North West London Critical Care Network Network Joint Clinical Forum Board

Transcription

1 North West London Critical Care Network Confirmed at JCFB 0622 North West London Critical Care Network Network Joint Clinical Forum Board Action Notes of the Network Joint Clinical Forum Board meeting held on 9th March from pm in the Boardroom at the Action Note Present Jeremy Cordingley (Network Chair) RBH - Royal Brompton and Harefield Hospitals NHS FT Andrea Blay Chelsea and Westminster NHS FT Jane Marie-Hamil Chelsea and Westminster NHS FT Pippa Dorney Kingdom Hillingdon Hospital NHS FT Maie Templeton Imperial College Healthcare Trust Claire Gorham Imperial College Healthcare Trust Parind Patel Imperial College Healthcare Trust Dilip Panan London North West Healthcare Trust Christine Sharp London North West Healthcare Trust Jamie Zanardo London North West Healthcare Trust Ganesh Suntharalingam London North West Healthcare Trust (& Network Medical Lead) Anthony Bastin Royal Brompton and Harefield Hospitals NHS FT Donna Hall Royal Brompton and Harefield Hospitals NHS FT Pascale Gruber Tim Wigmore Emma Stilwell Rohit ja Keetje Gull Jo Gilroy Jonathan Handy (skype) ( & Network Clinical lead Transfers, Education and Research ) Lorraine Papapavlou Royal National Orthopaedic Hospital NHS Trust Brian Dorman Royal National Orthopaedic Hospital NHS Trust Margaret Dowling Royal National Orthopaedic Hospital NHS Trust Rose Tobin North Central and East Critical Care Network Charlie Evans ICNARC Kevin Hunt ICNARC Angela Walsh Critical Care Network Gezz Van Zwanenberg Critical Care Network Apologies for absence Duncan Wells Patient member, Roseanne Meacher- ICHT, Tariq Husain- LNWHT, Fionna Moore- LAS CE Mike Dean LNWHT, Sarraa Al-Mahdi- LNWHT Jacek Borkowski- LNWHT, Gary Wares- RMH, Chris Woollard- THH, Cliona Berman NHSBT, Parind Patel ICHT, John Vogel LNWHT, Julie Oxton ICHT, Trish Mukherjee LNWHT, Jacqui Finch- LNWHT, Suzanne Brompton - WMUH, Barbara Thomas WMUH, Alex Sell- RNOH, Linsey Christie CW, Kath Fawcett- LNWHT 1 & 2. Welcome and apologies for absence Who When JC welcomed members to the meeting. Apologies had been received and were recorded as above. 3. Agree the notes of the last meeting held on 23 rd September 2015 Who When The action notes of the Network Joint Clinical Forum Board meeting held on 17 th December 2015 were agreed. ALL CONF 4. Matters arising Who When 4.1 Network Annual report shared the DRAFT Network annual report which was circulated at the meeting. TW commended the style and content of the report and the informatics used. All members agreed to sign off the DRAFT Network annual report. JC asked for it to be widely distributed and loading onto Network website as well as sending to key stakeholders. 4.2 Infection Control proposal regarding transfer of patients. Anthony Bastin suggested a piece of work Page 1 of 8

