Attachment 3
ITEM FOR:
Network Board
MEETING DATE:
December 13th 2007
SUBJECT:
Definitions, Objectives and Quality Indicators
OPTIONS AND ACTIONS FOR BOARD CONSIDERATION:
For the Board to agree:
the adoption of the definitions;
the business objectives;
the quality indicators
RISK ASSESSMENT:
IMPLICATIONS FOR PATIENTS:
EXECUTIVE DIRECTOR WITH OVERALL RESPONSIBILITY:
Bernardine Rees
Mid and West Wales Critical Care Network
Board Meeting on 13/12/07
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Attachment 3
Report for the All Wales Critical Care Advisory Group from the 3 Critical
Care Networks regarding Definitions, AWCCAG Business Objectives
and Critical Care Quality Indicators
Report by:
South East Wales
Dr George Findlay
Mrs Jennie Willmott
Mid & West Wales
Dr Dave Hope
Mr Ifor Evans
North Wales
Dr Ed Farley-Hills
Mrs Sue O’Keeffe
Date: 12th October 2007
Purpose
At the AWCCAG meeting held on the 13th September, the 3 Critical Care
Networks, working together, were tasked with a number of actions to resolve
or agree a lead Network on behalf of the AWCCAG.
1.
Definitions
The definitions, subsequent targets and recording issues have been agreed
by the 3 Network Lead Clinicians and Network Managers as follows:-
Cancelled
Operations
Premature
Discharges
Out of Hours
discharges
Transfers for
non clinical
need
Definition agreed
Patient who requires Level 2
or Level 3 care who did not
get their elective surgery on
the planned day due to lack
of a Critical Care bed.
Patient who is discharged
from a Critical Care facility to
a lower level prematurely
(defined by the Senior
Clinician in charge of the unit
at that time) due to lack of
critical care capacity in the
Critical Care unit
As per the ICNARC
definitions – a discharge
which takes place between
2200hrs and 0659hrs
Target Recording issues
0%
Networks need to produce
guidance which informs the Trusts
how this data should be recorded
involving the Critical care units.
WAG policy may need to give
guidance to Trusts that they
involve Critical Care units in this
data collection.
0%
Networks identified that this needs
to be included in the CCMDS as a
new field to identify if the discharge
was an “appropriate clinical
discharge”. These may also need
to be considered for recording as
an untoward incident.
0%
A patient who is transferred
0%
to a Critical Care Unit in
another hospital for non
clinical reasons due to lack of
Critical Care capacity in the
first hospital
Mid and West Wales Critical Care Network
Board Meeting on 13/12/07
This is recorded through CCMDS
and where appropriate linked to a
DTOC report.
Trusts should also be reporting this
as an Untoward incident in line
with NICE guidance
This is an issue for the receiving
unit to identify.
Networks will look to include this in
the development of a Transfer
Policy and transfer forms.
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Attachment 3
Delayed
transfers of
care
A patient who is identified as
fit for discharge when the
time between requesting a
Ward bed and discharge
from the Critical Care unit
exceeds 4 hours
0%
Networks to check against the
definition in the CCMDS of “fit for
discharge” and the time the
discharge was initiated but it was
considered that the “clock starts”
around the time the ward level bed
was requested.
Targets – the 3 Networks felt that as their remit is to develop safe, high quality
services, the targets should be 0%. Once a consistent baseline had been
established, a year on year reduction would be a secondary goal.
2.
Business Objectives – Network Leads
At the time of meeting, the 3 Networks had not received the updated
AWCCAG Business Objectives for 2008-11. In discussing the initial paper,
the 3 Networks considered that rather than repeat the current 2006-2008 work
areas the key areas of work should be around:
Unified Information – to consolidate and review the completion of,
and compliance to, the whole data set of critical care information
including CCMDS, ICNARC, transfers, cancelled operations, etc.
Networks will seek to develop a Performance Monitoring framework
using the current information recorded and to present this back to the
Critical Care Units for use within the Networks
Collaborative/Improvement Groups, the Network Boards and
commissioners.
Network Lead – South East Wales

