Blog 2: AQ Detection and Response – a combined focus on AKI, pneumonia and sepsis

In our second blog of the series, we’ll be focusing on the importance of data, innovation and early diagnosis for delivering better outcomes for patients.

Improvement through data

The first AKI session comprised a workshop on statistical process control (SPC) charts, led by Nancy Prospero, AQ Principal Analyst. We ran three of these in total, Nancy leading a session focussed on sepsis and me a further session concentrating on pneumonia, supported throughout by Simon Wickham, AQuA analyst, who designed and produced the SPC charts. These sessions proved really valuable. We brought along trusts’ actual data and talked about how to read an SPC chart and how to use them to highlight opportunities for improvement. A number of trusts were able to pinpoint key moments of change, whether these were clinically or administratively driven and went away with plenty to discuss and work further on. One delegate memorably described SPC charts to me as proving a ‘wet kipper moment’, where you are ‘slapped around the face’ with evidence of change, either good or bad.

Delegates work together to highlight improvement opportunities

Early diagnosis, better outcomes

In our second AKI session, Dr Lynne Sykes, AKI Fellow at Salford Royal NHS Foundation Trust, presented her analysis on outcomes for patients suffering multiple episodes of AKI. She showed that these patients are more likely to develop chronic kidney disease, have a greater risk of developing AKI again, often more severely, and are more likely to eventually need a kidney transplant. Lynne demonstrated that AKI increases mortality risk in combination with other conditions. For example, a patient presenting with pneumonia is more than five times more likely to die if they also develop AKI. Lynne’s work illustrates the importance of looking beyond the immediate episode of AKI being treated. We must consider the patient’s other conditions and their history and, by doing so, care for them better in the future. Lynne was followed by Elaine Paul, Orthopaedic Clinical Nurse Specialist at Manchester University NHS Foundation Trust, who talked about the work the trust has done on AKI detection, using a toolkit developed by Maria Hamilton, working at Southport and Ormskirk Hospital. The toolkit highlights key variables indicating a patient is at risk of developing AKI. These include congestive cardiac failure (CCF), diabetes and hypertension. Using the tool enables patients to be treated early through methods such as fluid administration. The session generated huge interest in Maria’s toolkit, details of which will shortly be published in the Journal of Nursing. In our parallel sepsis session, Katie Whittle, Matron for the Deteriorating Patient at Wirral University Teaching Hospital NHS Foundation Trust, talked about improving patient safety and outcomes through the early recognition of and response to deterioration. Katie described how Wirral used a QI approach to transform services, emphasising the importance of measurement and fostering a supportive culture, as well as system changes, such as the trust’s transition to using the National Early Warning Score 2 (NEWS2). Katie will be continuing her QI work with a new role as Patient Safety Programme Manager at the Innovation Agency, the Academic Health Science Network for the North West Coast. Before this, Mr James Collingwood discussed his experience as a sepsis patient, which involved many delays and missed opportunities for diagnosis and treatment. Mr Collingwood was only finally diagnosed following the intervention of his daughter, who recognised the symptoms of sepsis through a telephone conversation. Patient stories are a vital part of our events, showing the real world impact of the work we do and for many delegates Mr Collingwood’s presentation was a highlight of the day.

Lynne Sykes demonstrates the increased risks for patients with multiple AKI episodes

The wild west

After lunch, we had our second keynote, from Dr Dan Wootton, Senior Fellow in Respiratory Infection at the Institute of Infection and Global Health, University of Liverpool. Dan has been integral to our hospital acquired pneumonia (HAP) programme. We collected data about HAP in the first six months of 2019, with the aim of developing a set of measures to define good practice. Dan’s presentation demonstrated why this is necessary, showing that there isn’t a solid evidence base for HAP and there are no agreed definitions of what constitutes good care. In Dan’s words, HAP is ‘the wild west’. HAP is a high mortality condition and can occur at any point in the patient’s hospital stay, including when they are ready to go home. Building on the work already done and using the data we’ve collected, our next step is to set up a Clinical Expert Group to draw on knowledge in the north-west and use the data we have to devise a set of measures, which we’ll launch in 2020.

Innovation reducing readmissions

Our HAP measures will complement those we have for CAP which, along with hip and knee replacement, is our longest running clinical focus area. Our clinical lead for CAP, Dr Bis Chakrabarti, was due to present his research, using AQ data, into pneumonia readmissions. Unfortunately, Bis was unable to attend, but Dan kindly offered to present in his place. Bis’ work shows that more than one in five pneumonia patients will be back in  hospital within thirty days of discharge and nearly one in ten will be back specifically because of pneumonia. Patients with chronic conditions, such as diabetes and liver disease are particularly vulnerable. Connecting with Bis’ work, Carl Woodroffe, Business Development Manager from Vision Health, described how pneumonia patients can be tracked pre- and post-hospital admission using Vision’s GP information system. AQ will be working with Carl and Vision to extend our work in primary care, enabling us to develop a joined up picture of the pneumonia patient’s journey. Nancy Prospero also talked about readmission triggers, in this case relating to AKI. Using AQ data, Nancy identified that patients with comorbidities such as peripheral vascular disease and congestive heart failure are more likely to return to hospital, as are patients who present initially with a high AKI, patients whose AKI progresses during their hospital stay and patients admitted as emergencies. Tying in with this, Marie McCarthy, an AKI Specialist Nurse at Royal Liverpool spoke about their programme to keep AKI patients out of hospital by treating them in community clinics. Marie’s case studies really brought her team’s work to life and showed the value of a multi-disciplinary approach. The programme allows more patients to be safely discharged to their GP, avoiding readmission and reducing length of stay. More time spent in hospital can be detrimental for patients. They are at risk of contracting other conditions and time spent in bed can have implications for muscle function and mobility, particularly in older patients. Add to this the cost to the NHS of additional bed days and it’s clear why reducing readmissions is important.

Carl Woodroffe talks about connecting pneumonia data

In our final event blog tomorrow, we’ll be focusing on the small changes and big results in sepsis management and the importance of fluids for managing AKI.