EAST AND NORTH HERTFORDSHIRE PCT

East and North Hertfordshire PCT

Abstract

The Directly Standardised Mortality Rates (DSRs) presented in this report give an indication of the different levels of mortality in the wards in East and North Hertfordshire PCT for 2000-2008.

Introduction

Much emphasis is placed on improving patient flow, to reduce length of stay, increase hospital efficiency and productivity, to help meet the performance agenda particularly to promote access and ensure financial stability. However there are only a few publications (Cameron, 2006; Classen et al., 1997; Pittet et al., 1994; Richardson, 2006; Spirulus et al., 2006) on improving flow through a clinical focus that will deliver more responsive and safer care with the ultimate outcome of reducing avoidable hospital mortality.

Over recent years, acute hospitals have witnessed an increase in attendances to Accident & Emergency Departments and emergency admissions, particularly in Medicine. In recognition of this, one of the performance targets set by the Department of Health, has been to reduce the number of emergency bed days utilised. Many suggestions are given as contributory factors to the rise in emergency bed days such as poor primary care infrastructure and increasing longevity with associated co-morbidities.

The early response to increasing numbers of patients presenting to secondary care was to increase the number of beds available, but this is not sustainable. When demand exceeds capacity the solution commonly employed has been to transfer patients out from a speciality bed pool, to another area. The flow which dominates for the hospitals in Blackburn has been, and remains, medical patients into surgical bed capacity - medical outliers. The relentless influx of medical patients across into surgical wards is the antithesis of right patient, right place, and right time. It obviously interferes with the elective surgical flow and is an impediment to high quality clinical care.

In 2003 the Trust was sponsored by the MA to join the Institute of Healthcare Improvement's (IHI) Impact Collaborative which consisted of five work streams, one of which was “Flow through acute care settings”. The Trust was the only UK member of the flow group. The IHI also advocated quality review based on a mortality audit. To facilitate flow through acute care the agreed aim was to eliminate medical outliers and optimise bed management.

Setting

East & North Herts PCT NHS encompasses Stevenage, Welwyn and Hatfield, Broxbourne, Cheshunt, Hertford, Hoddesdon, North Herts (Letchworth), Royston, Buntingford, Bishop's Stortford and their surrounding villages. Medical outliers were seen daily by the “outlier physician of the week”. The “outlier physician of the week” was a change brought in two years earlier to ensure regular review and continuity of care by a senior member of the medical team.

The number of medical outliers averaged 30 a day and had peaked at 80. The constant pressure on hospital beds had previously resulted in the commissioning of 30 nursing home beds by the Trust and for which the Trust provided additional services allowing them to function as intermediate care beds.

Mortality analysis is frequently used to evaluate hospital effectiveness, quality of care and ...