BMI The Duchy Hospital Queen s Road Harrogate Quality Accounts April 2014 to March 2015
Chief Executive s Statement I am pleased to welcome you to our Quality Accounts 2015. Now in their sixth year, Quality Accounts continue to provide a truly objective metric for us, and others, to gauge the quality of our 59 hospitals and the services they provide against a broad range of criteria. The past year has seen another step change in the way healthcare providers are externally challenged on the quality they provide. Following a spate of high profile controversies around patient safety, the Care Quality Commission, the UK s health regulator, has introduced a new inspection regime designed to raise standards. No healthcare provider can afford to be complacent and whilst I believe BMI s hospitals provide safe and effective care, we should always be striving for improvement. To this end we recently introduced a new Quality Strategy, which articulates how we will provide the best possible care and strive for continual improvement, and live up to our brand promise to be serious about health, passionate about care. Its four core themes safety, clinical effectiveness, patient experience and quality assurance provide our staff with the platform to consistently deliver the care patients, their insurers, and commissioners expect and deserve. BMI hospitals have been enthusiastic participants in the pilot programme of the new CQC inspection regime for private providers, and to ensure our facilities are prepared we have developed a selfassessment tool to enable hospitals to compare their perceptions of themselves with those of the external inspectors. The rigorous inspection process itself also underpins the sharing of best practice between hospitals which further drives improvement and consistency. BMI Healthcare strives to provide the best care but the ultimate arbiters of whether we succeed are our patients. We are committed to monitoring every aspect of the care we provide, and the results of the detailed questionnaires we ask patients to complete inform improvement. We aim to provide a consistent, high quality patient experience and an environment that empowers our consultants to excel. Providing a dependably high quality of care requires constant focus on improvement; the most recent independent research conducted for BMI shows that over 98% of our patients rate their care as excellent or very good. The information available here has been reviewed by the Clinical Governance Board and I declare that as far as I am aware the information contained in these reports is accurate. Finally I would like to thank all the staff whose application, professionalism and ceaseless commitment to improvement is recognized here and in the positive experiences of the patients we care for. Since I joined BMI late last year, I have witnessed this firsthand on my many visits to our hospitals and I am committed to ensuring we build on that success. Jill Watts, Group Chief Executive
BMI The Duchy Hospital Hospital Information Set on the outskirts of the beautiful spa town of Harrogate, within one minute walk of the legendary Stray and Valley Gardens, our 27 bedded facility offers day and in-patient care, along with a full range of outpatient services which includes physiotherapy and diagnostic imaging. All our patient bedrooms have en-suite facilities, with a bath or shower, nurse call system, TV and telephone. We offer free on-site car parking, visitors may come and go as they please, with no restriction on visiting hours (subject to medical considerations). Our catering service provides for an extensive choice of dishes, with all special dietary requirements catered for. We are proud of our facility and the services we offer, and having been established in Harrogate since 1959, our customer demand has led to our success as one of the leading private health care providers in the area. All consultants treating patients at BMI Healthcare hospitals have fulfilled rigorous eligibility criteria that are used to ensure patients receive the highest possible standard of care. All are reviewed every 2 years to ensure the upkeep of these criteria, examples of which include inclusion on the specialist register of the General Medical Council, currently holding a permanent appointment as a consultant or senior lecturer in an NHS hospital or having equivalent status and clinical experience, performing procedures or techniques that are only part of his or her normal practice and which he or she can provide evidence of adequate training and ongoing experience.
