The central QIP team is based at Southmead Hospital in Bristol. The project director is David Mitchell, consultant vascular surgeon and Chair of the VS Audit and Quality Improvement Committee. Day to day management of the QIP is run by Roxanne Potgieter our project manager. Roxanne is responsible for delivery of our project plan and she is assisted by Julia McCleary. Our implementation team is made up of VS, VASGBI and BSIR members from around the U.K. They are working to publicize and carry out our programme nationally.
Also working in Bristol is Helen Hindley. Helen's role is to ensure data entry onto the NVD for AAA procedures and regular reporting of this information against national HES data. Helen also is responsible for managing the national Acute Kidney Injury (AKI) Audit on behalf of the VSGBI. Her role is to chase and monitor data entry providing assistance and improvement opportunities were possible to units and VS members. Our target is to reach 90% data contribution for AAA procedures and to gather a complete AKI dataset on 500 cases. Helen will be posting progress reports on a regular basis.
The team in Bristol works closely with Sara Baker the Associate Director of the NVD. Sara manages day to day enquiries for the NVD and is responsible for NVD access permissions. She also supports communications between the British Society of Interventional Radiologists (BSIR) and the Vascular Anaesthesia Society of Great Britain & Ireland (VASGBI). Clinicians requiring access permissions need to contact Sara at sara.baker@rbch.nhs.uk . Emily Diment aIso supports Sara in this role as well as being the contact for national AAA screening data enquiries. If you have any queries regarding the database please contact the NVD team at nvdonline@rbch.nhs.uk
The AAA QIP Mortality Aim
After consultation with a Quality Improvement consultant from the Health Foundation and discussion with the VS membership, it was established that the AAA QIP required a more refined mortality aim. The agreed aim is detailed below:
To reduce the elective mortality for AAA repair in the UK to 3.5% by 2013 (Infrarenal AAA only/ excludes urgent symptomatic unruptured AAA).
- Elective admissions
- Elective repair
- Unruptured AAA
AAA QIP Project Plan
Our project plan was prepared on behalf of the Vascular Society by the AAA QIP Project Team and has now been approved by the Health Foundation. The project plan sets out how we will deliver improved outcomes following AAA repair. This will bring about the quality improvement target of reduced mortality following AAA surgery within the U.K. In addition, this plan will ensure that the Vascular Society meets the quality standards defined nationally by the National Abdominal Aortic Aneurysm Screening Programme (NAAASP).
These include:
- Mortality standards following elective AAA surgery.
- 100% contribution to the NVD (Standard for both QIP & NAAASP).
- We are aiming to ensure that all vascular units perform a minimum of 20 elective AAA procedures per year. Where this is not the case, the Vascular Society will support collaboration to achieve this.
- AAA patients should undergo a standardized pre-operative risk assessment and the decision to proceed to open or endovascular surgery should be taken by a multidisciplinary team, involving radiologists, anaesthetists and surgeons as a minimum.
- We are collaborating with patients around the U.K. through regional patient group meetings.
To view our full AAA QIP Project Plan please see below:
Download AAA QIP Project Plan Final (pdf)
It will take an effort by the whole Vascular Society membership to achieve our goals, but we believe that this will be of significant benefit to our patients and to us.
Changes to the Original Project Plan
As the project has progressed we have faced several challenges as well as learning about more effective strategies. The project is now in the implementation phase and we have adopted trusted Quality Improvement methodologies to introduce change and are keen to roll these out nationally.
These include:
- Regional Action Plans: We plan to introduce BEST PRACTICE AAA protocols at organised Regional Action Plan Meetings. Template protocol documents will be discussed and reviewed through group sessions. Meetings will then be followed by action plans where AAA protocol documents are amended with agreed changes to suit the region. These will be adopted as the standard AAA Care Pathway for that region. Through the rest of the year, we will be helping to run days in each area to help develop a local action plan for change. This will involve all clinicians who provide care for patients with AAA.
- Care Bundles: We are currently developing care bundles to include actionable points that must be performed at each element in the care pathway. This will ensure full patient safety. We are looking to trial these in a few vascular centres to produce feedback on any changes. Once finalised we will use these methods to target change in centres with high mortality. Assistance will be provided with national problems and local issues will be dealt with through offers of help and the implementation of these care bundles.
To view changes to the AAA QIP so far see the ammended Project Plan below:
