BTS audit and quality improvement Friday 7 December 2012

1. BTS audit and quality improvementFriday 7 December 2012

2. Background • BTS Objectives: • Raise standards of healthcare for all • Promote optimum standards of care • Promote & advance knowledge

3. BTS Audit: aims • To provide tools to allow health professionals to participate in national and local audits • Quality assurance • Data to support revalidation • Quality improvement

4. BTS Audit • Reports generated by users, comparing • An institution’s data with the national dataset. • An institution’s data with previous periods. • Users can export their institution’s data for their own analysis/presentation. • Annual overview reports on the national dataset • National reports published in Thorax.

5. BTS Audit Programme Number of Participating Institutions

6. BTS Audit – number of submitted records

7. Current and future audits • Current audits (9) included on recommended list for Quality Accounts in England • Plans for new audits including: Paediatric emergency oxygen Bronchoscopy Smoking cessation audit RCP national COPD audit (includes secondary care and pulmonary rehabilitation) • Some audits will move to every two years from 2013 onwards.

8. Challenges • Although number of institutions and number of cases increasing the results show little overall change; • But – Part 2 of the audit suggests that institutions are taking action as a result of audit participation

9. Strengthening the quality improvement stimulus/support for users Electronic tools to encourage use of data for quality improvement Improved dissemination – regional reports, annual reports for sites Enhancing audit reports including funnel plots/caterpillar plots

10. BTS Quality Standards • Aim; Quality Standard based on each BTS Guideline to assist in implementation of a Guideline’s recommendations. • A Quality Standard is a set of specific, concise statements that: • act as a summary statement of high-quality, cost-effective patient care across a pathway • are derived are evidence based & produced collaboratively with the NHS and service users. • Basis for clinical audit

11. BTS Quality Standards • The first BTS Quality Standard document on Bronchiectasis in adults was published in July 2012. • Quality Standards for the respiratory management of children with neuromuscular weakness will be published in 2013. • Quality Standards for pulmonary rehabilitation and for bronchoscopy are planned for 2013/14.

12. BTS Lung Disease Registry Programme To provide a means of national data collection for two conditions in the first instance: • Idiopathic Pulmonary Fibrosis (IPF) • Sarcoidosis

13. BTS Lung Disease Registry • Grant obtained from HQIP to support start up & development of online data collection system • Dataset for each Registry agreed, and will be available soon • Ethics approval obtained October 2012 • Launch date likely early 2013 • Development of series of research questions/research funding proposals/funding applications to draw on Registry data • Seek support for continuing maintenance and development of Registry system

14. BTS/NHSI Care Bundle Project • Care Bundles developed for community acquired pneumonia, COPD admission, COPD discharge • 25 hospitals involved • Continuous data collection over 12 months from November 2012 • Training and project support provided by BTS and NHS Lung Improvement programme • Preliminary results at 2013 Winter Meeting • Care bundle documentation available on BTS website in due course for local use.

15. Challenges • How to involve non participants • How to manage the variability of current practice/outliers • Need to set explicit standards of care for specific evidence based items • Strengthening the quality improvement aspect • Dissemination of results of audit to wider audience – including placing in public domain

16. The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one. Mark Twain