Alexandra
Hospital
Quality
Accounts
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 Today that work has been superseded by the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.
ϭ
Stephen Collier
Chief Executive Officer
Ϯ
BMI The Alexandra Hospital
BMI The Alexandra Hospital in Cheadle, Cheshire is part of BMI Healthcare, Britain's leading
provider of independent healthcare with a nationwide network of hospitals and clinics performing
more complex surgery than any other private healthcare provider in the country. Our
commitment is to quality and value, providing facilities for advanced surgical procedures
together with friendly, professional care.
BMI The Alexandra Hospital is licensed for 170 beds with all rooms offering the privacy and
comfort of en-suite facilities, satellite TV and telephone. The hospital has seven laminar flow
theatres, an endoscopy suite, an eight bed short stay unit and six level three critical care beds
and six level two critical care beds.
Our twelve critical care beds enable the hospital to care for a full range of complex patients who
may require multi organ support.
These facilities combined with the latest in technology and on-site support services enable our
consultants to undertake a wide range of procedures from routine investigations to complex
surgery.
As the largest private hospital outside of London, BMI the Alexandra has invested £1.2million on
infrastructure and is also about to upgrade its CT scanner to be the first of its kind in Private
Healthcare in the UK.
This adds to the most comprehensive suite of Imaging services including MR, CT, X-ray, digital
mammography, Nuclear Medicine and interventional radiology.
ϯ
New developments / refurbishments in the hospital during the year.
Infrastructure spend included a new air condition unit plant, and roof improvements and chiller
system for Theatres. This ensures that the building is well maintained and fit for purpose at all
times.
Plans are advancing to build a hybrid neuro-cardiovascular theatre in the medium term.
Planning is also being obtained to build a 3T MRI scanner which will be in addition to and
complement the current 1.5T machine.
20 % of NHS patients contribute to our overall work.
•
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•
•
•
•
•
•
•
•
BMI Healthcare is registered as a provider with the Care Quality Commission (CQC)
under the Health & Social Care Act 2008. BMI The Alexandra Hospital is registered as a
location for the following regulated services:Treatment of disease, disorder and injury
Surgical procedures
Diagnostic and Screening
Physical Disabilities
Sensory Impairments
Surgical Procedures
Caring for Children (0-18years) – Consultation only for under threes and interventional
treatment for over 3 years.
Caring for Adults under 65years)
Caring for Adults over 65 Years
The Care Quality Commission (CQC) carried out an unannounced inspection on the 10th
February 2014 and found the Hospital fully complaint with the standards assessed;
Respecting and involving people who use services
Consent to care and treatment
Care and welfare of people who use services
Nutritional needs
Safeguarding people who use services from abuse
Safety and suitability of premises
Requirements relating to workers
Staffing
Complaints
ϰ
The Alexandra 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 our Clinical Governance
function, multidisciplinary group and the Medical Advisory Committee.
Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the
quality improvements are operationalized.
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.
We have also introduced new Lean ways of working to ensure that we deliver a smooth and
consistent service to our patients, and effective ways of working for our staff. One element of
this is a series of Communication cells, which work in conjunction with creative problem solving.
Communication cells give everyone an opportunity to raise concerns and see through a
transparent process that their issue has been dealt with at an appropriate level. The Lean
Operating System acts as a foundation for the way that we work and helps us enrich our culture,
improve efficiency, and empowers staff to act which is having a positive effect on engagement.
The creative problem solving has enabled us to identify areas of opportunity to make process
improvements, for example, we have developed an electronic booking form which speeds the
process and ensures that clear information is issued from the referring clinician. This enhanced
way of working is called ‘The BMI Way’ and is directly linked to our BMI Behaviours and is
introduced in such a way that our desired behaviours become engrained in our day to day
working lives.
ϱ
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control continues under the leadership of the Group Head
of Infection Prevention and Control, in liaison with the link nurse in The Alexandra Hospital.
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 at The
Alexandra Hospital
We have had: • Zero cases of MRSA bacteraemia in the last year (NHS
1.17cases/100,000 bed days).
• Zero MSSA bacteraemia cases zero /100,000 bed days
• Zero E.coli bacteraemia cases zero/ 100,000 bed days
• 10.683 rate per 100,000 bed days of hospital apportioned Clostridium difficile in the last
12 months.
