Theme 1: Effective use of information
The overall aim of our research is to increase the effective use of data to improve the safety and quality of care. To achieve this, we are using several local and national sources of clinical and organisational data. These sources include routine administrative data (e.g. Hospital Episode Statistics) and primary care consultation data linked to other sources (CPRD), as well as interviews and focus groups with patients and clinicians. We collaborate with a number of other research projects across Imperial including the Dr Foster Unit at Imperial and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance.
Our approaches to this research include:
- Understanding clinicians’ information requirements for delivering safer care.
- Developing statistical methods for comparing performance across the care pathway.
- Improving the detection and recording of iatrogenic events in primary care. Identifying elements of the care pathway with most potential for quality/safety improvement.
- Sharing best practice about safety improvement, including information use, with healthcare groups.
In January 2015, a patient safety incident dashboard went live on Imperial College Healthcare NHS Trust intranet through a system called Qlikview. It is now available to all staff in the Trust who have access to Qlikview. The application allows users to drill down to ward-level incident data and provides the ability to analyse categories, degrees of harm and numbers of incidents. In addition, users can compare their local area against other areas across the Trust. The incident dashboard can be viewed from a Trustwide perspective or by Division. Incident data is pulled from Datix (an incident reporting tool) into Qlikview, and the data are refreshed hourly.
WEEKEND MORTALITY RATES
Hospital patients should expect an equally high-quality standard of care, regardless of which day of the week they are admitted. However, a study has shown that patients admitted to hospital as emergencies during the weekend have a higher chance of mortality than if admitted during the week (Aylin et al., BMJ Qual Saf 2010). Our work studying weekend mortality rates has started a debate as to the best means of improving quality care at weekends.
Further work has explored differences in quality of care indicators and other outcomes in stroke (Palmer et al., BMJ 2012), elective surgery (Aylin et al., BMJ 2013) and obstetric care (Palmer et al., BMJ 2015).
Possible explanations for variation in out-of-hours, including consultant experience (Ruiz et al., BMJ Qual Saf 2015 and staffing levels (Palmer et al., BMJ 2015), have been explored. This work has been a key driver in helping the NHS move towards a more consistent service.
Quality Investigator is a near real-time monitoring system produced by Dr Foster Intelligence. Currently, 70% of English NHS acute trusts use Quality Investigator to assist them in monitoring outcomes at the individual patient level. Partially funded by Dr Foster Intelligence, the Dr Foster Unit at Imperial uses the same methods and data as Quality Investigator to generate mortality alerts, which were instrumental in alerting the then Healthcare Commission (HCC) to problems at the Mid Staffordshire NHS Foundation Trust between July and November 2007. The resulting public inquiry recognised the key role the Dr Foster Unit played in identifying Mid Staffs as an outlier. More recently, the alerting system identified University Hospital Birmingham’s cardiac surgery system as a mortality outlier in 2015, which resulted in the trust making immediate improvements.
- High Performance in Surgery (HiPer) Phase 2
- Safety learning feedback from incident reporting to physicians through social media
- Enhancing feedback from incident reporting: Translating information into action