Case Studies

AQ: Reducing Avoidable Harm through Patient Assessment & Escalation

In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.

The Walton Centre is the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services. The Walton Centre established a critical care outreach team (surgical and medical acute response team: SMART) team in December 1999 in response to the Department of Health’s report; Comprehensive Critical Care: A Review of Adult Critical Care Services (May 2000).

This small team consisted of senior nurses with a background in neuro critical care with close links to the anaesthetic and nursing staff from the intensive care unit. In 2015 the team expanded to create a 24 hr / 7 day service to ensure expertise available during weekdays was expanded to cover the hospital at night and the weekends. Wards at the Walton Centre use a Track and Trigger system or Early Warning Score to monitor and assess patients and to detect deterioration in patient well-being. If a patient’s score indicates that they may be deteriorating or nursing staff are concerned, patients will be referred to the SMART. If after review, a higher level of care is required, the patient is transferred to the appropriate area, for more specialised treatment or monitoring.

The Track and Trigger system includes the routine collection of data broken down to ward area for analysis in the following categories:

  • Observations undertaken within prescribed frequency for patients currently admitted
  • Observations are only included if there is a preceding observation
  • Observations without a score (partial) are excluded from the total

In July 2018 it was found that of the 16,382 patients seen, there were almost 1,000 (6%) for whom no observation score was recorded. Only 4 in 10 patients who did receive a score were compliant with standards.

Read the full case study here.

AQ: Improving Care for Patients with Sepsis in an Acute Trust

Southport and Ormskirk Hospital NHS Trust provides acute hospital services to 258,000 people across Southport, Formby and West Lancashire. Acute care is provided at Southport and Formby District General Hospital and Ormskirk and District General Hospital. Sepsis accounts for around 1,200 acute admissions to the trust each year.

AQ: Aintree Improvement Journey for Patients with Alcohol Related Liver Disease

Aintree University Hospital NHS Foundation Trust joined the Advancing Quality (AQ) programme at its launch in 2008 and is currently participating in eight clinical focus areas (CFA), this includes Alcohol Related Liver Disease (ARLD).

AQ: Reducing Avoidable Harm through Patient Assessment & Escalation

In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.

AQ: Reducing Mortality in Community Acquired Pneumonia (Liverpool University Hospitals NHS Foundation Trust)

The NICE (2014) guidance publication ‘Pneumonia in Adult: Diagnosis & Management’ covers diagnosing and managing Community Acquired Pneumonia (CAP) in adults. Its aim is to improve the accurate assessment and diagnosis of pneumonia to help guide antibiotic prescription and ensure that people receive the right care. It estimates a mortality rate between 5% and 14% for patients admitted to hospital with CAP.

AQ: Serum Lactate in the Treatment of Sepsis

he Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) identified an opportunity to improve the early diagnosis of patients with sepsis. Evidence suggests that the sickest sepsis patients have high levels of serum lactate. Timely measurement of serum lactate levels in patient pathways can improve early diagnosis which will lead to improved outcomes.

AQ: Embedding Early Assessment In Out of Hours Primary Care

Sepsis and deterioration is a huge clinical problem and 70% of sepsis cases originate in Primary Care. In the last five years we have experienced a culture shift in primary care; from seeing sepsis as an acute condition that is difficult to detect, to recognising the need to actively assess patients where infection could be causing significant illness or deterioration.

AQ: Effective Management of Frailty in Hip & Knee Replacement (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust)

NHS England defines frailty as ‘where someone is less able to cope with and recover from accidents, physical illness or other stressful events’1. As the population ages, so frailty rates increase, presenting challenges to care systems. Elective hip and knee replacement patients undergo pre-surgical checks to ensure they are able to cope with their procedure.

AQ: Improving the Management of Acute Kidney Injury (AKI)- Role of the AKI Pharmacist

The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs.

AQ: Improving Care for Patients with Sepsis in an Acute Trust

Sepsis is a life-threatening condition which has in recent years become a high priority for healthcare providers. Early recognition and prompt management of sepsis can improve outcomes for patients, reducing the risk of mortality and morbidity. This could potentially save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, according to estimates by the Sepsis Trust.

AQ: A Collaborative Approach to the Management of Acute Kidney Injury (AKI)

Southport and Ormskirk Hospitals NHS Trust has established a steering group to improve care for patients with AKI. The group is using the care bundle data from the Advancing Quality Alliance (AQuA) Advancing Quality (AQ) AKI programme to monitor care delivery for patients with AKI and to provide a framework for improvement.

AQ: Improving the Ultrasound Scanning Process for Patients with Acute Kidney Injury

Acute kidney injury (AKI) may sometimes be caused by an obstruction in the urinary tract, which can require treatment with a nephrostomy. It is important that people with AKI who are suspected of having a urinary obstruction receive an ultrasound scan early in their management, as outlined in national guidance (NICE, 2019).

AQ Insight Reports: Case Study

More patients are admitted to hospital as a result of pneumonia in the north of England compared to the south. In the North West in 2019, the rate per 10,000 population was 58.5. To help reduce unwarranted clinical variation and health inequality, capture best practice and share evidence-based insights to AQ members across the North West, the AQ team created ‘Insight Reports’.

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