THE ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST Quality Narrative QUALITY ACCOUNTS 2011/12 (WORKING DRAFT OF CONTENT) 1. Statement from the Chief Executive, and summary of the quality of NHS services provided. 2. The Trust s priorities for quality improvement for the coming financial year. To include statements from the board that the Trust is: Performing to essential standards (such as meeting CQC Registration), as well as going above and beyond this to provide high quality care. Measuring your clinical processes and performance (for instance, through participation in National Clinical Audits). Involved in national cross-cutting projects and initiatives aimed at improving quality, for instance, through recruitment to clinical trials or through establishing quality improvement and innovation goals with the commissioner using the CQUIN payment framework. 3. Each priority and detail. At least three priorities How progress to achieve the priorities identified will be monitored and measured How progress will be reported Lead - Chief Nurse on behalf of CEO & Chair
Review of Services During 2011/2012 the Royal National Orthopaedic Hospital NHS Trust provided and subcontracted 14 services. The Royal National Orthopaedic NHS Trust has reviewed all the data available to them on the quality of care in all of these NHS services. The income generated by the NHS services reviewed in 2011/2012 represents 100 per cent of the total income generated from the provision of NHS services by the Royal National Orthopaedic NHS Trust for 2011/2012. The 14 clinical services provided by the Trusts are: London Spinal Cord Injury Centre Rehabilitation & Therapy Joint Reconstruction Shoulder & Upper Limb Paediatric & Adolescents Peripheral Nerve Injury Unit Anaesthesia The London Sarcoma Unit Radiology Urology Functional Assessment & Restoration (FARs) Spinal Surgical Unit Integrated Back Unit Clinical Neurophysiology Participation in Clinical Audit During 2011/12, five national clinical audits and three national confidential enquiry covered NHS services that the Royal National Orthopaedic Hospital NHS Trust provides. During that period the Royal National Orthopaedic Hospital NHS Trust participated in 100% (5/5) national clinical audits and 100% (3/3) national confidential enquiry of the national clinical audits and confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that the Royal National Orthopaedic Hospital was eligible to participate in during 2011/12 are as follows: National Joint Registry: Hip, knee and ankle replacements National PROMs Programme: Elective surgery National Pain Audit Bedside Transfusion (Comparative Audit of Blood Transfusion)
Risk factors (National Health Promotion Audit) NCEPOD: Peri-operative care study NCEPOD: Cardiac procedures study NCEPOD: Surgery in children study The Trust participated within all of the above. The national clinical audits and national confidential enquiries that the Royal National Orthopaedic Hospital NHS Trust participated in, and for which data collection was completed during 2011/2012, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of the audit or enquiry. Audit Number of Cases submitted cases required by Number Percentage the audit National Joint Registry: Hip, knee and ankle replacements National PROMs Programme: Elective surgery National Pain Audit 86 86 100% Bedside Transfusion (Comparative Audit of Blood Transfusion) 40 20 50% *Risk factors (National Health Promotion Audit Organisational) n/a n/a n/a NCEPOD: Peri-operative care study 6 6 100% *NCEPOD: Cardiac procedures study n/a n/a n/a *NCEPOD: Surgery in children study n/a n/a n/a *The RNOH took part in the Organisational section of the audit The reports of 3/3 national clinical audits were reviewed by the provider in 2011/12 and the Royal National Orthopaedic NHS Trust intends to take the following actions to improve the quality of healthcare provided: To ensure the Elective Surgery PROMs forms are fully completed for all patients treated within the RNOHT. To review documentation to include clear guidance on the timing of blood transfusions. To review the current Trust transfusion policies and accompanying documentation. To ensure monitoring the patient during transfusion is part of the blood awareness training. The reports of (7/7) high and medium priority local clinical audits were reviewed by the provider in 2011/12 and the Royal National Orthopaedic NHS Trust intends to take the following actions to improve the quality of healthcare provided, a summary of recommendations are listed below:
Safety Thermometer Audit: on-going monitoring of national patient safety issues including: pressure sores, urinary catheterisation, falls and venous thromboembolism (VTE). Record Keeping Audit: to conduct yearly multidisciplinary reviews of documentation within the medical/nursing notes to raise awareness of the importance of good record keeping within the Trust and ensure training is available for staff. VTE Audit: to establish a MDT multidisciplinary group to ensure VTE is monitored effectively within the Hospital and revise the VTE policy/risk assessment documentation. Consent Audit: to raise awareness to staff of the importance of taking high quality consent. Medicines Safety and Security Audit: to ensure the RNOH medicines equipment is compliant with national standards, revise RNOH local medicines polices and increase pharmacy led training provided for staff. Nutrition Risk Assessment Audit: to simplify and update the current nutrition risk score in line with the NICE guidance definition of malnutrition. Because of the specialist nature of the services that the RNOH provides, the Trust was not eligible to participate in many of the national audits and national confidential enquires, including studies from the Centre for Maternal and Child Enquires (CMACE) and the National Confidential Inquiry (NCI) into Suicide and Homicide by people with mental illness (NCI/NCISH). Research The number of patients receiving NHS services provided or sub-contracted by The Royal National Orthopaedic Hospital NHS Trust in 2011/2012 that were recruited during that period to participate in research approved by a research ethics committee was 213 both interventional and non-interventional research projects. Participation in clinical research demonstrates The Royal National Orthopaedic Hospital NHS Trusts commitment to improving the quality of care we offer and to making our contribution to wider health improvement. Our clinical staff stay abreast of the latest possible treatment possibilities and active participation in research leads to successful patient outcomes The Royal National Orthopaedic Hospital NHS Trust was involved in conducting 29 clinical research studies in neuro-musculoskeletal speciality including surgical research in 2011/2012. Over the same period, mortality amenable to healthcare/mortality rate from causes considered preventable in (medical speciality) changed from the previous year by (insert percentage). The improvement in patient health outcomes in The Royal National Orthopaedic NHS Trust demonstrates that a commitment to clinical research leads to better treatments for patients. Comment [ih1]: Not sure this is relevant to us.