During 2014 the hospital installed air conditioning in the Consulting Rooms clean utility, the boiler was replaced, cameras and batteries were purchased for theatres and new seating purchased for Physiotherapy. The hospital sees a mix of private and NHS patients on an outpatient and inpatient or day case basis. From 1st October 2014 31st March 2015 the case mix was 72% private and 28% NHS. The hospital s NHS workload comes from Choose and Book which is offered in the specialties of orthopaedics, urology, gastroenterology, ENT, spinal and general surgery. In addition to this the hospital has also performed spot purchase work for an NHS Trust in the region. BMI Healthcare is registered as a provider with the Care Quality Commission (CQC) under the Health & Social Care Act 2008. BMI The Duchy is registered as a location for the following regulated services:- Treatment of disease, disorder and injury Surgical procedures Diagnostic and screening Family planning The CQC carried out an unannounced inspection on 25 th hospital to be compliant with all the standards. September 2013 and found the Standards of treating people with respect and involving them in their care Standards of providing care, treatment & support which meets people's needs Standards of caring for people safely & protecting them from harm Standards of staffing Standards of management BMI The Duchy has a local framework through which clinical effectiveness, clinical incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to continuously improve the quality of care. This is through the work of a multidisciplinary group and the Medical Advisory Committee. Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the quality improvements are operationalised. There has been development of At corporate level the Clinical Governance Board has an overview and provides the strategic leadership for corporate learning and quality improvement. There has been ongoing focus on robust reporting of all incidents, near misses and outcomes. Data quality has been improved by ongoing training and database improvements. New reporting modules have increased the speed at which reports are available and the range of fields for analysis. This ensures the availability of information for effective clinical governance with
implementation of appropriate actions to prevent recurrences in order to improve quality and safety for patients, visitors and staff. At present we provide full, standardised information to the NHS, including coding of procedures, diagnoses and co-morbidities and PROMs for NHS patients.there are additional external reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers BMI is a founding member of the Private Healthcare Information Network (PHIN) UK where we produce a data set of all patient episodes approaching HES-equivalency and submit this to PHIN for publication. The data is made available to common standards for inclusion in comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website gives patients information to help them choose or find out more about an independent hospital including the ability to search by location and procedure. 1. Safety 1.1 Infection prevention and control The focus on infection prevention and control continues under the leadership of the Group Director of Infection Prevention and Control and Group Head of Infection Prevention and Control, in liaison with the Infection Prevention and Control Lead at BMI The Duchy We have had: - Zero MRSA bacteraemia cases/100,000 bed days Zero MSSA bacteraemia cases /100,000 bed days Zero E.coli bacteraemia cases/ 100,000 bed days Zero cases of hospital apportioned Clostridium difficile in the last 12 months. SSI data is also collected and submitted to Public Health England for Orthopaedic surgical procedures. Our rates of infection are; 0% Hips 0% Knees The hospital s IP&C team meets on a monthly basis with full Committee meetings being held three times per year. Full environmental audits were undertaken in the last year on the ward, theatre and in the Consulting Rooms. Action plans were completed which have been followed up by the respective link practitioners and Heads of Department. Audit results and action plans are discussed at both hospital and Committee meetings. In addition the hospital completed its PLACE audit.
The hospital team has implemented the peripheral cannula, surgical site infection (SSI) and indwelling catheter care bundles and a high level of consistent practice was demonstrated in the results. Hand hygiene audits are scheduled to take place in all clinical departments on a monthly basis. Environmental cleanliness is also an important factor in infection prevention and our patients rate the cleanliness of our facilities highly. Very good and excellent scores for bathroom cleanliness are consistently over 90% with the excellent score always achieving over 70%. This is an improvement on the achievement over the same period 2013/14 where the excellent score was always over 60%. Very good and excellent scores for bathroom cleanliness are consistently over 90% with the excellent score always achieving over 70%. This is an improvement on the achievement over the same period 2013/14 where the excellent score was always over 60%. 1.2 Patient Led Assessment of the Care Environment (PLACE) We believe a patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for
improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient environment, replacing the old Patient Environment Action Team (PEAT) inspections. This audit was repeated in 2014. The assessments involve patients and staff who assess the hospital and how the environment supports patient s privacy and dignity, food, cleanliness and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or how well staff are doing their job. The results will show how hospitals are performing nationally and locally. The table below shows the results of the 2013 and 2014 audits and improvement in all areas. The 2015 assessment took place in March 2015, the results for which are not yet available. Category 2013 2014 Cleanliness 90.1% 99% Food 77.4% 77.9% Privacy, Dignity and Wellbeing 88.6% 88.7% Condition, Appearance and Maintenance 81.4% 94.9% 1.3 Venous Thrombo-embolism (VTE) BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its whole network of hospitals including, BMI The Duchy. BMI Healthcare was awarded the Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the Runners up in the Best VTE Patient Information category. We see this as an important initiative to further assure patient safety and care. We audit our compliance with our requirement to VTE risk assessment every patient who is admitted to our facility and the results of our audit on this has shown 98.3% compliance. BMI The Duchy reports the incidence of VTE through the corporate clinical incident system. It is acknowledged that the challenge is receiving information for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE post discharge from the Hospital. As such we may not be made aware of them. We continue to work with our Consultants and referrers in order to ensure that we have as much data as possible. BMI The Duchy has had a 0% incidence of VTE in this reporting year.