Capacity and demand study - to map the current use of and demand
for Level 2 and Level 3/3T services
Network Lead – North Wales

Service specification for the core use of a critical care facility - which
will aim to identify appropriate elective surgical admissions to Level 3
and Level 2 facilities.
Network lead – South East Wales with NPHS

Costing of Critical Care services – to work with the WAG Resource
Management Unit to enable accurate costing of critical care services as
part of the Annual TFR2, HRG and Programme Budgeting returns.
Network lead – South East Wales and Mid & West Wales

Critical Care transport services for safe transfer of patients – to
develop an All Wales Transfer Policy and procedure in line with Welsh
Quality Requirements for Transport of Critically Ill patients. To identify
standardised education, communication and audit. To develop local
transport services in line with regional need and regional service
models.
Network lead: North Wales Network
Mid and West Wales Critical Care Network
Board Meeting on 13/12/07
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Attachment 3

Workforce development – to develop a framework to support
educational programmes for staff to facilitate achievement of the quality
requirements (including medical and nursing staff workforce
implications)
Network lead – Mid & West Network
3.
Key Quality Indicators
South East Wales Network made contact with Dr Jonathan Gray, project
leader for the System Level Indicator Measure Project and shared the
proposed 16 high level “System Level Indicators” with the 3 Networks. Advice
from Dr Gray was that when considering system level indicators for Critical
Care services which would support delivery of the WAG high level indicators,
Critical care indicators should be those that Critical Care services have the
ability to influence/impact.
We have also linked these indicators to the NHS Healthcare Standards for
Wales.
Quality
Domain
Critical Care
service Indicator
Safety
Implementation
and compliance
with care bundles
Effectiveness
Patient &
Staff
experience
Linkage to
Healthcare
Standards
11, 12,14, 16, 28
Outcome
for patients
Means of
Measurement
Key aspects
of care
delivered in
line with
recognised
best practice
Rate of central line
associated
infections
Rate of ventilator
associated
infections
Critical Care
standardised
mortality ratio
Readmission rates
4,5,11,12,14,
16,19,24,28,31
Reduction in
CRBSI
Safer care
Reduction in
VAP
Safer care
WCCIP database.
Proportion of bed
days where
ventilator, sepsis
and CVC bundles
were used (where
appropriate).
WHAIP ICU
surveillance
Patient/carer
satisfaction
1,2, 15, 24
4,5,11,12,14,
16,19,24,28,31
4, 5,9, 11, 12, 13,
24, 28,30, 31
11, 12, 24,28
Mid and West Wales Critical Care Network
Board Meeting on 13/12/07
WHAIP ICU
surveillance
ICNARC data
Inappropriate
discharges
monitored
with aim to
reduce
Views and
experiences
shared to
assist in
service
planning
CCMDS
Local audit
through Network
agreed surveys
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Attachment 3
Staff absence due
to illness
Staff turnover rates
Efficiency
Cancelled
operations due to
lack of ICU bed
Delayed Transfers
of Care
Timeliness
Out of Hours
discharges
4,5,9,20,22,23,24 Staffing
pressures
identified
within the
Networks
4, 20, 22, 23, 24 Staffing
pressures
identified
within the
Networks
3, 11,12,24,27,28 Reduction in
cancelled
operations
Improved
patient flow
3, 11, 12, 24,
Reduction in
27,28
delayed
transfers of
care
Improved
patient flow
3, 11, 12, 14, 16 Reduction in
out of hours
discharges
Improved
patient flow
Trust sickness
returns
Trust workforce
returns
CCMDS
CCMDS and
Significant
incident reporting
Networks will aim to build the reporting of these key indicators into Critical
Care Network Performance Monitoring frameworks.
Networks recognised the importance of monitoring the rate of MRSA and C.
difficile infections in hospitals but as these are being included in the WAG high
level indicators it was considered of value to critical care services to include
the potential for infections directly associated with critical care services.
Mid and West Wales Critical Care Network
Board Meeting on 13/12/07
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