There were 25 of clinical staff participating in research approved by a research ethics committee at The Royal National Orthopaedic NHS Trust. These staff participated in research covering neuro-musculoskeletal medical specialities. As well, in the last three years, 5 publications have resulted from our involvement in NIHR research, which shows our commitment to transparency and desire to improve patient outcomes and experience across the NHS. Our engagement with clinical research also demonstrates The Royal National Orthopaedic NHS Trust commitment to testing the latest medical treatments and techniques. Goals agreed with commissioners A proportion of the Royal National Orthopaedic Hospital NHS Trusts income in 2011/2012 was conditional on achieving quality improvement and innovation goals agreed between the Royal National Orthopaedic Hospital NHS Trust and our host commissioner NHS North Central London through the Commissioning for Quality and Innovation payment framework. CQUIN VTE Assessment Patient Experience Enhanced Recovery Programme Pressure Ulcers Pre-operative assessment screening Inpatient Electronic Booking
What others say about the Royal National Orthopaedic NHS Trust The Royal National Orthopaedic Hospital NHS Trust is required to register with the Care Quality Commission and its current registration status is registered without conditions. The Care Quality Commission has not taken enforcement action against The Royal National Orthopaedic Hospital during 2011/2012. Statement from CQC Report on latest available periodic review published by CQC Data Quality During 2011/2012 RNOH has taken the following actions with regard to Data Quality: o Implemented all recommendations from 2011 Data Quality Audit. o The data quality dashboard developed in 2010 / 2011 has been further developed to incorporate additional data items collected at the Referral stage and data collected in Theatres. Theatre data quality has improved significantly and in 2012 has consistently achieved 100% completion of key data items. o Re-started Data Quality Group meeting monthly o Data Quality Group has agreed the approach to completing the work required to fully identify RNOH data quality requirements. See slide below.
The Royal National Orthopaedic Hospital NHS Trust submitted records during 2011/2012 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient s valid NHS number was: 99% for admitted care (from SUS DQ dashboard) 99.2% for outpatient care (from SUS DQ dashboard)
The percentage of records in the published data which included the patient s valid General Medical Practice Code was: 100 % for admitted care (from SUS DQ dashboard) 100% for outpatient care (from SUS DQ dashboard) The Royal National Orthopaedic Hospital NHS Trust Information Governance Assessment Report score for 2011/12 was 71% and was graded green. The Royal National Orthopaedic Hospital NHS Trust was subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission and the error rates reported in the latest published audit for that period for diagnosis and treatments coding (clinical coding) were: o Primary Diagnosis incorrect 5.0 o Secondary Diagnosis incorrect 3.5 o Primary Procedures incorrect 2.5 o Primary Procedures incorrect 2.6 Review of quality performance Patient Experience Complaints PALS Enquiries Real time Patient Feedback Single Sex Accommodation Patient/Staff Stories Patient Safety Clinical Incident Trends Pressure Sores Mortality Rates Drug Errors Litigation NICE/National Patient Safety Issues Infection Control Surgical Site Infections MRSA Cleaning Standards Audit Safety Walk Rounds
Lead Chief Nurse/Clinical Audit Lead Statements from Local Involvement Networks, Overview and Scrutiny Committees and Primary Care Trusts Lead Clinical Governance Manager/Customer Care Manager Stuart Coalwood Asst Director of External Compliance & Quality Assurance 2 nd April 2012