SAFE
Presented to NHS Fife Board on 28th October 2014
Hospital Standardised Mortality Rate Apr 2011 - Mar 2014
For the 2 month
period JulyAugust 2014,
there were
10,426
admissions to
NHS Fife
Hospitals. Of
which 5,446
were unplanned,
1,433 planned
and 3,547 day
cases. In
addition there
were 16,616
new outpatient
attendances and
40,916 reviews.
Mean for 2013
Fife
99.3%
96.5%
96.0% 95.8%
94%
95.6% 95.4%
95.3%
94.9%
92%
125
20
109
0
Apr-14
Feb-14
Jan-14
Mar-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Sep-14
Sep-14
116
Aug-14
97
Lower is better
Num ber of falls
9.7%
Jul-14
121
9.5%
Jun-14
143
11.5%
11.0%
May-14
148
11.5%
10.3%
10.1%
Apr-14
120
0.0
11.4% 11.3%
Mar-14
40
151
Jan-14
Sep-14
Jul-14
Dec -13
2.0
11.8%
Feb-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
0
13.0%
12.0%
11.0%
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Jan-14
50
232
Sep-14
268
Aug-14
230
60
Jul-14
233
100
3.2
80
Jun-14
271
3.6
3.8
2.9
May-14
100
316
0.0
3.6
4.0
Apr-14
4.0
3.7
Mar-14
150
120
4.3
Feb-14
200
MSSA bacteraemia Apr-Jun 14
4.9
4.7
80%
70%
160
140
6.0
Rate
250
Lower is better
6.8
90.7% 90.1%
12.7%
8.0
Num ber of falls
300
8.1
7.0
91.6%
Emergency Readmissions with 28 days
Trajectory (20% reduction by end of Dec 2015)
350
91.9%
75%
NHS Fife
Inpatient Falls with Harm Rate per
1,000 occupied bed days
Mean rate based on NPSA guidance (6.0/1,000 OBD)
6.0
Dec-13
5
37
Trajectory (25% reduction by end of Dec 2015)
8.3
322
35
Mean rate based on NPSA guidance (6.0/1000 OBD)
9.5
263
22
NHS Fife rate
7.8
298
23
NHS Fife rate
7.0
2.0
23
Number of falls with harm
8.0
Rate
Lower is better
10.0
17
Number of falls
10.6
9.3
22
0
NHS Fife
Inpatient Falls Rate per 1,000 occupied bed
days
12.0
27
91.1%
85%
Dec-13
Sep-14
Aug-14
J ul-14
J un-14
May-14
Apr-14
Mar-14
Feb-14
Dec-13
18
0.0
92.3%
91.1% 91.4%
Dec-13
2.0
92.2%
90%
Oct-13
10
0
J an-14
0.0
4.0
MRSA bacteraemia Apr-Jun 14
91.8%
91.5%
Nov-13
2
5
Aug-14
10
Jun-14
6
15
May -14
6
20
Apr-14
4
30
6.5
25
6.0
Mar-14
7
6.7
4.9
Jan-14
5
6.7
5.5
Jan-14
7
7.0
8.0
Dec-13
7
7.8
95%
Oct-13
4
35
Feb-14
1.0
40
Nov-13
6
10.5
Number of pressure ulcers
8
1.1
0.9
10.1
10.0
Rate
Rate
1.3
0.9
Lower is better
10
1.5
Number of falls
Lower is better
1.8
1.5
12.0
12
Higher is better
100%
Mean rate bas ed on NPSA guidanc e (6.0/10000
OBD)
2.2
2.5
0.5
Standard (90%)
Rate
Target 50% reduc tion by end of Dec 2015 (0.8/1000
dis c harges )
1.5
Combined target
Number of pres s ure ulc ers
Rate
1.5
18 Weeks Referral to Treatment
Combined Performance
NHS Fife Reported Pressure Ulcers
(Grades 2-4) per 10,000 Occupied Bed Days
Number of c ardiac arres ts
2.0
Dec-13
Oct-13
REDUCE HARM
Nov-13
90%
C difficile (over 65) Apr-Jun 14
Cardiac Arrest Rate per 1,000 discharges
Acute Services Division Only
94.9%
Sep-14
Oct-14
Sep-14
J ul-14
Aug-14
J un-14
Apr-14
May -14
Mar-14
J an-14
Feb-14
Dec -13
Oct-13
Nov-13
Sep-13
J ul-13
Aug-13
200
97.4%
96%
Jul-14
400
98.5%
Aug-14
600
Higher is better
98%
800
J un-13
Target (by end Sept 2014)
100%
1151
1117
1108
1106
1079
102510101034
1015
1010
1008
1007
960
953 983
911 927
1000
0
National Standard (98%)
Jun-14
905
CHPs
May-14
967 958
Apr-13
Apr-J un Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec J an-Mar Apr-Jun J ul-Sep Oct-Dec Jan-Mar
2011
2011
2011
2012
2012