• SSI data is also collected and submitted to Public Health England for orthopaedic
surgical procedures. The Alexandra Hospital rates of infection are;
o Hips – 1.141 - infection rate per 100 hip replacements
o Knees – 0.446 - infection rate per 100 knee replacements
As a result of our Infection Prevention & Control area audits which are undertaken once a year
and approximately two areas are reviewed every month. For example the surgical audit
highlighted the omission of suitable hand-washing facilities in the treatment room. This
was subsequently risk assessed and a new sink has been fitted. In two further areas the bed
pan washers were found during audit to be noncompliant with health and safety regulations due
to their age so were replaced with safer cleaner bedpan macerators.
Care bundles are undertaken throughout the year by the staff in each area and overseen by
infection control. Over the last 6 months they have scored 100% on all the care bundle audits.
To ensure data quality the Infection Prevention Control Coordinator will be undertaking one care
bundle in each area during over the year.
ϲ
Weekly training sessions incorporate the 5 moments and aseptic non touch technique. All
clinical members of staff attend these sessions as part of Mandatory Training as well as an elearning module.
Environmental cleanliness is also an important factor in infection prevention and our patients
rate the cleanliness of our facilities highly.
1.2 Patient Led Assessment of the Care Environment (PLACE)
We believe a patient should be cared for with compassion and dignity in a clean, safe
environment. Where standards fall short, they should be able to draw it to the attention of
managers and hold the service to account. PLACE assessments will provide motivation for
improvement by providing a clear message, directly from patients, about how the environment
or services might be enhanced.
In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient
environment, replacing the old Patient Environment Action Team (PEAT) inspections.
The assessments involve patients and staff who assess the hospital and how the environment
supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It
focuses entirely on the care environment and does not cover clinical care provision or how well
staff are doing their job.
The results of The Alexandra Hospital PLACE Audit for 2013 are:
ϳ
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, The Alexandra 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 with our requirement to VTE risk assessment every patient who is admitted to our
facility and the results of our audit has demonstrated that we are 100% complaint. This audit
and our continuous improvement programme is signed off by the Director of Clinical Services.
A rolling programme of monthly VTE audits is in place and our aim is to strive to continuously
improve and keep our results at 100%.
The Alexandra 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. .
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.
Latest results can be found by going on the online SOLAR system provided to you by Quality
Health
For the current reporting period, the tables below demonstrate that the health gain between
Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing
hip replacement and knee replacement at Hospital.
Oxford Hip Score average
April 2013March 2013
Alexandra
Hospital
Q1
Q2
Health gain (Q2 - Q1 average)
21.109
40.957
21.819
17.907
39.224
21.317
England
Copyright © 2011 Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.'
ϴ
Oxford Knee Score average
April 2013March 2013
Alexandra
Hospital
England
Q1
Q2
Health gain (Q2 - Q1 average)
21.509
35.702
15.418
18.893
34.902
16.01
Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved.
2.2 Enhanced Recovery Programme (ERP)
The ERP is about improving patient outcomes and speeding up a patient’s recovery after
surgery. ERP focuses on making sure patients are active participants in their own recovery and
always receive evidence based care at the right time. It is often referred to as rapid recovery, is
a new, evidence-based model of care that creates fitter patients who recover faster from major
surgery. It is the modern way for treating patients where day surgery is not appropriate.
ERP is based on the following principles:1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care
b. Reduced length of stay
2. Patient Preparation
a. Pre Admission assessment undertaken
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
ϵ
ERP is well established at BMI The Alexandra Hospital. The hospital ERP board meet bimonthly to discuss progress against a number of factors critical to the success of delivering
ERP. These factors include:
•
The vision – ensuring the hospital team understands the evidence for ERP and its
benefits to patients.
•
Skills – ensuring clinical practice and competencies support the implementation of ERP.
•
The patient journey – ensuring care pathways are effectively utilized, evidence based
practice is delivered and improved outcomes for patients are discussed and shared.
•
Performance monitoring.
Over the year 2013-14 there have been a number of initiatives implemented to improve
outcomes for patients. These include:
•
Multi-disciplinary team led discharges for all patients.
