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www.england.nhs.uk
Sepsis and CQUINs Celia Ingham ClarkMedical Director for Clinical EffectivenessNHS England
February 2019
www.england.nhs.uk
• Purpose is to incentivise improvements in clinical quality
• A small %age of the standard contract value is withheld and only paid if certain criteria are met
• They work best where existing performance is already 40-60%
• Need valid and reliable and simple measurement - usually process measures
• Example of VTE CQUIN
CQUINS: Clinical QUality INcentive Scheme
2
www.england.nhs.uk
• From Sepsis Six selected first dose antibiotics as key measure
• used clinical assessment for suspected Sepsis in high risk groups (NEWS2) to identify cohort for measurement
• initially ED only
• added in-patients who deteriorate
• linked with AMR to ensure 3 day review and minimise inappropriate antibiotics
• Right treatment, right person, right time
3
Sepsis CQUINs
www.england.nhs.uk 4
Screening performance over time: ED
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
20151
6 Q1
20151
6 Q2
20151
6 Q3
20151
6 Q4
20161
7 Q1
20161
7 Q2
20161
7 Q3
20161
7 Q4
20171
8 Q1
20171
8 Q2
20171
8 Q3
20171
8 Q4
2018/1
9 Q1
2018/1
9 Q2
% o
f pat
ient
s sc
reen
ed fo
r sep
sis
Proportion of emergency patients screened for sepsis having met the appropriate criteria from Quarter 1 2015/16 to Quarter 2 2018/19
The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data
www.england.nhs.uk 5
Treatment performance over time: ED
40.0%
45.0%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
2015/1
6 Q1
2015/1
6 Q2
2015/1
6 Q3
2015/1
6 Q4
2016/1
7 Q1
2016/1
7 Q2
2016/1
7 Q3
2016/1
7 Q4
2017/1
8 Q1
2017/1
8 Q2
2017/1
8 Q3
2017/1
8 Q4
2018/1
9 Q1
2018/1
9 Q2
% o
f pat
ient
s sc
reen
ed fo
r sep
sis
Proportion of patients that received intravenous antibiotics within 1 hour of arrival at Emergency Departments (Q2 2015/16 to Q2 2018/19)
*The dashed line refersto the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1 hourof arrival for emergency departments.
The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data
www.england.nhs.uk 6
Screening performance over time: Inpatients
40.0%
45.0%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
90.0%
201617 Q1 201617 Q2 201617 Q3 201617 Q4 201718 Q1 201718 Q2 201718 Q3 201718 Q4
% o
f pat
ient
s sc
reen
ed fo
r sep
sis
Proportion of inpatients screened for sepsis having met the appropriate criteria from Quarter 1 2016/17 to Quarter 2 2018/19
The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data
www.england.nhs.uk 7
Treatment performance over time: Inpatients
40.0%
45.0%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
2016/17 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2017/18 Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2
% o
f patie
nts
scr
eened for
sepsi
s
Proportion of patients that received intravenous antibiotics within 1.5 hours of recognition of detioration at Inpatient Departments (Q1 201617 to Q2 201819)
*The dashed line refersto the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1.5 hours of recognition of deterioration within inpatient departments.
The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data
www.england.nhs.uk 8
Outcome of 72 hour review
0
10
20
30
40
50
60
70
80
90
100
2016/17Q1
2016/17Q2
2016/17Q3
2016/17Q4
2017/18Q1
2017/18Q2
2017/18Q3
2017/18Q4
2018/19Q1
2018/19Q2
Perc
enta
ge
Available from PHE AMR Fingertipshttps://fingertips.phe.org.uk/profile/amr-local-indicators
72h review
Stop / IV / change IV AB
Stop
IVOS
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• The rate of inclusion of patients in ED as being at high risk of sepsis and rate of exclusions very varied between trusts
• The trusts with electronic recording of vital signs and electronic prescribing and drug administration systems are able to understand their data completely (thousands of patients not small samples, and no additional work in collecting the data)
• It is estimated that just from the sepsis CQUIN sample population at least 1000 deaths from Sepsis have been averted over the past three years
9
Other learning from the Sepsis CQUIN
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• Systems for prompt recognition and treatment of sepsis have moved into standard contracts from 2019
• No specific sepsis CQUIN for 2019/20 but anticipate something on AMR
• Opportunity to design potential CQUINs for following year that address:
• A significant problem that affects many patients
• Where the methodology has been tested in the real world already and shown to make a difference in at least one Trust
• Where there is a straightforward and simple process measure, ideally based on data that is already routinely available
• Where there is some evidence that around half of trusts are already achieving the standard set
10
Where next?
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• To design and test potential candidates for 2020 CQUINs relating to sepsis and AMR
• How about something on source control [the process of identifying common presentations of sepsis where there is a focus of infection that requires source control e.g. drainage of an abscess]
11
The challenge
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Thank you for listening