2012
2012
2013
2013
2013
2013
2014
1200
ASD
May -13
0.50
1400
Mar-13
1.00
4 hour Emergency Access Performance
NHS Fife
J an-13
Standardised Mortality Rate
1.50
Reported Patient Incidents for NHS Fife
Feb-13
Scotland
No. of reported patient incidents
Fife
0.00
EFFECTIVE
NHS Fife HealthCheck July-August 2014
PERSON-CENTRED
Activity
Total activity for the period July-August 2014 was 67,958. This included 10,426 admissions to NHS Fife Hospitals and 16,616 new out-patient attendances and 40,916
reviews.
Hospital Standardised Mortality Rate (HSMR)
Complaints, Concerns, Comments, Compliments
Compliments
Comments
The last quarterly data to March 2014 was published in August 2014. This shows a HSMR of 0.78 for Fife. The HSMR data shows an improvement however the
quality of the data return has reduced due to coding backlog. There are a number of actions underway to improve the quality of the coding returns. It is difficult at this
point to assess the impact of the improvement work which is currently in progress to reduce mortality.
Concerns
95% Harm Free Care
At this time, Catheter Associated Urinary Tract Infection (CAUTI) has been excluded from the SPSI to allow testing and establishment of the outcome measure in
NHSS boards. Testing and reporting of process and outcome measures for CAUTI remains a priority for the Acute Adult programme with the aim of including CAUTI
within the SPSI when consensus is reached on a scalable definition.
152
74
89
75
32
6
40
11
29
8
42
20
59
73
Aug-14
Jul-14
77
Jun-14
65
5
35
5
May-14
53
Cardiac Arrests – Failure to Rescue has been a theme identified through the SAER process and the mortality reviews. Identifying deteriorating patients has been
identified within the SPSP programme as an area to focus improvement activity. There are multiple strands under this broad heading which include Sepsis, and
DNACPR.
• Pressure Ulcers – There has been an increase in the number of reported pressure ulcers in July and August. The reason for the increase is multi-factorial and
partly due to increased awareness of reporting, change in reporting in certain grades of pressure ulcer. Whilst there has been an increase this does not necessarily
mean that these pressure ulcers have been acquired whilst under care from NHS Fife. Work is underway to review the pressure ulcer incidents and data to identify
the key improvements across the system which are required to reduce the occurrence of pressure ulcers acquired under NHS Fife care.
• Falls – In addition to looking at the 25% reduction in all falls (with and without harm) a chart depicting the 20% reduction in falls with harm is included. This is to
support the strategic priority of reducing inpatient falls. The Frailty Steering Group (and the groups who report directly to the Frailty Steering Group) have initiated a
number of improvement activities which include initial frailty screening of all patients on admission to hospital; Immediate implementation of “safety bundle” for
those at risk; Equipment review; Staff training; Robust implementation of comfort rounds; Review of observation policy; Review of patient pathway; Review of
medical pathway; Documentation review with a view to integration and removal of duplication; Environmental review.
