Improving the quality of services is now a key requirement within the NHS. Initiatives include Commissioning for Quality and Innovation (CQUIN) payment frameworks and quality accounts. The AAA QIP aims to drive up and standardise AAA care delivery making it safer, more effective and patient centered.
We have developed best practice protocols (see below) through joint collaboration with the Vascular Society, Vascular Anaesthesia Society and British Society of Interventional Radiology. These are based on evidence from trials such as the EVAR 1 & 2 trials and aim to standardise AAA care delivery and improve patient safety. These proformas provide vascular clinicians with the tools to integrate quality standards outlined by NAAASP and the AAAQIP into current practice.
Best Practice Protocols
(click below to view template protocol documents)
Multi-Disciplinary Team Assessment
What is “Quality” in healthcare?
Safe: avoiding harm to staff and patients from the care that is intended to help them.
Timely: reducing waits and harmful delays for both those who receive and those who give care.
Effective: care based on robust evidence to all who could benefit and not given to those not likely to benefit.
Efficient: avoiding waste, of equipment, supplies, ideas, and energy.
Equitable: care that does not vary in quality because of personal characteristic such as gender, ethnicity, geographic location, and socio-economic status.
Patient centered: care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.
What is Quality Improvement?
Quality improvement is a systematic approach that uses specific techniques to improve quality.
How we are using Quality Improvement in the AAAQIP?
Data Communication
We are providing Trusts with their Hospital Episode Statistics (HES) and National Vascular Database (NVD) data for all AAA and carotid cases for 3 monthly time periods. This acts to provide a baseline to acknowledge discrepancies and areas for improvement. Some regions are adopting Commissioning Quality and Innovation (CQUIN) framework targets for their data entry onto the NVD. These act to provide a financial incentive for data entry.
Run Charts
Improvement takes place over time. We are producing monthly run charts on mortality and data contribution onto the NVD to demonstrate whether changes have really resulted in improvement, how instrumental a particular change has been and whether it has been sustained.
Increasing Standardization of AAA Care Delivery
In clinical processes, variation in situations for which there is an established evidence based best practice can result in error and harm, as well as poor outcomes for the patient. Addressing this can be described as increasing the reliability of care – a key competent of which is standardisation. We are introducing best practice protocols into Trusts throughout the U.K.
Improving Reliability
Ensuring reliability mitigates against waste and defects in the system, and reduces error and harm. We are using a systematic quality improvement approach through ‘care bundles’ to create error-free processes that deliver high-quality, consistent care and use resources efficiently. We have developed an AAA pre-operative care bundle which groups together best practice guidelines to help standardize practice and improve patient outcome.
Regional Action Plans
We are hosting multi-disciplinary days for those involved in the care of patients with aortic aneurysm to develop a standardized care pathway within each region. Groups of hospitals address the same problems as each other, learning from each other’s experience. They adopt internal approaches, which involve developing and setting own goals, with full staff engagement.
Care Bundles and AAA Care Pathways are tested through Plan, Do, Study, Act (PDSA) Cycles
The core principle of this model is empowerment of 'local teams' of staff to develop and undertake small scale testing of our care bundles to make local ammendments to ensure full implementation into practice.
- Testing a change in the real work setting.
- Small rapid scale testing.
- Minimises resistance.
- Indicates whether proposed change will work in environment in question.
- Provides opportunity to refine change as necessary before implementing on a broader scale.
Step 1: Plan
- Plan the test or observation, including a plan for collecting data.
- State the objective of the test.
- Make predictions about what will happen and why.
- Develop a plan to test the change. (Who? What? When? Where? What data need to be collected?)
Step 2: Do
- Try out the test on a small scale.
- Carry out the test.
- Document problems and unexpected observations.
- Begin analysis of the data.
Step 3: Study
- Set aside time to analyze the data and study the results.
- Complete the analysis of the data
- Compare the data to your predictions.
- Summarize and reflect on what was learned.
Step 4: Act
- Refine the change, based on what was learned from the test.
- Determine what modifications should be made.
- Prepare a plan for the next test.
Involving Patients and Co-design
Patients, carers and the wider public have a significant role to play: not only in designing improvements, but in monitoring whether they have the desired impact, not least because they are the only people who really experience the patient pathway from start to finish. We are holding patient groups around the U.K to explore patient experiences and identify areas for improvement. We also work collaboratively with patients to develop patient information leaflets and self help tools.