2 North West London Critical Care Network Confirmed at JCFB 0622 looking into Trusts infection control policies and the ICU policies vis-a-vis, the potential for a Network wide agreement and behaviours to ensure we have maximised flow and reduced any potential barriers to timeliness of patient transfers. 1. Electronic version of annual report to be sent to all units 2. Send annual report to all stakeholders including CCGs and NHSE 3. Load Network annual report onto Network website 4. Refer potential project on Infection control/ transfers and local variations to Transfer faculty group annual meeting for consideration as part of work programme April/ May ICNARC reporting Kevin Hunt and Charlie Evans, ICNARC Who When Update and changes to Network-wide ICNARC reports Charlie Evans, ICNARC reported on the changes to Network wide ICNARC reports that were expected in the near future. This included simplification and fewer data items. Also greater clarity on comparison used and interpretation of graphs used. 5.2 Network wide report for Members had received the Network wide report for which had been produced by ICNARC for the Network in March. This (3 parts) had been sent to Unit clinical leads. confirmed that Network wide reports were now forthcoming as each site had confirmed agreement to share the subset of data produced in the ICNARC Network wide reports. Waivers had been signed across the network for this data for use locally at Trust level, at Network level and to aggregate to London level if required. They were signed on the basis that any London report would be available to every participant in NWL CC network that was included in the report. It was understood that a quarterly report would be sent to each critical care Network ( with waivers in place), this would automatically run and include 8-9 quality indicators including sepsis, readmissions, Night Time discharges, risk of mortality, delayed discharge, and acquired infections. 5.3 Items and definitions on -17 NHS England NHS methods/analytics reporting of ICNARC data items and trust items described the reporting produced via NHS Methods analytics which sites received direct and into which the Network was copied each quarter. Data was not reported in NHS financial year quarters as ICNARC uses calendar quarters and this created some of the mis-match queries that arose when looking at the data sets. Data was shown for some items on rolling annual basis. KH from ICNARC reported that they would be moving their reporting to match NHS financial quarters in. The NHS England CRG recommended and agreed metrics for NHSE specialised commissioning -17 had been circulated. These would be reported for The data was also moving to an online reporting system with gatekeepers in each organisation and a regional hub for access. The Network had asked for further information on this (to ensure access was available) from the national lead. 5.4 Level 2 units - There was discussion about stand-alone HDUs and how will they are incorporated into the ICNARC case-mix programme. There were 18 of these currently reporting nationally. ICNARC was looking at a modular data set, collecting less than in an ICU and also to reduce duplication of having to capture and input again basic data when patients move from ICU to HDU. A question was raised regarding stand-alone HDUs where the main ICU is already in the case-mix programme. KH confirmed a 50% reduction for HDUs within that hospital site. Clinicians also discussed ICNARC creating a modular dataset, and also some further cardiac risk predictor work for cardiothoracic unit activity case-mix. 5. KH and CE from ICNARC agreed to provide further information to the Network once agreement was CE Sept 16 Page 2 of 8

3 North West London Critical Care Network Confirmed at JCFB 0622 reached on the above items. 6. to follow up on access to NHS methods data and queries Update from each member and site - All Who When An update was given from each site present 7. National Critical Care CRG Jeremy Cordingley Who When National Critical Care Clinical Reference Group- Jeremy Cordingley, CRG member 7.1 Feedback from National Critical Care CRG meeting 28 January Dashboard Dashboard items discussed and changes made: Removal of capacity transfers, addition of 4 hr. discharges, blood infection leave in for moment, data to come from PHE. This metric stopped for other Trusts not part of initial group submitting. Cancelled electives new metric for patients cancelled twice. There will be a gatekeeper in each Trust for the dashboard internally organised (see also item 5.3 above). Anyone in Trust can register through allocated gatekeeper. Networks may/should be allowed to get report via a regional hub team. ICNARC update New personnel at ICNARC: Bob Nicholls Chair, 3 new Clinical Trustees - Tim Gould, Simon Baudouin, Gareth Sellors. New database with infrastructure more amenable to changes EPRR update given by and Bob Winter see item 16 for details. BW continuing as NCD for EPRR Surge guidance being rewritten, including triage for if services overwhelmed by mass events. Trauma resilience exercises being carried out. VA ECMO Draft policy accepted with plan to ask for commissioning by evaluation for heart failure and to facilitate ecpr trial. CQIN Delayed discharge CQUIN being advocated for -17 NHS update was given by Michelle Davis Policy pipeline any areas to develop policies for -17, CRGs review to occur in next 2 months D16 draft CC Specification to be approved by April. 7.2 Lord Carter Review and critical care Prof Tim Evans is the clinical lead for this work looking to save money within Critical care (estimated saving of 200M. It was agreed to invite Prof Evans to present to the National Critical Care Group AGM. 7.3 Specialised Commissioning CRG consultation - DRAFT response A draft response was proposed that supported maintaining close contact and inclusion from networks. JC agreed to to this effect on behalf of the Network. 7. Invite Prof Evans to National Critical Care Network s AGM 8. response to CRG consultation to confirm support for maintaining close involvement and inclusion from Networks. JC Mar 16 Mar 16 Information, Quality and Patient safety 8. Peer review lite Who When Peer Review lite Ganesh Suntharalingam, Network Medical Lead 8.1 DRAFT Network outline option appraisal and way forward was presented for discussion. There was agreement to the proposal including 360 degree feedback surveys from hospital wide staff about the critical care service. It was also suggested that patients or relatives on the unit being visited might be asked to feed back to peer review team. The pilot was agreed with refinement to the process and design to be made along the way as part of the pilot. 8.2 Including locally prioritised and inter-trust initiatives The draft documentation included data, feedback and network activity. As a peer review process it was being underpinned by the same principles as clinician appraisal and would be undertaken by volunteers Page 3 of 8

