Transcript Document
Highlights Dr Brian Cook Scottish Critical Care Activity 2009 SICSAG: Why? “We exist to improve the quality of care delivered to critical care patients by monitoring and comparing activities and outcomes across Scottish Critical Care. We intend to drive standards and quality of care upward by engagement with clinical staff, and to provide them with information that can be used in quality improvement programmes.” Quality of Care: Quality Indicators? • Structure: • • • • Numbers/Occupancy Staffing levels (Cons, Nursing, Others) Quality Improvement Programmes Infection Control Strategies • Process: • • • • Out of Hours Discharges/Admissions Early Discharges Delayed Discharges Readmissions • Outcome • Mortality: SMR • HAI’s (Not comparative between units) SMR by Various Means CUSUM Early Warning- Monthly Reports Decrease Indicator Increase Control Limit Decrease Control Limit Case-mix adjusted CUSUM Increase Indicator Aug08 Nov08 Feb09 May09 Time Span Aug09 Oct09 Feb10 Response to SMR > 2SD from Mean • Letter to unit lead and managers May (17/5/10) • Suggested courses of action • • • • • • Case mix unusual? Data accurate and complete? Selected case note reviews? Discuss with referring specialties? Supporting evidence- local and other audits? External review? • Further analysis by SICSAG • Report from unit to SICSAG by July (20/7/10) • SICSAG report published with original data July (27/7/10) SMR Through Time Rank 2007-09 AllOrder unitsUnit SMRSMR 2007-9 25 1.4 1.3 20 1.2 1.1 15 1 E Ayr ICU G Crosshouse ICU U BGH ICU/HDU U BGH ICU/HDU C PRI ICU H DGRI ICU Q SRI ICU O QMH ICU H DGRI ICU B VHK ICU/HDU D Stobhill ICU Q SRI ICU G Crosshouse ICU W ARI ICU E Ayr ICU K GRI ICU W ARI ICU A IRH ICU A IRH ICU J RAH ICU X RIE ICU/HDU F SGH ICU M SJH ICU/HDU Y SGH O QMH ICUNeuro ICU Stobhill ICU K GRIDICU L VIGells ICU ICU N Ninew 0.9 T WIG F SGH ICUICU/HDU 10 P Raigmore ICU T WIG ICU/HDU 0.8 S Hairmyres ICU/HDU B VHK ICU/HDU I MDGH ICU P Raigmore ICU V Wishaw V Wishaw ICU ICU 0.7 5 J RAH X RIE ICU ICU/HDU L VIGMICU SJH ICU/HDU 0.6 I MDGH ICUICU/HDU R WGH R WGH ICU/HDU N Ninew ells ICU 0.50 S Hairmyres C PRI ICU ICU/HDU 11 2 2 3 3 Y SGH Neuro ICU Scotland Out of Hours Admissions and Discharges “Bed blocking epidemic in Scottish intensive care units” 28th July 2010 Delayed Discharges Early Discharges, Readmissions and Capacity Quality of Care: The Future • SICSAG funded in current form (ISD/NHS QIS) • Quality Indicators NHS QIS/NHS Scotland – Structure – Process – Outcomes • SPSP measures • HAI surveillance HPS Thank You