97
63
25
6
46
2
Apr-14
23
27
2
37
1
49
Mar-14
17
6
Feb-14
31
11
36
Jan-14
53
36
Dec-13
44
5
•
85
64
Nov-13
66
Oct-13
160
140
120
100
80
60
40
20
0
-20
-40
-60
-80
-100
-120
-140
Complaints
Significant Adverse Events Review (SAER)
There were a total of 2257 incidents reported from July 2014 to August 2014. Of these 3% (78/2257) reported were graded as major/extreme and 6% (5/78) of those
have been commissioned for an internal SAER. These were categorised as tissue viability (2); unwanted behaviours, violence and aggression (1); Healthcare
Acquired Infection (1); and clinical (1).
Staff Sickness
Readmissions
Readmissions data is currently being reviewed with a view to using validated national data provided by ISD rather than locally derived data.
Staff Sickness
5.34%
4.64%
4.90%
Complaints
5.21%
4.82%
4.71%
4.69%
4.57%
4.85%
The formal definition of complaint is ‘an expression of dissatisfaction about an action or lack of action or standard of care provided’. In Fife our approach is to make
direct contact with the individual raising the complaint or concern, to be clear about any issue and to distinguish how this is coded on the system. Our policy in Fife is
to seriously consider all forms of feedback and to act on and learn from them.
There were 71 formal complaints (with multiple issues) reported in July and August 2014. The 3 key themes from these formal complaints were: clinical treatment
44% (120/274); attitude and behaviour 23% (64/274); and communication (oral) 16% (45/274).
5.22%
4.71%
5.00%
4.00%
3.00%
Staff Experience
Overall experience of patients during their
stay/visit to hospital
(Percentage of respondents who answered in a positive way)
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Scottish Public Services Ombudsman (SPSO)
Dec-13
Your Care Experience
0.00%
Nov-13
A national tool, i-Matter, is being developed. Work is in progress to determine whether this would be an appropriately sensitive measure to capture staff experience.
1.00%
Oct-13
2.00%
Four decisions were reached by the SPSO during July/August; two relating to GP practices and two relating to Acute Services.
The SPSO upheld one of the practice cases, concluding that the GP failed to make a timely referral to a specialist and only did so when prompted by the family. It
was also considered that referral to a geriatrician rather than a psychiatrist would have been more appropriate. The Practice were asked to feedback the failings
identified to the staff involved and to offer the family a written apology. All recommendations have been completed.
In the second case the SPSO did not uphold the complaints that a GP failed to perform an appropriate examination to establish the cause of symptoms and failed to
offer a NHS referral. There was recorded evidence of the examinations undertaken and no evidence of service failure identified in reviewing the complaint.
SPSO did not uphold a complaint regarding the provision of appropriate care and treatment concerning an injured knee. The non surgical approach taken by the
Orthopaedic Consultant was in keeping with NICE guidelines and was therefore considered reasonable.
100%
The SPSO upheld a complaint that the Board failed to provide appropriate and co-ordinated medical treatment to a patient when it was evident that the patient’s
condition had deteriorated. The SPSO also upheld the complaint that the Board failed to provide the family with appropriate palliative care. A number of
recommendations were made including; the offer of an apology, a case review to identify ways of improving communication, an audit of compliance of monitoring pain
levels and consideration of ways to better involve community palliative care teams. The Associate Medical and Nurse Directors within Acute are leading on the actions
being put in place as a result of the recommendations made.
80%
Higher is better
Lower is better
6.00%
Target (4.00%)
60%
100%
The theme for Person Stories at today’s Board is the importance of the links between health and education in terms of mental health and wellbeing. The Board will
hear from Ms. A who has received support from the mental health Occupational Therapy service in order to help her transition into higher education.
40%
20%
0%
Inpatient
Outpatient
Data from Your Care Experience
No data collected from inpatient areas
Outpatient data are from 1 outpatient area –collected August 2014 (n=51)
Data
The source of data contained within this document varies and can be derived from validated published sources, official government returns and databases, and local activity data and management
information from a variety of internal sources.
The frequency of data updating also varies, with some data being updated monthly and others quarterly.
Data correct as at 30/09/2014.