2. Effectiveness 2.1 Patient reported Outcomes (PROMS) Patient Reported Outcome Measures (PROMs) are a means of collecting information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves. PROMs is a Department of Health led programme. Latest results can be found by going on the online SOLAR system provided to you by Quality Health For the current reporting period, the tables below demonstrate that the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post operative) for patients undergoing hip replacement and knee replacement. Oxford Hip average April 14 September 14 Health gain between reporting Q1 Q2 periods BMI The Duchy No data No data England 18.16 40.081 21.922 Copyright 2013, The Health and Social Care Information Centre. All Rights Reserved. Oxford Knee average April 14 September 14 Health gain between reporting Q1 Q2 periods BMI The Duchy No data No data England 19.401 36.103 16.702 Copyright 2013, The Health and Social Care Information Centre. All Rights Reserved. The Duchy considers that this data is as described as less than 30 patients went through the process and therefore the hospital cannot be scored. 2.2 Enhanced Recovery Programme (ERP) The ERP is about improving patient outcomes and speeding up a patient s recovery after surgery. ERP focuses on making sure patients are active participants in their own recovery and always receive evidence based care at the right time. It is often referred to as rapid recovery, is a new, evidence-based model of care that creates fitter patients who recover faster from major surgery. It is the modern way for treating patients where day surgery is not appropriate. ERP is based on the following principles:- 1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care b. Reduced length of stay 2. Patient Preparation a. Pre Admission assessment undertaken b. Group Education sessions c. Optimizing the patient prior to admission i.e HB optimisation, control comorbidities, medication assessment stopping medication plan. d. Commencement of discharge planning 3. Proactive patient management a. Maintaining good pre-operative hydration b. Minimising the risk of post-operative nausea and vomiting c. Maintaining normothermia pre and post operatively d. Early mobilisation 4. Encouraging patients have an active role in their recovery a. Participate in the decision making process prior to surgery b. Education of patient and family c. Setting own goals daily d. Participate in their discharge planning The table below shows a consistently low Length of Stay in 2013 and 2014 compared to 2012 before ERP principles were embraced into every day practice. The hospital s AVLOS for primary knee and hip replacements is 3.5 days which is slightly below the AVLOS in the BMI Group. Following the successful implementation of the Back Class for patients having spinal surgery, patients having knee arthroscopy are seen together with the physiotherapist on admission and some groups of patients having hip and knee replacements are seen prior to admission as an outpatient. The in-patient physiotherapy provision has also been increased.
2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre. Unplanned readmissions and unplanned returns to theatre are normally due to a clinical complication related to the original surgery. There were 5 unplanned readmissions to The Duchy compared to 7 the previous year. All such incidents are investigated and reported through the hospital s governance structure and reviewed at the Governance Committee on a quarterly basis. There were 2 unplanned returns to theatre compared to 5 in the previous year.
3. Patient experience 3.1 Patient satisfaction BMI Healthcare is committed to providing the highest levels of quality of care to all of our patients. We continually monitor how we are performing by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third party. The following 3 tables are examples of just some of the key questions within the survey and The Duchy s performance over a rolling 12 month period. The hospital discusses the reports at the Operational Team and Hospital Governance meetings. Specific actions that might be required are agreed at either forum. When considering both very good and excellent, the overall impression of nursing care has remained consistently over 90%. When considering both very good and excellent, the overall impression of accommodation has remained on or over 90%.
When considering both very good and excellent, the overall impression of catering has remained on or over 80%. 3.2 Complaints In addition to providing all patients with an opportunity to complete a satisfaction survey BMI The Duchy actively encourages feedback both informally and formally. Patients are supported through a robust complaints procedure, operated over three stages: Stage 1: Hospital resolution Stage 2: Corporate resolution Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied with the outcome at the other 2 stages.
In the previous year, one of the main themes was addressed which was that patients felt that the cost of procedures and invetigations undertaken in outpatients were not always made explicit to them by both the hospital and Consultants. The hospital s Executive Director and hospital team took a series of measures to improve on openess about charges and the visibility of prices, particularly in Consulting Rooms. The actions have seen a reduction in this type of complaint. 4. CQUINS BMI The Duchy hospital had 2 locally agreed CQUINS in 2014/15. 4.1 Completion of a monthly audit of NEWS scoring ( Early Warning ) on working day 10 for inpatients with a stay greater than 24 hours examining the accuracy of scoring and where required, evidence of interventions. Although there were only small numbers in the denominator figures, there was 100% compliance across the year. 4.2 The second CQUIN concerned the early mobilization of patients undergoing primary hip and knee replacement surgery within 24 hours. The number of patient s to be audited was 10 unless fewer patients underwent the procedure. As with the above CQUIN, numbers were small but there was 100% compliance. 5. Clinical Audits BMI The Duchy was only eligible to participate in Joint Registry audit and all joint replacements are submitted to this. The hospital s consent compliance was as follows: Quarter 1 14/15 66% Quarter 2 14/15 100% Quarter 3 14/15 98.6% Quarter 4 14/15 100% 6. Research No NHS patients were recruited to take part in research. 7. Priorities for service development and improvement In 2015, The Duchy is aiming to expand the services offered in the Outpatient Department with the introduction of an outpatient hysteroscopy service in addition to moving some minor cosmetic procedures into this environment from theatre. The Minor Procedure Room in the hospital s Consulting Rooms offers a more comfortable and less stressful experience for patients in comparison to a full Operating Department pathway. The hospital has recently purchased an Ocular Coherence Tomography (OCT) scanner for the Ophthalmology Consultants which will be used to provide additional services for their group of patients beyond that which is considered routine in an outpatient environment. The Ward and Theatre Manager s will be working towards offering an increased number of procedures on a Walk In Walk Out (WIWO) basis. This will require a review of environmental factors as well as the patient pathway.
