In this new series of blogs, we put a spotlight on the work of the Future Hospital development sites. Data and analysis are core components of all service improvement projects and here the North West Paediatric Allergy Network and Worthing Hospital teams share their experiences of quality improvement measurement and analysis.
North West Paediatric Allergy Network
Integrated services for children with allergies in the north west
The North West Paediatric Allergy Network is the only paediatric service among the Future Hospital development sites. The network has a hub in Manchester and covers the whole of the north west.
Their mission is to educate and empower primary care to manage children’s allergies, with a particular focus on:
- milk allergy in young children
- nut allergy in older children.
Notably, most GPs are not trained in how to manage allergies. Indeed, in a questionnaire given by the team to 150 GPs, only half got the right answer when asked which milk formula they would give a 3-month-old with a cow’s milk allergy.
A new way to share electronic records
In this project, electronic records are not just being used to collect data but are a tool for empowering GPs and supporting them in providing safe care for their young patients with allergies.
In order to improve outcomes for patients, the network decided to advocate the EMIS (Education Managment Information System) for GPs to use when they see children with a milk allergy. They developed an e-form covering demographics, disease, allergies and management and investigations.
Using technology that is already available, the project is streamlining care and bringing it to the patient.
Data is collected by the doctor or nurse and submitted to a data manager for analysis. Children with red flag symptoms are referred to secondary or tertiary care. For those without red flags, GPs are advised what to do and how to follow up the patient. Using technology that is already available, the project is streamlining care and bringing it to the patient.
Improving the care of frail and older patients
The project at Worthing Hospital involves a multiprofessional team working to minimise the number of transfers of care experienced by frail and older patients. The improvements they have made through their collaboration with the Future Hospital Programme (FHP) are guaranteeing that the time patients spend in hospital is utilised optimally.
The project, which is based on Worthing Hospital’s emergency floor, aims to:
- standardise clinical pathways and streamline care for frail and older patients
- achieve safe, effective clinical management for all patients.
Merging IT systems
Worthing Hospital had three medical, surgical and elderly care assessment units – each with different teams and surrounded by complicated administration and systems – that were merged into one. Fortunately, additional land on the site meant that they were given more space and could expand the unit from 29 to 67 beds.
Throughout this ambitious redesign work, the team carried out data-guided quality improvement. The most important learning so far has been to:
- identify the metrics early on to demonstrate where you are making a difference
- be rigorous in how you report and share that information.
Developing a data strategy with the FHP
The FHP have helped the development site teams to develop a data strategy. Crucially, the teams have learned to have ‘fun’ with data and use it in a productive way. The data demonstrate change over time, for example:
- the average time patients waited has dropped by more than 26 minutes
- waiting times for those awaiting surgery have dropped by more than half
- time to consultant review has improved by 20%
- there was no deterioration in the quality of care
- there was a small reduction in the average length of stay.
Worthing Hospital report one side effect: now everyone is collecting data. The occupational therapists are collecting data on falls and hip fractures, and physiotherapists on how quickly they get to see patients.
For this team, the biggest impact has been on surgery with patients either not being admitted or having a much shorter length of stay so that surgery wards were able to be reconfigured to medical wards. They have had increased patient numbers – and have started to meet the needs of people coming through the doors.
This blog is inspired by the presentations/conversations captured at a meeting of all eight development site teams in September 2016.