•
ERP established as an agenda item at daily ward meetings to discuss and resolve day
to day issues.
•
Night staff trained in the principles, benefits and delivery of early mobilization of patients.
•
A drop-in clinic for pre-assessment has been established to improve service provision to
patients.
•
A change to the structure of nursing pre-assessment appointments has been
implemented to ensure patients are better prepared for their admission.
•
Carbohydrate loading has been introduced to improve patient recovery from major
surgery. This has mitigated the impact of pre-operative thirst and anxiety and reduce
post-operative nausea and vomiting for a number of patients.
•
A rehabilitation facility has been established to deliver 1:1 and group-based
assessments and treatment to improve the quality of Physiotherapy intervention.
•
A change to the information provided to patients and their carers has been introduced to
help manage expectations around length of stay.
•
Audit of ERP has taken place with findings discussed and action plans for further
improvement developed
Future plans for ERP at BMI The Alexandra Hospital include further staff training in the
principles and benefits of ERP, review of anaesthetic protocols, re-audit of current practice and
review of pain management strategies.
ϭϬ
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.
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.
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3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
The Alexandra 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.
100% of complaints are acknpowledged within 2 workign dyas and 100% of complaints
resonded to within 20 working days or where not resonded to wiuthin 20 workign dyas, holding
leter sent).
Complaints are dealt with on a daily basis through our communiation cascade and individually
through our Directors offices. Patients are encouraged to come to the Hospital to discuss their
concenrs with the staff invovled and Directors as appropriate in an effort to seek to understand
and ensure that issues are given the right attention and patients know we are taking concerns
seriously.
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4. COMMISSIONING FOR QUALITY AND INNOVATION (CQUINS)
Our CQUINS for 2013-14 have included quality initiatives of:
•
•
•
•
•
•
•
All areas within the hospital provide patients with the Quality Health patient satisfaction
questionnaire for completion
A response rate that achieves a response rate of at least 20% by Q4 and which also
improves on the Q1 response rate. (based on monthly response rates from acute
inpatient areas)
BMI Staff Survey to include the Friends and Family Test question in 2014 annual staff
survey. Results to be shared with the commissioner and uses as the baseline for future
% of all adult inpatients who have had a VTE risk assessment on admission to hospital
using the clinical criteria of the national tool
Establish a system for secure electronic transmission of compliant discharge summaries
to GP practices
Provide the Commissioner with information on quality monitoring on a monthly and
quarterly basis.
All patients will have a follow up telephone conversation 24 to 72 hours post-operatively
to ensure patient satisfaction, identify potential problems and reduce occurrence of readmission.
The Alexandra Hospital has achieved all of the above CQUIN quality Initiatives for 2013-14.
5. National Clinical Audits
ϭϯ
The Alexandra Hospital was eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this.
BMI hospital data is from page 196 onwards in attached latest NJS report. Use this if
appropriate with your narrative on the data and any improvement plans.
6. Research
No NHS patients were recruited to take part in research.
7. Priorities for service development and improvement
Our priorities for 2014-15 for service and new developments include:
•
•
•
Development and refurbishment of pre-assessment and pre-admission facility.
Refurbishment of the Hospital Restaurant and waiting areas.
Upgrade of CT scanner to 320 slice.
8. Mandatory Quality Indicators
8.1 The value and banding of the summary hospital-level mortality indicator (SHMI) for the The
Alexandra Hospital for the reporting period.
The
Alexandra
Hospital
0*
•
Reporting Periods
(at least last two
reporting periods)
Oct 2011- Jun 2013
National
Average
Highest National
Score
Lowest National
Score
1.0006
1.1822
0.6735
- Excludes expected deaths that may occur after palliative care
8.2 The Alexandra Hospital patient reported outcome measures scores for
(i) Groin hernia surgery
The
Alexandra
Hospital
Reporting Periods
(at least last two
reporting periods)
National
Average
Highest National
Score
Lowest National
Score
*
April 2012-March-2013
0.083
0.157
0.0014
* less than 30 patients going through the process, meaning that the site cannot be scored.
