SNAP Scottish National Audit Project

1. SNAPScottish National Audit Project CE Bucknall Chair, Bicollegiate Physicians Quality of Care Committee, on behalf of project team

2. SNAP • Health Foundation funded (EwQ initiative) • Community acquired pneumonia • Epilepsy • Long term aim – a model for quality improvement for medical topics

3. Epi-SNAP Improving the quality of annual review for epilepsy patients in primary care Quality of Outcomes Framework awards points for annual reviews which: • Record seizure frequency • Undertake medication review Epi-SNAP: • Protocol which targets poorly controlled • Guidance for exemption coding • Patient information leaflets with Epilepsy Scotland Collaborated to adapt SPICE* software epilepsy screens,used by approx 1/3rd of Scottish GP practices *Scottish Programme for Improving Clinical Effectiveness

4. Epi-SNAP First Seizure Clinics • Problems: poor quality of referrals poor documentation of driving advice (medicolegal obligation) • Electronic First Seizure Service referral template – forces referrer to document driving advice • Fast track appointments for professional drivers • Re-audit started 1st October

5. SNAP-CAP: Care bundle key aspects of care, linked to evidence delivered by a single team over a short period of time Influenced by parallel policy of SPSA & possibility of benefiting from developing experience of hospitals using these

6. SNAP-CAP Care bundle of key items severity scoring using CURB65 Management guided by severity first antibiotic dose within 4 hrs Oxygen saturations ≥ 92% during first 4 hours Monthly monitoring & feedback Small changes in practice in response to data, using PDSA technique

9. Having appropriate antibiotics (& formulations) in A&E Writing up first dose as “once only” Fast tracking patients for X-ray System for enabling home Rx of mild CAP cases Telephone follow-up of dischargedpatients Electronic referrals Structured/targetted annual review Hyperlinks to Patient information leaflets Examples of Practice Changes SNAP-CAP:practical Epi-SNAP:structural

10. Challenges • Persuading clinicians that monitoring the process of care is important • Rapid turnover of junior & middle grade staff (4 monthly) • Collecting bundle data in real time • (Unavoidable) delays involved in consulting with national bodies (eg electronic referrals, changes to GP data monitoring screens) • Engaging managers in non priority topics • In hospital: building useful prompts into systems which are still largely paper based

11. SNAP: secondary objectives • Sharing experience in a network with other HF projects • Developing professional leaders • Ensuring sustainability – start-up packs, organisational prompts, long term “home” within quality organisation in NHS in Scotland, • Identifying problem areas early using a mapping process

13. Lessons Learnt • Getting started with small number of committed sites & evolving • Simple data entry systems / prompt feedback • Collaborating with other agencies & health policy initiatives (Scottish Patient Safety Alliance) • Feedback has some impact, but we need to incorporate quality reminders into system of care – not easy in Acute Medicine (paper based system;huge variety of caseload) • Different approaches needed for different topics but adapting existing policies & practices to add value in terms of quality is the essence of the model which emerges. Royal College of Physicians and Surgeons of Glasgow