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Objectives:

Objectives:. Overview of WMQRS review of vascular services 2010 WMQI - update on vascular metrics project. AIM. To support NHS organisations in the West Midlands in improving the quality of health services by undertaking reviews of the quality of clinical services.

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Objectives:

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  1. West Midlands Quality Review Service

  2. Objectives: • Overview of WMQRS review of vascular services 2010 • WMQI - update on vascular metrics project

  3. AIM To support NHS organisations in the West Midlands in improving the quality of health services by undertaking reviews of the quality of clinical services. To support NHS organisations in the West Midlands in improving the quality of health services by undertaking reviews of the quality of clinical services.

  4. ACHIEVED: Vascular Quality Standards Peer reviews - 2010 10 vascular services All West Midlands except UHB Reviewer CPD

  5. FINDINGS: • Lots of examples of good practice: • S+WB, S+TH – NVD entries • WORCS – one-stop model • S+WB – consultant WR model • HEFT – physio involvement in discharge • Dudley – ward environment • UHCW – psychologist/counsellor, daily vasc. US • UHNS – impressive intervention room, low rate of dialysis on lines • Shropshire – good follow-up for amputees

  6. Compliance against standards:

  7. FINDINGS: Configurationof services Herefordshire & Worcestershire sorted HEFT sorted Many in transition Black Country not sorted National Vascular Database

  8. FINDINGS (CONT) Activity per vascular specialist Nursing competences - ward Availability of vascular anaesthetists and interventional radiologists High dependency care Guidelines and protocols

  9. VARIABLE Use of CNSs One-stop clinics Access to vascular ultrasound Links with other services Diabetes Renal Patient information

  10. PROCESS of review – COULD HAVE DONE BETTER Patient and carer input Sites without in-patient services Out-patient facilities Rehabilitation Imaging Others?

  11. The FUTURE: All reports available on WMQRS website ? Further review in 2013 Future of WMQRS uncertain

  12. WMQI: • The Quality Observatory of NHS West Midlands • Aim: “to become the one-stop shop for clinical teams and organisations for information about quality of services”. • Leadership: • Richard Wilson - Director • Domenico Pagano - CD

  13. Vascular metrics project: • Why? • Measurement essential for quality improvement • Outcomes measures to support process measures from quality review • How? • Clinician survey 2010 • User agreement on metrics • Development of metrics from HES • UHB informatics department

  14. The metrics: • Amputation for critical limb • Carotid endarterectomy • AAA – elective, EVAR, ruptured • Surgery for lower limb ischaemia • Funnel plots – 95%, 99% • Based on HES

  15. Amputation Critical Limb Ischaemia Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  16. 30-day mortality rate following Amputation Critical Limb Period April 2008 – March 2011

  17. 28-day readmission rate following Amputation Critical Limb Period April 2008 – March 2011

  18. Carotid Endarterectomy Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  19. 30-day mortality rate following Carotid Endarterectomy Period April 2008 – March 2011

  20. 28-day readmission rate following Carotid Endarterectomy Period April 2008 – March 2011

  21. Elective Infrarenal AAA Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  22. 30-day mortality rate following Elective AAA (infrarenal) Period April 2008 – March 2011

  23. 28-day readmission rate following Elective AAA (infrarenal) Period April 2008 – March 2011

  24. Endovascular Aneurysm Repair Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  25. 30-day mortality rate following EVAR Period April 2008 – March 2011

  26. 28-day readmission rate following EVAR Period April 2008 – March 2011

  27. Lower Limb Ischaemia Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  28. 30-day mortality rate following Lower Limb Ischaemia Period April 2008 – March 2011

  29. 28-day readmission rate following Lower Limb Ischaemia Period April 2008 – March 2011

  30. Ruptured Infrarenal Aneurysm Line chart: Number of procedures by year. Bar chart:30-day mortality rate (in hospital).

  31. 30-day mortality rate following Ruptured AAA (infrarenal) Period April 2008 – March 2011

  32. 28-day readmission rate following Ruptured AAA (infrarenal) Period April 2008 – March 2011

  33. Feedback on metrics • Validation • Discussion in measurement station • Paper copies available

  34. WMQI • The future: • Merging of SHAs – NHS Midlands and East • Uncertain future • UHB • Website • Observatory

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