4 North West London Critical Care Network Confirmed at JCFB 0622 from different sites not a centralised Network team. The Network clinical leads ( GS/ JMH) would support the process and one of them would always be part of the visiting peer reviewer teams. This would support consistency and learning and feedback. 8.3 Leadership of process and reporting locally and for Network. GS would be leading the work with unit leads asked to nominate from their units staff to be part of the peer review process in NWL. This supported the opportunity for leadership development, and sharing at both local and Network level best practice and learning from the peer review visits. 8.4 Next steps and evaluation methodology GS would be reporting at JCFB meeting about pilot peer reviews underway, the volunteering process and volunteers so far, 360 survey final questions and next steps. D16 national draft service specification would be used as the standards ( using updated self assessments that were defined and completed in Autumn 2015) Members were asked for feedback on process document, data and information and volunteers for their sites 9. GS to develop 360 survey 10. GS to finalise pilot documentation 11. GS finalise agreement on 2 pilot sites 12. GS to communicate with unit leads and onward communication with clinical staff 13. GS to identify potential dates onward for with unit leads 14. GS to coordinate 2 initial pilots GS May 9. National Draft Critical Care Service Specification D16 Who When 9.1 Gap Analysis Network summary was shared with members This was received and noted. No further update on staffing/workforce requirements was available from the CRG or NHSE. 9.2 Managing variation in interpretation and prioritisation Interpretation had varied nationally. There was some variation locally. In absence of some detailed definitions this would continue. Generally felt that consistency in a local area would be helpful. 15. to follow up with national lead regarding due date for implementation 16. to follow up with national network lead for Gap analysis if any further intelligence on managing interpretation and variation. 10. Critical Care Quality Measures Q2 Who When 10.1 Q3 Draft report - presented the Network Q3 report and discussed options for reporting further information. If required. Members confirmed they wanted the quick reports (spider grams) and the Network wide reports. Also to continue with the reports for Trust critical care delivery groups Network and ICNARC and other data It was agreed that the Network QMs would continue and that the ICNARC reports would be reviewed and shared at JCFB. Members were thanked for sending in data in a timely way which helped enormously with the report production and helped with a speedy turnaround. 17. It was agreed to continue using the current report format showing comparison of quarterly data and that units would notify Network office of their TCCDG dates in order that local reports might be available 18. to summarise in paper to the next meeting (the reporting in place for ) and confirm the same definitions in place. Page 4 of 8

