Objectives:

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Objectives

• Overview of WMQRS review of vascular services
  2010
• WMQI - update on vascular metrics project

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AIM

• To support NHS organisations in the West
  Midlands in improving the quality of health
  services by undertaking reviews of the quality of
  clinical services.

To support NHS organisations in the West Midlands
in improving the quality of health services by
undertaking reviews of the quality of clinical
services.
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ACHIEVED

• Vascular Quality Standards
• Peer reviews - 2010
• 10 vascular services
• All West Midlands except UHB
• Reviewer CPD

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FINDINGS

• Lots of examples of good practice
• SWB, STH NVD entries
• WORCS one-stop model
• SWB consultant WR model
• HEFT physio involvement in discharge
• Dudley ward environment
• UHCW psychologist/counsellor, daily vasc. US
• UHNS impressive intervention room, low rate of
  dialysis on lines
• Shropshire good follow-up for amputees

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Compliance against standards
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FINDINGS

• Configuration of services
• Herefordshire Worcestershire sorted
• HEFT sorted
• Many in transition
• Black Country not sorted
• National Vascular Database

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FINDINGS (CONT)

• Activity per vascular specialist
• Nursing competences - ward
• Availability of vascular anaesthetists and
  interventional radiologists
• High dependency care
• Guidelines and protocols

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VARIABLE

• Use of CNSs
• One-stop clinics
• Access to vascular ultrasound
• Links with other services
• Diabetes
• Renal
• Patient information

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PROCESS of review COULD HAVE DONE BETTER

• Patient and carer input
• Sites without in-patient services
• Out-patient facilities
• Rehabilitation
• Imaging
• Others?

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The FUTURE

• All reports available on WMQRS website
• ? Further review in 2013
• Future of WMQRS uncertain

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WMQI

• The Quality Observatory of NHS West Midlands
• Aim
• to become the one-stop shop for clinical teams
  and organisations for information about quality
  of services.
• Leadership
• Richard Wilson - Director
• Domenico Pagano - CD

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Vascular metrics project

• Why?
• Measurement essential for quality improvement
• Outcomes measures to support process measures
  from quality review
• How?
• Clinician survey 2010
• User agreement on metrics
• Development of metrics from HES
• UHB informatics department

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The metrics

• Amputation for critical limb
• Carotid endarterectomy
• AAA elective, EVAR, ruptured
• Surgery for lower limb ischaemia
• Funnel plots 95, 99
• Based on HES

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Amputation Critical Limb Ischaemia
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following Amputation
Critical Limb Period April 2008 March 2011
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28-day readmission rate following Amputation
Critical Limb Period April 2008 March 2011
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Carotid Endarterectomy
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following Carotid
Endarterectomy Period April 2008 March 2011
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28-day readmission rate following Carotid
Endarterectomy Period April 2008 March 2011
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Elective Infrarenal AAA
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following Elective AAA
(infrarenal) Period April 2008 March 2011
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28-day readmission rate following Elective AAA
(infrarenal) Period April 2008 March 2011
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Endovascular Aneurysm Repair
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following EVAR Period April
2008 March 2011
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28-day readmission rate following EVAR Period
April 2008 March 2011
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Lower Limb Ischaemia
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following Lower Limb
Ischaemia Period April 2008 March 2011
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28-day readmission rate following Lower Limb
Ischaemia Period April 2008 March 2011
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Ruptured Infrarenal Aneurysm
Line chart Number of procedures by year. Bar
chart 30-day mortality rate (in hospital).
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30-day mortality rate following Ruptured AAA
(infrarenal) Period April 2008 March 2011
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28-day readmission rate following Ruptured AAA
(infrarenal) Period April 2008 March 2011
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• Feedback on metrics
• Validation
• Discussion in measurement station
• Paper copies available

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WMQI

• The future
• Merging of SHAs NHS Midlands and East
• Uncertain future
• UHB
• Website
• Observatory