Dark ages to renaissance rebirth of stroke care in Wales

Transcription

1 Presenters: Michelle Graham & Mike Davidge 18 April 2012 rebirth of stroke care in Wales Insert name of presentation on Master Slide

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3 Acute Stroke care in Wales: 6,300 admissions in 2010/11 Age standardised admission rate was 127 per 100,000 population 28 day mortality was 18.7% over period Source: Google

4 The journey The Malvern Hills mark the border between Worcestershire and Herefordshire This is our journey, what is yours?

5 1 st viewpoint: Burning platform

6 2006 Sentinel Audit Overall Key Indicator Score indicators: 100 = maximum possible score

7 The 2007 letters

8 Dr Tony Rudd, who assessed services in Wales, England and Northern Ireland two years ago, said services in Wales were "scandalously bad".

9 Discussion What is your burning platform? Do you have one and if not, can you create one? Introduce yourself to your neighbour and tell them about your project and your burning platform. Then let them tell you about theirs.

10 2 nd viewpoint: A good process Select Topic (develop mission) Expert Meeting LS Learning Session AP Action Period IHI Breakthrough Series (6 to 18 months time frame) Develop Framework & Changes Planning Group Participants ( teams) Prework A P S D A LS 1 LS 2 LS 3 AP1 AP2 AP3* (listserv) Visits P S D Supports Phone Conferences Assessments Monthly Team Reports A P S D Dissemination Holding the Gains Publications Congress etc. *AP3 continue reporting data as needed to document success 2004 Institute for Healthcare Improvement

11 A good process 2012 IHI Breakthrough Series (6 to 18 months time frame) Select Topic (develop mission) Expert Meeting LS Learning Session AP Action Period Develop Framework & Changes Planning Group Participants ( teams) Prework LS 1 A P S D A P S LS 2 LS 3 AP1 AP2 AP3* (listserv) Visits D Supports Phone Conferences Assessments Monthly Team Reports A P S D Dissemination Holding the Gains Publications Congress etc. *AP3 continue reporting data as needed to document success 2004 Institute for Healthcare Improvement

12 The evidence

13 3 rd viewpoint: the right support

14 Early lessons Identify teams 2012 PDSA s - small and locally relevant (ownership) Reinforce the improvement message Learning sets and team lead meetings Data, data, data Most important: SUPPORT, SUPPORT,SUPPORT

15 Discussion What improvement process are you following? Do you have the right people to support the project? Continue the conversation with your neighbour. Tell them about the process and the people you are using. Then let them tell you about theirs.

16 Days 14/01/ /01/ /02/ /02/ /03/ /03/ /04/ /04/ /05/ /05/2009 % patients % patients who have a manual handling assessment in first 72 hours Stroke patients from Jan 2009 to May th viewpoint: Effective data % compliance with First 3 Days bundle Stroke patients from Jan 2009 to May Length of Stay Stroke patients from Jan 2009 to May 2009 Weeks No target Jan 2009 Feb 2009 Mar 2009 Apr 2009 May 2009 Months 0 Patients

17 7 steps to measurement 1 Decide aim Choose measures 3 Define measures Review measures 7 Repeat steps Collect data Analyse & present

18 Data collection plan 1 Decide aim For each data item: Choose measures Format Who records this Define measures At what point Where is it stored Review measures 7 Repeat steps Collect data How reliably do we collect Issues to resolve Analyse & present

19 The Excel data tool 1 Decide aim 2 Choose measures Define measures Review measures 7 Repeat steps Collect data Analyse & present

20 Using the data Decide aim 2 Choose measures 3 Define measures How to interpret sessions A common language between clinicians and managers Review measures 7 Repeat steps Collect data Analyse & present

21 Discussion What is your approach to using data? Do frontline teams want to use it? Do they have the ability to use it? Continue the conversation with your neighbour. Tell them about how you support teams to use their own data. Then let them tell you about what they do.

22 The last lap ALL OUR DUCKS ARE IN A ROW! Continued support Intelligent Targets Serendipity From Pilot to Performance 2006

23 Journey s end? 1. First Hours Bundle 100.0% 90.0% 80.0% 70.0% 60.0% % 2. First Days Bundle 40.0% % 100.0% 20.0% 90.0% 10.0% 80.0% 0.0% 70.0% 60.0% 50.0% Values Mean 2010 UCL 40.0% LCL 30.0% 20.0% 10.0% 0.0% 3. First 3 Days Bundle 2009 Values Mean UCL LCL 100.0% 90.0% 80.0% 70.0% % 50.0% 4. First 7 Days Bundle 40.0% % 100.0% 20.0% 90.0% 10.0% 80.0% 0.0% 70.0% 60.0% 50.0% 2006 Values Mean UCL 40.0% LCL 30.0% 20.0% 10.0% 0.0% Values Mean UCL LCL

24 Summary Select Topic (develop mission) Expert Meeting LS Learning Session AP Action Period IHI Breakthrough Series (6 to 18 months time frame) Develop Framework & Changes Planning Group Participants ( teams) Prework Dissemination P P P Holding the A D A D A D Gains S S S Publications LS 1 LS 2 Congress LS 3 AP1 AP2 AP3* etc. (listserv) Visits Supports Phone Conferences Assessments Monthly Team Reports *AP3 continue reporting data as needed to document success 2004 Institute for Healthcare Improvement % compliance with First 3 Days bundle Stroke patients from Jan 2009 to May Jan 2009 Feb 2009 Mar 2009 Apr 2009 May 2009 Months