5 North West London Critical Care Network Confirmed at JCFB Critical Care inclusion in sector wide quality and information schedules for CCGs and Trusts Who When 11.1 Update documentation of critical care transfers was now included in the NWL Quality Schedule, asking that critical care transfers be documented using Network transfer forms. Inclusion of risk assessment and stabilisation was included. 19. Unit leads to reinforce with staff the benefits to patients of transfer documentation. All ongoing 12. Critical Care Reviews - Jeremy Cordingley /Jonathan Handy/Angela Walsh Who When Critical Care Reviews - Jeremy Cordingley /Jonathan Handy/Angela Walsh 12.1 Imperial Healthcare Trust data for critical care activity to note ( reports separately) completed November LNWHT to note ( reports separately) - completed and reported February and meeting held with CCG representatives. Further meeting expected with Trust and CCG. 13. Critical Care Patient transfers and Patient Transfer safety developments - update Who When Critical Care Patient Transfers - Network data - shared at the meeting 13.1 Total number of critical care transfers - all sites : this data was shared at the meeting 13.2 Capacity transfers: data was shared at the meeting. There were 85 documented capacity transfers. The majority (66) originated from NPH of which 64 were to CMH Specialist/clinical transfers: data was shared at the meeting. Members were reminded that any concerns regarding access to specialist services, in the first instance, should be escalated by 24 hrs. to Trust Ops Directors. Also inform the Network office. There had been 3 renal access delays reported and escalated to the Network in last three months Transfer incidents: a summary of these was shared at the meeting. The ambulance call signs were discussed as there were several incidents where delays linked to ambulance requesting had been reported. When the incidents had been investigated misunderstandings by clinical team members about the terminology required to book the correct ambulance transfer was evident. Critical and Immediate terminology for transfers remains extant. A meeting between the ECMO team and LAS was being arranged to review their specific requirements with ambulance utilisation Network Transfer course recognition Deanery statement was shared with the meeting and members and this now means that staff in NWL were being given study leave to attend transfer training. Patient Transfer Safety developments - updates 13.6 Intra-hospital transfer form an update reporting the numbers of intra hospital Transfers from those units who have rolled out the network form and collection tool was shared. Across 7 units it had been demonstrated that 570 hours of staff time had been utilised off the unit or dept. in transferring patients. Of these patients L3 and L2 patients 13.7 Network Transfer App Launched with o - over 500 downloads on IOS and downloads on Android. - Further information showed that 13 calls to LAS had been initiated from within the App. Phase 2 would be outlined and agreed at the Network Transfer Faculty meeting in July Network Transfer bag The bag contents and design had been agreed and work was continuing Page 5 of 8

6 North West London Critical Care Network Confirmed at JCFB 0622 on perfecting the fastening straps. Orders would be from units / Trusts directly with the manufacturer and work was starting now to identify how many bags each hospital in NWL would need and order. The article writing up the modified Delphi process for and on behalf of the Network was in progress and would be submitted in May 13.9 Network inter-hospital transfer form Digital work up had started to inform the Network transfer faculty meeting in July. Design was based on the current network form. Looking to move to a paper free version over the coming years. Initial IT support from the CCGs in NWL was also being explored. was demonstrating the form at various fora across the Network. Also working with CATS to see if any joint work was possible. 20. Unit leads to encourage completion of intra hospital transfer forms and submission of data 21. Unit leads to confirm to intended numbers of transfer bags for network summary list 22. to send out transfer bag order stock code details and units to order directly from manufacturer as per local policy for ordering 23. Transfer faculty to look at pilot of digital transfer forms next faculty meeting July All Facul ty April April July 14. Critical Care Workforce in NWL Who When 14.1 Network submission to London workforce programme Jan this was completed and thanks to all members for their input and effort towards this large piece of work 14.2 NWLCC Network CLASP project DRAFT statement of intent for -17 was submitted and discussed. It was agreed and signed off by the JCFB with no alterations. This would now be added to the Network work programme for the coming year 14.3 Critical care non medical workforce survey national survey - The Network had submitted this work, thanks to all members for their effort in collecting this valuable data. Locally we have workforce in the work programme. London steering group have yet to decide on any actions regards workforce but we will follow up with them at next meeting about getting this back onto their agenda. 24. to arrange next meeting of the CLASP task group and to divide workload 25. / to follow up with London group on actions regards workforce May 15. NICE CG 83 Rehabilitation after Critical illness - Drs Steve Brett, Anthony Bastin & Who When 15.1 Network rehabilitation film update & training with GPs updated about progress with bridging the gap between primary and secondary care colleagues to support patients after critical illness. The films were now completed and being edited and had been tested at a number of events including ICS and local events and evaluated well. These would be hosted on the NWLCCN website and freely available for use locally to support education 15.2 Discharge letters from ICU - and sector wide IT CQUIN provided an update regards the IT requirements and successful transmission of automated notifications from ICU to GP colleagues which were still being tested (but looked promising). There was also feedback on the CCG IT maturity plan and sector wide IT CQUIN which could enable providers to get support with development of notifications locally from their IT departments. would send around the IT instructions and liaise with local IT teams 15.3 Care planning critical care discharged patients in primary care MDT AB feedback on the first educational MDG that had been attended where care navigators were identified as possible resources to support patients and liaise between primary and secondary care teams. This was being explored further as funding and staffing issues were currently being worked through. 26. Members to be notified once films were available on the Network website 27. to discuss with,local IT teams the notifications map 28. and to liaise with CCG IT team 29. AB and to continue to next steps in MDG liaison / Page 6 of 8