ϭϰ
(ii) Varicose vein surgery
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
*
April 2012-March-2013
National
Average
Highest National
Score
Lowest National
Score
-8.738
8.172
-15.918
* = less than 30 patients going through the process, meaning that the site cannot be scored.
(iii) Hip replacement surgery
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
21.819
April 2012-March-2013
National
Average
Highest National
Score
Lowest National
Score
21.280
24.684
17.214
(iv) Knee replacement surgery during the reporting period.
The
Alexandra
Hospital
Reporting Periods
(at least last two
reporting periods)
National
Average
Highest National
Score
Lowest National
Score
15.418
April 2012-March-2013
15.99
20.37
12.20
8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital which forms part of
The Alexandra Hospital within 28 days of being discharged from a hospital which forms
part of the hospital during the reporting period.
The
Alexandra
Hospital
Reporting Periods
(at least last two
reporting periods)
National
Average
Highest National
Score
Lowest National
Score
0
April 2012-March-2013
11.45
14.35
7.96
8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of
the Alexandra Hospital within 28 days of being discharged from a hospital which forms
part of the hospital during the reporting period.
ϭϱ
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
3
April 2012-March-2013
National
Average
Highest National
Score
Lowest National
Score
10.01
14.51
5.54
8.4 The Alexandra Hospital responsiveness to the personal needs of its patients during the
reporting period.
The
Alexandra
Hospital
92.168 %
Reporting Periods
(at least last two
reporting periods)
2012-2013
National
Average
Highest National
Score
Lowest National
Score
68.1
84.4
57.4
8.5 The percentage of patients who were admitted to The Alexandra Hospital and who were risk
assessed for venous thromboembolism during the reporting period.
The
Alexandra
Hospital
100%
Reporting Periods
(at least last two
reporting periods)
April 2013-January
2014
National
Average
Highest National
Score
Lowest National
Score
96
100
79
The Alexandra Hospital considers that this data is as described for the following reasons. A
Venous Thromboembolism Risk Assessment (VTE) is completed for every patient. The
Alexandra Hospital continues to monitor the completion of VTE Risk Assessments monthly to
ensure the continuous 100% completion of Risk Assessments.
8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the Alexandra
Hospital amongst patients aged 2 or over during the reporting period.
The
Alexandra
Hospital
10.683
8.7
Reporting Periods
(at least last two
reporting periods)
April 2012- March 2013
National
Average
Highest National
Score
Lowest National
Score
17.3
30.8
0
The number and, where available, rate of patient safety incidents reported within the
Alexandra Hospital during the reporting period, and the number and percentage of such
patient safety incidents that resulted in severe harm or death.
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Number of patient safety incidents reported
The
Alexandra
Hospital
Number
Reporting Periods
(at least last two
reporting periods)
April 2013-March 2013
National
Average
Highest National
Score
Lowest National
Score
44.55
1,810
0
184
We encourage all of our staff to report both clinical and non clinical incidents regardless of
severity.
Rate of patient safety incidents reported (incidents per 100 admissions)
The
Alexandra
Hospital
Rate
Reporting Periods
(at least last two
reporting periods)
April 2012-March 2013
National
Average
Highest National
Score
Lowest National
Score
7.76
30.95
1.68
1.295 per
100
admissions
Number of patient safety incidents that resulted in severe harm or death
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
0
April 2012-March 2013
National
Average
Highest National
Score
Lowest National
Score
0.64
28
0
Percentage of patient safety incidents that resulted in severe harm or death (incidents per100
admissions)
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
0.0%
April 2012-March 2013
National
Average
Highest National
Score
Lowest National
Score
0.9
2.9
0.0
ϭϳ
8.8 The percentage of staff employed by the Alexandra Hospital during the reporting period,
who would recommend the Alexandra Hospital as a provider of care to their family or
friends.
The
Alexandra
Hospital
86%
Reporting Periods
(at least last two
reporting periods)
2013
National
Average
Highest National
Score
Lowest National
Score
64.58
96.43
33.73
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 the Alexandra Hospital as a provider
of care to their family or friends.
The
Reporting Periods
Alexandra
(at least last two
Hospital
reporting periods)
80.54%
June 2013-Jan 2014
National
Average
Highest National
Score
Lowest National
Score
66.23
94.38
35.63
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