Quality Priorities 2016/17

Every year the hospital has to produce a Quality Account which sets out our performance in areas of quality of patient care over the last year, and sets out our key quality improvement priorities over the coming year.

As part of the process to identify our quality priorities we ask our members, local stakeholders, patients, volunteers and staff to vote on the areas you believe we should particularly focus on in the next year. We have identified the list of potential areas of focus from reviewing our data, areas for known improvement and discussions with staff and stakeholders.

Please ONLY select your top three quality priorities from each domain. This should take no more than 10-15 minutes to read and complete.

You can view our last published Quality Account for 2015/16 on our website www.kingstonhospital.nhs.uk/trust-information/publications

Thank you for your support in identifying our quality priorities for 2016/17.

Question Title

* 1. Domain: Patient Safety – prevent harm

Reducing Catheter Associated Urinary Tract Infections (CAUTI)
CAUTIs are the most common cause of hospital acquired infections in the UK, accounting for up to 40% of all cases. Reducing these infections is important as they can lead to lead to pain, discomfort, loss of dignity, increased length of stay and can lead to sepsis. This priority would therefore focus on reducing these infections. It is sometimes necessary to catheterise patients for clinical reasons but we need to ensure that catheters are left in place for the shortest time possible, thus reducing the potential for infection.

Reducing falls in the hospital setting
Patients over 65 are vulnerable to falling in Hospital because of their illness, frailty and the unfamiliarity of the clinical setting. Falls usually delay patient’s recovery and confidence and if injuries occur, such as hip fractures in the frail patients, the impact of this this can be very serious. By ensuring that the key recommendations of NICE to prevent falls in adults are implemented the number of falls should be reduced. This is important because many of the patient’s at Kingston Hospital are over 65 and we need to ensure that patients don’t have to spend a long time in hospital and that they are likely to return to their usual place of residence on leaving.

Reduce avoidable harm from sepsis
This is important because sepsis and septic shock have a high mortality and morbidity. If sepsis is recognised and patients receive antibiotics and fluids early in their treatment the outcome is improved and this will mean saving lives and reducing harm. It is therefore important that all our staff and our patients know about the risk of sepsis and that through education and we can increase awareness of the condition and save lives.

Intrapartum fetal wellbeing assessment and management in high risk pregnancy
This is important because one of the ways we make sure that babies are safe during labour is to monitor their heartbeats and the mothers contractions with Cardiotocography (CTG). In order for this to be used effectively all the midwives and doctors need to be skillful in interpreting what the monitor is telling us. Misinterpretation of CTGs is one of the commonest mistakes that is seen in claims of harm to babies. Improving monitoring in labour will enable signs of distress to the baby to be managed safely and improve the outcome for babies. It also means that caesarean deliveries might be avoided when the monitoring shows the baby is healthy.

Reduce use of agency staff by reducing vacancies
This is important because staff who are permanently employed by the Trust are more likely to be familiar with our policies, procedures, the Trust values and have access to our programmes of work to improve patient safety.

Reduce the risk of Hospital Acquired Thrombosis (HAT)
This is a condition where patients can get blood clots in the veins of their legs which causes swelling and pain but can also lead to a blood clot travelling to the lungs, which is dangerous. In hospital we assess everybody for their risk of getting this condition but some patients are particularly at risk and may need extra intervention. We need to reduce the risk of HAT by making sure that we analyse every time this happens so we can learn how to prevent the condition in more of our patients.

Improve completion of National Early Warning Score (NEWS) and escalation of the deteriorating patient.
We measure vital signs such as pulse, blood pressure, temperature and breaths per minute in all of our patients whilst they are in hospital. The most unwell patients have their vital signs measured more frequently. We do this because these observations tell us whether patients are responding to their treatment or whether a different treatment is required. All observations must be completed and the right staff told if there is an abnormality in order that we give patients the best care.

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* 2. Domain 2 - Clinical Effectiveness - improve clinical outcomes for our patients

To work towards ‘paperlight’ using information technology and record management in Outpatients
This is important because; implementing electronic patient records and information technology solutions help reduce the amount of time staff spend on administrative tasks. This releases more time for them to provide patient care. It also allows us to introduce systems that support improved patient safety.