8. Mandatory Quality Indicators 8.1 The value of the summary hospital-level mortality indicator (SHMI) for the BMI The Duchy for the reporting period. Highest Lowest 0% Oct 2012 Jun 2014 0.9987 1.1849 0.58345 8.2 The Duchy s patient reported outcome measures scores for (i) Groin hernia surgery Highest Lowest 0.162 Apr 14 Sept 14 0.0786 0.278-0.112 The Duchy s score is above the national average. (ii) Varicose vein surgery No BMI Data Highest Lowest Apr 14 Sept 14-7.395-1.957-12.571 There are no scores available for BMI Healthcare and therefore The Duchy cannot be scored (iii) Hip replacement surgery Highest Lowest No score Apr 14 Sept 14 21.542 28.6 9.714 The Duchy considers that this data is as described as less than 30 patients went through the process and therefore cannot be scored. (iv) Knee replacement surgery during the reporting period. Highest Lowest No score Apr 14 Sept 14 16.641 24.429 5.833
The Duchy considers that this data is as described as less than 30 patients went through the process and therefore cannot be scored. The Duchy complies with PROMS requirements and all eligible patients are included at preassessment 8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital which forms part of BMI The Duchy within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period. Highest Lowest No score Apr 13 - Mar 14 11.45 14.35 7.96 BMI The Duchy does not admit or treat any patients in this age group. 8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of BMI The Duchy within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period. Highest Lowest 0.26% Apr 13 Mar 14 10.01 14.51 5.54 BMI The Duchy considers that this data is as described as there were only 5 readmissions during the timeframe. 8.4 BMI The Duchy s responsiveness to the personal needs of its patients during the reporting period. Highest Lowest 96.4% 2013-2014 68.7 85 54.4 BMI The Duchy considers that this data is as described as it reflects the overall satisfaction of our patients. The score reflects an improvement on last year s figure and the hospital will continue its level of care delivery whilst continuing to aim for improvement. 8.5 The percentage of patients who were admitted to BMI The Duchy and who were risk assessed for venous thromboembolism during the reporting period. Highest Lowest 98.3% Apr 14 Jan 15 95 100 87
BMI The Duchy considers that this data is as described as on rare occasions due to human error patients have not been risk assessed. The Duchy will continue to aim for 100% compliance for this measure. 8.6 The rate per 100,000 bed days of cases of C difficile infection reported within BMI The Duchy amongst patients aged 2 or over during the reporting period. Highest Lowest 0% Apr 13 Mar 14 14.7 37.1 0 There have been no cases of C difficile at BMI The Duchy. 8.7 The number and, where available, rate of patient safety incidents reported within BMI The Duchy during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. Number of patient safety incidents reported Highest Lowest 82 Oct 13 Sep 14 20 139 0 Rate of patient safety incidents reported (Incidents per 100 Bed Days) Highest Lowest 5.3 Oct 13 Sep 14 3.589 7.496 0.0245 BMI The Duchy Hospital reports all clinical incidents and patient safety related incidents. The numbers reported above include a high proportion of patients who were planned as day cases and for clinical safety reasons stayed overnight, which is classed as an adverse outcome on the BMI Sentinel reporting system. As well as using different reporting methodology, BMI Healthcare use a different reporting system to the NHS and therefore, some of our results may not be directly comparable with NHS data. Number of patient safety incidents that resulted in severe harm or death Highest Lowest 0 Oct 13 Sept 14 40.2 97 0
Percentage of patient safety incidents that resulted in severe harm or death (Incidents per 100 Admissions) Highest Lowest 0% Oct 13 Sept 14 0.3 2.4 0.0 BMI The Duchy has had no patient safety incidents in this category. 8.8 The percentage of staff employed by BMI The Duchy during the reporting period, who would recommend the hospital as a provider of care to their family or friends. Highest Lowest 95% 2014 64.58 96.43 33.73 9. Non-Mandatory Quality Indicators 9.1 The percentage of patients who received care as inpatients or discharged from A &E during the reporting period, who would recommend The Duchy as a provider of care to their family or friends. Highest Lowest 80% Apr 13 Mar 14 66.23 94.38 35.63 BMI The Duchy hospital considers that this data is correct The hospital continually endeavours to retain and improve its score.