7 North West London Critical Care Network Confirmed at JCFB EPRR Who When EPRR 16.1 BAXTER supply chain disruption Colleague pump lines, wide bore blood lines, replacement products - gave an update that the supply chain was being maintained using replacement and US stock. Thanks to all unit leads and supply departments for their information and support Critical Care vertical evacuations (Hillingdon and RBH) and had attended both evacuation exercises. Lots of valuable learning which would be shared with those attending transfer training to add updated details Exercise Unified Response to note the Network had participated in supporting this exercise and the Network will provide feedback to NHS England 30. Units leads to remain vigilant regards Baxter supplies and any disruption in supply chain 31. to remain in contact with supply leads regards stock 32. All 17. Network administration update Who When DRAFT work plan - for consideration locally and feedback ( sustaining existing projects and new initiatives) new initiatives illustrated with hand signs Network Value for money statement produced by Network in September 2015 and had recently been submitted to NHS England Specialised Commissioning (nationally) Feb as part of a telecom they held seeking to inform Network provision from Members to feedback on work programme to. all ASAP 18. AOB and date of next meeting There was no AOB. Network Joint Clinical Forum Board meeting dates 5.45pm Wednesday 22 nd Boardroom, 5.45pm Wednesday 14 th September Boardroom Charing Cross Hospital 5.30pm Wednesday 14 th December Wrench Room combined with Network Event at ROSL Network Event 14 th December at the ROSL Transfer Training Dates ( supported by Network wide faculty) Unit leads were asked to book dates into off duties and faculty were asked to look at availability and confirm to dates / sessions they are able to support Thursday 24 March West London University Wednesday 30th March Royal Brompton Hospital (Local) Friday 1 st April Harefield Hospital (Local) Wednesday 6 th April Ealing Hospital Tuesday 7th St Mary's Hospital (Local) Monday 13th Northwick Park Hospital (Local) Thursday 14th July (Network wide) Tuesday 13 th September St Mary's Hospital (Local) Thursday 15 th September West London University Monday 10 th October Harefield Hospital (Local) Monday 17th October Northwick Park Hospital (Local) Page 7 of 8

8 North West London Critical Care Network Confirmed at JCFB 0622 Tuesday 18th October Tuesday 22nd November (Network wide) (Network wide Transfer training booking opens on website approx. 6 weeks ahead. For advance booking of a particular course critcarenetworknwl@nhs.net Free to Network Members For Twitter updates follow Page 8 of 8