Reduction in readmissions in non-elective care
We want to ensure that people don’t have to stay in hospital any longer than is needed. But we must not send patients home too soon or without the right treatments to continue, or the right instructions about how to manage when they leave. We will make reducing the frequency that readmissions occur a priority, by making sure that we make the right plans with our patients so that they do not have to come back to the hospital.

Reduction in length of stay
This is important because staying in hospital for longer than necessary can be harmful as well as inconvenient. This is especially true for frail and elderly patients who can become very weak in hospital and are at greater risk of falling or getting pressure sores and infections. We will work to make sure that we reduce any delays in hospital waiting for investigations and test results and that when it comes to the time to go home we have planned what is required and made sure that everything is ready at discharge.

Increase 7 day working provision
Emergency services are available every day in the hospital but they are not always the same as during the week. We will work to provide services that are important at weekends as well as week days if this means that our patients don’t have to wait as long for their treatment and we will increase the number of senior doctors who are available to look after our patients, especially on our Acute Assessment Ward.

Hospital mortality index better than expected
This is a measure that compares results between hospitals. Kingston Hospital has a lower mortality index than many hospitals. We will look at our results in detail and the areas where we can make improvements we will take action to ensure that all areas of the hospital have a low mortality.

Reduction in patient reported painThis is important because it is an area where we can make improvement. We know this because our inpatient survey told us that we do not always recognise and treat pain effectively. We also know that patients with dementia are particularly vulnerable to not receiving enough pain relief. We will make it a priority to ensure all our staff know how to assess that pain is being managed effectively even when it is difficult for our patients to explain this to us. We will also ensure that we use the most effective interventions to manage pain well.

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* 3. Domain 3 - Patient Experience - listen and respond to patients’ concerns

To transform administration across the hospital
One of the areas that patients and GP’s have told us we need to improve on is our administration. This includes such things as how clear patient letters are, and the ease of making and changing appointments. This priority would therefore seek to improve the experience of the Trusts administration processes.

Improve end of life care
There is only one opportunity to get the care at the end of a patient’s life right for both them and their loved ones. This priority would therefore focus on making improvements in the care given to patients at the end of their life and the experience of their loved ones at this difficult time.

Improve experience of discharge
Ensuring patients are discharged in a planned and timely way, with good communication with external parties is a critical to ongoing patient care. This priority would seek to increase understanding of patients experience of the discharge process and make improvements to that experience.

Improving the experience of children & young people
The majority of children and young people are seen and treated in specific children & young people’s settings. Due to the specific nature of some outpatient and emergency services some children & young people have to be cared for within areas which predominately treat adult patients. For example places such as the Royal Eye Unit, A&E, our x-ray and CT departments, or our dental services. It is important that any child or young person coming to hospital receives the best experience wherever they are seen, and this priority would focus on ensuring this is the case.

Improving the experience of patients with dementia in outpatient settings
As part of the Trusts Dementia Strategy we have significantly focused on improving the care of patients and their carers within inpatient settings. We will continue to do this, but we know that of the 350,000 patients that attend our outpatient settings each year also have a significant proportion that are affected by dementia. This priority would therefore focus on ensuring patients with dementia and their carers receive a positive experience of our services, and specific actions are in place to address their needs in these settings.

Improve the experience of seldom heard groups and/or those with protected characteristics
There are groups in the communities that we serve that are seldom heard or who have additional needs that require specific attention so that our services are equally accessible, they are not disadvantaged or have a poor experience of our services. Examples of this include people with vision or hearing impairment, are lesbian, gay, bisexual or transgender or those from black, Asian or minority ethnic groups. This priority would therefore focus on identifying specific seldom heard and/or groups with protected characteristics that we could work with to ensure a positive experience of our services.

If you have specific suggestions of seldom heard groups or those with protected characteristics that you believe warrant the specific attention of the Trust please can you provide below.

Any other comments