QUALITY: One of England’s largest teaching hospitals has achieved a dramatic turnaround in the care and survival of patients with sepsis after developing a tool to hold individual clinicians to account for their care.
Doctors at Nottingham University Hospitals Trust believe their work, covering more than 600 patients, could be adopted by other trusts and help save lives and improve patient outcomes.
They developed an individualised feedback and audit process which reports monthly to consultants, junior doctors and nurses about how well they and their teams cared for specific patients.
Their care is “red, amber, green” rated and given a score on how well the team complied with guidelines for treating severe sepsis.
It was prompted by an initial assessment of the trust’s sepsis care in 2005, which showed the trust was just 15 per cent compliant with the international guidelines launched that year.
As a result of the new tool, and a local commissioning for quality and innovation premium, the trust has improved to up to 80 per cent compliance earlier this year. Its crude mortality rate for sepsis cases admitted to critical care has fallen from 42 to 28 per cent over the same period, while trust-wide standardised mortality for septicaemia has fallen from 119 to 86 per cent since 2009.
The treatment of patients with sepsis, a time critical condition which can lead to multi-organ failure and death, has been identified as a national CQUIN priority for 2015-16 with a value of 0.25 per cent of a provider’s contract value.
There are 102,000 cases of sepsis each year in the UK and 36,000 deaths, costing the NHS an estimated £2bn a year. Sepsis kills more people a year than bowel cancer, breast cancer and prostate cancer combined.
Acute and critical care medicine consultant at NUH and sepsis lead Dr Mark Simmonds said he believed the individual feedback had led to a change in practice by staff and improved outcomes. The trust is now applying the process to a range of other conditions including cardiac arrest, early warning score policy and emergency surgery pathways, he added.
Dr Simmonds said the audit process identified “who was seeing the patient and where, who was getting involved in their care and when key decisions were made. For every case we sent a simple traffic light report back to the treating team as rapidly as possible and where there were issues we made comments.”
He added: “We have moved from audit being an institutionalised dull and boring process into something that actually makes a difference. Audit is now part of the intervention.”
The trust also took action where poor care was identified and Dr Simmonds cited one case where the local coroner was informed as a result of the audit. In other cases issues were referred to the trust’s associate medical director for patient safety.
Dr Simmonds said this accountability was an important element of the audit tool, saying: “If you make teams and individuals aware of their performance they will improve. Everyone thinks they are doing the best for their patients but if they are not they will learn and improve from that far more than they will a lecture or email.
“The way you move from blame to accountability is that blame is always negative whereas accountability can be both positive and negative.”
Information supplied to HSJ
10 April 2015