieved Improved contact with patient following discharge Reduce the need for further follow-up appointment through telephone contact 5. National Clinical Audits BMI Goring Hall Hospital was eligible to participate in the National Joint Registry and data for all joint replacements are submitted to this national audit tool that measure long term results of primary joint replacements. Data from this registry is used at annual appraisal and revalidation of our consultants. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 6. Research No NHS patients were recruited to take part in research. 7. Priorities for service development and improvement Priorities Refurbishment Clinical Training Oncology Imaging Infection control Resuscitation Actions Continue rolling programme of carpet replacement in patient accommodation Roll out of mandatory training schedule and a focus on dementia awareness The hospital is working towards Macmillan accreditation Phase two Imaging department refurbishment: MRI, Interventional room Continue rolling programme of hand washing sink replacement Replacement of resuscitation equipment 8. Mandatory Quality Indicators 8.1 The value and banding of the summary hospital-level mortality indicator (SHMI) for BMI Goring Hall Hospital for the reporting period. Unit Reporting Periods National Highest National Lowest National 2013-2014 Average Score Score Value Zero 1.006 1.1822 0.06735 and Banding Zero inpatient deaths through 2013-14 8.2 BMI Goring Hall Hospital patient reported outcome measures scores for (i) Groin hernia surgery Unit Reporting Periods National Highest National 2013-2014 Average Score Number N/A N/A N/A Less than 30 patients so site cannot be scored (ii) Varicose vein surgery Unit Reporting Periods National 2013-2014 Average Number N/A N/A Less than 30 patients so site cannot be scored Highest National Score N/A Lowest National Score N/A Lowest National Score N/A BMI Goring Hall Hospital Quality Account April 2013 to March 2014 (iii) Hip replacement surgery Dec 2013 (iv) Knee replacement surgery Dec 2013. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital within 28 days of being discharged. Unit Reporting Periods National Highest National Lowest National Apr- Mar 14 Average Score Score % NA as no paediatric services at BMI Goring Hall Hospital 8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of the BMI Goring Hall Hospital within 28 days of being discharged. Unit Reporting Periods National Highest National Lowest National Average Score Score % NA as no paediatric services at BMI Goring Hall Hospital 8.4 BMI Goring Hall Hospital responsiveness to the personal needs of its patients during the reporting period. Unit Reporting Periods National Highest National Lowest National Apr- Mar 14 Average Score Score % 93.13 68.1 84.4 57.4 BMI Goring Hall Hospital considers that this data is as described for the following reasons: patients consistently report that care delivery is responsive to their needs. This data is support by positive feedback from patient groups at regular patient forums. BMI Goring Hall Hospital intends to maintain excellent levels of responsiveness by continual review of services and care delivery. During 2014 a clinical strategy will be embedded in the clinical areas and clinical teams will be further challenged to reflect on how their care can meet the needs of our patient population. 8.5 The percentage of patients who were admitted to BMI Goring Hall Hospital and who were risk assessed for venous thromboembolism during the reporting period. Unit % Reporting Periods Apr- Mar 14 100% National Average 96% Highest National Score 100% Lowest National Score 79% BMI Goring Hall Hospital considers that this data is as described for the following reasons: it reflects the high standard of risk management carried out. BMI Goring Hall Hospital intends to maintain its current level of attainment and further develop VTE champions within the clinical areas. Together with reviewed patient information, new mechanical prophylaxis and early mobilization we will further reduce our incidence of VTE. 8.6 The rate per 100,000 bed days of cases of C difficile infection reported within BMI Goring Hall Hospital amongst patients aged 2 or over during the reporting period. Unit Rate Reporting Periods Apr- Mar 14 0.16 National Average 17.3 Highest National Score 30.8 Lowest National Score 7.9 BMI Goring Hall Hospital considers that this data is as described for the following reasons: it reflects the high standards of infection control procedures carried out. BMI Goring Hall Hospital Quality Account April 2013 to March 2014 During 2014 a nationally recognised training programme will be developed to further support hand hygiene and ANTT techniques. 8.7 The number and, where available, rate of patient safety incidents reported within BMI Goring Hall Hospital during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. Number of patient safety incidents reported Unit Number Reporting Periods Apr- Mar 14 1 National Average 7.76 Highest National Score 30.95 Lowest National Score 1.68 National Average 0.64 Highest National Score 28 Lowest National Score 0 Rate of patient safety incidents reported Unit Rate Reporting Periods Apr- Mar 14 0.00001 Number of patient safety incidents that resulted in severe harm or death Unit Number Reporting Periods Apr- Mar 14 0 National Average 0.9 Highest National Score 2.9 Lowest National Score 0 Percentage of patient safety incidents that resulted in severe harm or death Unit % Reporting Periods Apr- Mar 14 0 National Average 7.76 Highest National Score 30.95 Lowest National Score 1.68 BMI Goring Hall Hospital considers that this data is as described for the following reasons: the hospital takes a proactive approach to risk management, gathers learning from incidents and actively shares the learning with its clinical teams and other hospitals within the Group. 8.8 The percentage of staff employed by the BMI Goring Hall Hospital during the reporting period, who would recommend BMI Goring Hall Hospital as a provider of care to their family or friends. Reporting Periods National Highest National Lowest National Apr 13 Average Score Score % 87% 64.5% 96.4% 33.7% BMI Goring Hall Hospital considers that this data is as described for the following reason: as this is supported by patient feedback. Unit BMI Goring Hall Hospital Quality Account April 2013 to March 2014 9. Non-Mandatory Quality Indicators 9.1 The percentage of patients who received care as inpatients or discharged from A&E during the reporting period, who would recommend BMI Goring Hall Hospital as a provider of care to their family or friends. Unit % Response rate Reporting Periods Apr 14 84 National Average 74 Highest National Score 94 Lowest National Score 33 32% 34% 100% 13% BMI Goring Hall Hospital intends to maintain and further improve patients’ perception and experience of care through embracing and embedding the fundamentals of care (6 “C”s) in every day practice and further improving its excellent patient response rate of 32%.