Clinical Pathways to enhance quality of care

1. Clinical Pathways to enhance quality of care Morris Gordon, Strategic quality lead Simon Tucker, Consultant Emergency Medicine

2. Why do we need clinical pathways? facilitating care in accordance with evidence based best practice guidelines reducing harm and insuring patient safety appropriate treatment / appropriate team / appropriate location Offering “Best in NHS” option IT MAKES A DIFFERENCE

3. For many patients – the first doctor assessing them is often a “junior” doctor • Pathway is a “tool” to insure appropriate care is delivered by those with less experience • Pathway review and revision – insures care plans offered are up to date • Patient safety : • Fewer adverse events • Improvements in morbidity & mortality • Earlier referrals to allied health professionals • Reduced length of stay / improvements in patient flow

4. It works!! • Sepsis – we all know and should be able to recognise sepsis and treat. • However, major cause of mortality – over 2000 deaths in the last 12 months in this trust were caused by sepsis. • Sepsis 6 – 6 core items for diagnosis and management of sepsis to be delivered 1 hour after registration in and ED. • If 100% compliance, the Relative risk (odds of) death reduce by 45% - proven!!!! If we translate this locally to the 2000 patients a year we identify as septic in ED and consider the 1200 of them we currently don’t deliver sepsis 6 to, there are potentially 100 completely preventable deaths per annum

5. What would you include if you were designing a care pathway?

6. What to consider when designing a pathway? • Best practice clinical guidelines : • NICE • BTS • AQ • Key performance indicators : • Department of Health • Strategic Health Authority • NHS England • College recommendations • Untoward incidents / Lessons learned

7. How would you measure compliance with the pathway you have designed?

8. Measuring pathway compliance – the pathway checklist

9. The specialist pathway audit team are watching youALWAYSSo write it downCLEARLY

10. How does the checklist influence quality of care? • “mission critical” steps – aide memoire • Daily review of compliance – failed measure reporting • Failed measures forwarded to me • Discussion with doctor involved where appropriate • Maybe a reflective entry in doctor’s portfolio • Remedial action for recurrent offenders

11. Where are the pathway checklists kept on your ward? • When reviewing a patient – be aware which pathways exist and if your patient should be commenced on a pathway.

12. Final word • Since introducing the pneumonia pathway with regard to AQ standards of care – the compliance score for pneumonia care improved from 60% to 90% - resulting in both a national award for the team and an award at the Celebrating Success award. Recent review of AQ care standards shown that compliance associated with better patient outcomes • Since introducing the sepsis pathway, the SHMI for patients coded for sepsis has reduced from 117 to 91 – THAT IS MANY LESS PATIENTS DYING FOR SOMETHING WE COULD AND NOW ARE DOING BETTER!!!!