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Regional Action Plan Process

Regional Action Plan Process. Roxanne Potgieter AAAQIP Project Manager Vascular Society of GB&I. Focus on Quality. High variability in practice demonstrated nationally Unreliable care Need to address the gaps in quality Standardisation of the process of care

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Regional Action Plan Process

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  1. Regional Action Plan Process Roxanne Potgieter AAAQIP Project Manager Vascular Society of GB&I

  2. Focus on Quality High variability in practice demonstrated nationally Unreliable care Need to address the gaps in quality Standardisation of the process of care Consistent use of risk assessment, MDT decision making… Institution of a clinical pathway for all non urgent AAAs resulted in charge savings of 40.6% and overall LOS reduction of 3.5 days. (Muluk et al, 1997).

  3. Intra-operative Care (Inpatient Episode) Post-Operative (Discharge) Pre-operative Care (Outpatient Episode) Patient consultation: verbal reassurance & written information Recovery information Risk Assessment (Safe for surgery checklist) Criteria/ nurse led discharge Telephone follow up Intra-operative Care CT angio MDT Discharge Pre-op assessment Complications/ variance from agreed milestones Final discharge/ ongoing follow up Key personnel Consultant led review Surgical/Anaesthetic team Radiology Area for intervention Nursing All Care Pathway Interventions

  4. National AAA patient group findings Recovery

  5. Care and Treatment

  6. Discharge

  7. Post-Operative Communication 86% response rate

  8. What changes are needed? Set staff and patient expectations Strong predictor of patient experience (Pettersen at al, 2004). Measure patient experience Identifies problem areas (Sitzia at al, 1997).

  9. NationalAAAQIP Progress X3 X2 X3 X4 X3 X2 X5 X2 X2 X3 X2 X3

  10. Outcomes: Criteria Led Discharge N&N EVAR Nursing Care Pathway (March-July 2011) • EVARS 13 • Post-op • Vascular ward 12 • Planned HDU 1 • Unplanned HDU 0 • No unplanned HDU admissions • All complications dealt with on the ward.

  11. Patient Feedback – AAA Recovery Leaflets Patient leaflets tested in all regions Consistently outperform other information leaflets Developed through patient groups Advice based on practical needs 86% response rate

  12. Medway: Telephone Follow Up Recurrent problems - poor appetite & weight loss - lethargy & depression - wounds - medication Provided patients as well as partners with reassurance Despite being provided with contact numbers patients reported “we didn’t like to bother you”

  13. Regional Action Plans • Drive changes at a regional level • Clinician Involvement: VSGBI, VASGBI, BSIR, SVN • Managers, C & S Networks and Commissioners • Share and agree best practice • Develop tools to implement standards into practice • Test interventions

  14. Structure of the Group Sessions Each group session focuses on an area for intervention: ASSESSMENT: Pre-operative care CARE DELIVERY: Intra-operative care CARE DELIVERY: Post-operative care COMMUNICATION: Patient information, consultation & consent process (Surveillance/Treatment/ Recovery) MEASUREMENT: Outcome/process and balancing measures

  15. Group sessions

  16. The Next Steps • Trust/teams to implement one best practice intervention and provide feedback. • Follow up meeting to share progress and agree next steps (June/July 2012)

  17. What will QIP team do? • Track data contribution onto the NVD • Provide outcome measures • Mortality, complication rate, length of stay • Present findings back to region • Provide ongoing support to teams • Regular feedback, evidence of best practice from elsewhere in UK.

  18. Home Data Standards & Commissioning Regional Action Plans Best Practice Protocols Patients News About Us Contact Us FAQs External links www.aaaqip.com • Share region’s current and newly developed protocols. • Highlight reports of national progress.

  19. Patient “Although statistically I know I am very fortunate to be alive, I have had many issues relating to the AAA rupture and am still very anxious that the implant might leak. I have not experienced much helpful follow up advice. Contacting the surgical team at the hospital for advice is extremely difficult and can take a very long time. It would help enormously to have a named person to contact.” Carer “We get good (but infrequent) support from John’s GP, but the visits to the registrars do little for John’s wellbeing as they simply seem to regard him as a walking miracle and say no more! I don’t know why there is so little useful communication when we wait so long to see them - it could be a lot better I feel. What would improve John’s quality of life now, in the longer term, would be more professional advice.” Ruptured AAA Patient

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