Neonatal Quality Standards
Dr Sandra Calvert
Background
• 2009 NICE Commissioned by DoH to manage
process for development of quality standards
• Initially pilot project running until April 2010
• Four topics – dementia, stroke, VTE prevention
and neonatal care
• Overtime a library of over a hundred topics will
be developed sequenced by NQB
Definition of Quality Standard
• A quality standard is a set of specific, concise
statements that:
– act as markers of high-quality, cost-effective
patient care across a pathway or clinical
area;
– are derived from the best available evidence;
and
– are produced collaboratively with the NHS
and social care, along with their partners and
service users
Components
• Qualitative statements
Descriptive statements (5 to 10) of the critical
infra-structural and clinical requirements for
high quality care as well as the
desirable/expected outcomes.
• Quantitative measures
Measure of the expected degree
of adherence/achievement.
Overview of Quality standards
process
Topic
Requires
Evidence Source
Generates
Guidance Recommendations
Distilled
into
Quality Standards
Produce
Quality Indicators
5
Professional groups on the TEG
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•
•
•
•
•
•
•
•
•
•
6
Academic x2
Allied health professional x2
Audit (RCM & NNAP) x2
Clinician x3
Commissioner x1
DH representative x1
NHS Information Centre representative x1
NQB shadow x1
Patient / lay representative x1
Surgeon x1
Technical x1
Difficulties of developing QS for Neonatal Care
VTE
Neonatal Care
• Specific diagnosis
• Broad topic
• CG exist
• No existing CG
– No simple “gold” standard
• Evidence based research
• Very little or no evidenced
based source or research
– Input based on consensus or
opinion
Overall Approach
• Need to define what a high quality specialist
neonatal care service should look like
– Tertiary, secondary and community care
• Need to use care pathway approach
– Allows safety, effectiveness and experience to be
considered
• Ensure alignment with maternity services
8
Documents used for
Development of Standards
• Toolkit for high quality neonatal services
• BAPM standards for hospitals providing
neonatal intensive and high dependency care
• Standards for maternity care: report of a
working party
10 areas of care which QS should focus on
15 draft quality statements
Consultation and field testing
Final 9 statements for published quality standards
Is there a quantitative measure
of adherence/achievement
• Is there a measurable outcome?
• Is there a standard for comparison?
• What is the evidence that this standard is “best”
√
√
X
√
X
√/x
X
√/x
√
Quality Statement 1
% babies < 28 wks who receive IC in NICU within network
% babies with known fetal malformations requiring surgery
delivered at designated network surgical centre
% babies transferred back to local NNU within 24hr of request
% babies undergoing surgery at designated network surgical
centre
% mothers still requiring inpatient care transferred with baby
Quality Statement 2
% mothers whose babies required specialist neonatal
care who received all perinatal care within network
% babies receiving specialist neonatal care in network
who are from another network
Bed occupancy at each level of care
Quality Statement 4
With emergency transfers proportion of transfer teams that
depart from base with 1hr of referring call
Quality Statement 6
% babies < 33 wks who are breast fed at discharge
% babies < 33 wks who remain in hospital and still receive
MBM at 6 weeks
Quality Statement 8
Completion NNAP dataset
% babies whose parents invited to participate in research
studies
Quality Statement 9
% babies < 30 wks who have 2 yr outcome form completed
% babies ≥ 30 wks receiving specialist neonatal care who
have 2 yr outcome form completed
% babies < 32 wks and/or <1501g who have ROP screening
% babies < 32 wks and/or <1501g requiring laser surgery
% babies wks receiving specialist neonatal care who have
culture +ve blood or CSF culture