VANGUARD ENDOSCOPY QUALITY COLLABORATIVE
Ed Seward Dec 2016
OVERVIEW What is a Vanguard
Why endoscopy efficiency is important
What we’d like to achieve
How you can help
BMT Nursing Highlights
BMT review day 01/2016
BMT Nursing Highlights
BMT review day 01/2016
National Cancer Vanguard
Part of the New Care Models
Programme (from NHS Five Year Forward
review)
Designed to try out novel ways of
working to inform the rest of the NHS
In collaboration with two other cancer
centres (Royal Marsden and The Christie)
BMT Nursing Highlights
BMT review day 01/2016
Waiting lists across the sector have grown by 82% (Colonoscopy) from December 2013 to December 2015
Total waiting lists grown
by 84% from
December 2013 to
December 2015 Increasing
proportion of
patients waiting 6+
weeks
BMT Nursing Highlights
BMT review day 01/2016
Most CCGs in NCEL/WE are below
national median in terms of
endoscopy access
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BMT Nursing Highlights
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4000
6000
8000
10000
12000
14000
16000
18000
20000
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
Sco
pes
NHS England Trajectory
Actual (attended)
PICTURE OF CURRENT ROLLOUT OF BSS
BMT Nursing Highlights
BMT review day 01/2016
nhsiq.nhs.uk
BMT Nursing Highlights
BMT review day 01/2016
BMT Nursing Highlights
BMT review day 01/2016
BMT Nursing Highlights
BMT review day 01/2016
TCST BASE LINING EXERCISE
Understanding capacity, demand and activity
Modelled 2015 baseline, provided a 2020 projection, and a
projection plus ‘optimisation’
JAG return
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WHAT DO WE MEAN BY ‘OPTIMISATION’
DNA/same day cancellation
List utilisation
Room utilisation
Start/stop audits
Bowel prep/surveillance/ STT
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WHAT DO WE MEAN BY ‘OPTIMISATION’
But mostly – it’s up to you!
What does good look like?
What do you do well? What do you do less well?
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90%
6%
1%
3%
How likely are you to recommend our clinic
to friends/ family?
Extremelylikely
Likely
Extremelyunlikely
Don't know
Endoscopy Information - October
*based template points against actual points; excluding BCS, bronchoscopy and cystoscopy
Referral Triage – outstanding
1
All staff were excellent, helpful and very informative.
Good communica
tion from all staff
Patient comments
80%
85%
90%
95%
100%
105%
Room1
Room2
Room3
Room4
Room5
Room7
Total
This month's utilisation
0
50
100
150
200
250
300
350
Monthly average
Waiting <24hours
Waiting <48hours
Waiting <72hours
Waiting 72>hours
The whole experience
was excellent.
In October 56% morning sessions started late, totalling 2040 mins lost – equivalent to 136 points!
0%
20%
40%
60%
80%
100%
AM PM AM PM
Starts Finishes Total
Start and End Times
> 30 mins late
16-30 mins late
0-15 mins late
On Time
Early
Late Cancellations 2% - 36 points
(Last month 3%)
DNA Rate 3% - 53 points
(Last month 3%)
BMT Nursing Highlights
BMT review day 01/2016
Endoscopy Information - November
*based template points against actual points; excluding BCS, bronchoscopy and cystoscopy
The staff were incredible,
professional, empathetic, kind
and very knowledgeable and reassuring.
Patient comments
Well done on first
class 5 star treatment.
In November 23% of sessions ended more than 20 minutes early. Thank you to Phoebe for the Comfort Score information
Late Cancellations 4% - 72 points
(Last month 2%)
DNA Rate 3% - 55 points
(Last month 3%)
Friends & family test: 96.4% would recommend
0
5
10
15
20
25
30
Notrecorded
None,resting
comfortably
1 or 2episodes of
milddiscomfort
> 2episodes of
milddiscomfort
Significantdiscomfort
CO2
AIR
CO2/Air COMFORT SCORE – Results of Nurses’ Audit Diagnostics waiting
time compliance
Routine patients seen within 6
weeks 84.8%
Urgent patients seen withn 2
weeks 85%
80%
85%
90%
95%
100%
105%
Room1
Room2
Room3
Room4
Room5
Room7
Total
Monthly Utilisation Oct % Nov %
0%
20%
40%
60%
80%
100%
AM PM AM PM
START FINISH
Start and Finish Times (%)
>30 mins late
16-30 mins late
1-15 mins late
On time
Early
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BMT review day 01/2016
WHAT TO DO WITH THE DATA
Do not allow it to be a one off
It must inform ongoing practice
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OTHER IDEAS
Process mapping – optimise patient pathway
Split dosing of bowel prep – to reduce repeat procedure rate
Home enemas – to reduce pressure on recovery beds
Unsedated/entonox recovery pathways
In patient liaison nurse – to improve prep and smooth patient flow
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BMT review day 01/2016
TEAM HUDDLE
Measure Outcome RAG
STT Pathway in place
Demand/capacity awareness IMAS support tool or similar
List utilisation Backfilling >90%
DNA/cancellation rates <4%
Room utilisation Points on list optimised
Start/stop audits Lists start and finish on time >90%
Surveillance request
validation
100% of surveillance requests
Bowel prep adequate >90% of procedures
QUALITY COLLABORATIVE DASHBOARD
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BMT review day 01/2016
OBJECTIVE OUTCOMES
Measured at 6 and 12 months (and thereafter?)
Improvement in dashboard RAG status
Improvement in throughput: activity/capacity = efficiency
ratio
Possible clinical outcomes such as unit ADR to follow
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BMT review day 01/2016
OTHER OUTPUTS FROM VANGUARD
Colon capsule
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BMT review day 01/2016
CONCLUSIONS
Service improvement is a necessity
Service improvement can allow every department to run more
efficiently, be more patient focused, be more team centred and
be more fun
Vanguard wide quality collaborative should provide support