Healthcare quality and efficiency support team: annual report 2013

Older People's Collaborative

NHS Grampian: Older People in Acute Care Collaborative

Background/Context

Older People in Acute Care is now a national improvement programme which also fits with the national Dementia Strategy. There is also a national inspection programme around Older People in Acute Care. The local collaborative between NHS Grampian and NHS Tayside has informed the national programme and our local team have worked to support this.

Problem

There is a need to ensure consistent, standardised, high-quality care for older people in acute care.

Aim

To improve the experience of older people in acute care through the delivery of a person-centred approach by November 2013.

Goals include:

• 95 per cent of patient satisfaction scores are excellent
• 300 days between formal complaints
• 95 per cent of appropriate patients receive a standardised screening on admission to hospital

Action Taken

A driver diagram has been developed with an associated measurement plan.

Results

Achievements in patient experience, standardised screening, multi-disciplinary working, safety briefs and board rounds leading to enhanced communication. Other areas include open visiting, use of volunteers, nutrition, comfort rounding - supporting data is shown in charts 21-25.

Efficiency Savings and Productive Gains

The following have been achieved:

• patient experience issues are dealt with at the time of issue allowing for better communication between patients and staff and therefore improved experience
• consistent, standardised screening of patients over 65 ensuring patients are positioned on the right care pathway enabling access to appropriate services in a timely manner
• enhanced communication between multi-disciplinary teams ensuring less repetition for patients, enhancing experience

Sustainability

A leadership meeting is planned in July 2013 to discuss sustainability and spread of the collaborative. Formal plans will be drawn up. The collaborative is being funded through third year funds in order to ensure sustainability. The fourth learning set is planned for December 2013, jointly with NHS Tayside.

Lessons Learned

The collection of data has been a challenge for teams and we need to look at a new way of collecting data that is more effective and less of a burden for teams. Early testing is underway using case note review to collect data relating to the patient journey. This involves looking through a patient's record, tracking the journey of care and collecting relevant data. The aim is to make this process multi-disciplinary and real-time so the team can ensure everything that needs to happen for the patient happens at the right time. The outcome for patients being that this will reduce the risk of harm and they will have a good experience of care.

The collaborative team are also looking at simplifying the measurement plan, by reducing the number of measures and ensuring that there is a balance when the teams report on the measures. An example of this can be seen with the complaints measure, which has a target of 300 days between complaints. Some areas have achieved this target; however, for other areas this may seem like an impossible target.

Building the 'dream team' to drive sustainable improvements to care is critical.

Give permission to teams to lead improvements in their areas.

Chart 21: Overall NHS Grampian patient experience - percentage with excellent rating

Chart 22: Percentage of patients screened using a standardised screening tool

Chart 23: Ward 44 ARI, complaints information

Chart 24: Ward 11/12 Older People in Acute Care Collaborative

Change 8: Education of staff using the Promoting Excellence Skills Framework
Change 7: Introduced 'Tuck Shop' to wards 11/12
Change 6: Introduction of comfort rounding
Change 5: Introduction of the Board Round
Change 4: Introduction of safety briefing
Change 3: Patient experience
Change 2: Introduction of standardised screening for all patients over the age of 65
Change 1: Introduction of the Butterfly scheme for all

Chart 25: Safety Brief Paper Copy. Observation ward day and night shift