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Rivers Hospital Quality Accounts 2012/2013

Quality Accounts 2012/13 of 25

Contents

Introduction Page

Welcome to Ramsay Health Care UK and Rivers Hospital 4 -6

Introduction to our Quality Account 6

PART 1 – STATEMENT ON QUALITY

1.1 Statement from the General Manager 7

1.2 Hospital accountability statement 8

PART 2

2.1 Priorities for Improvement

2.1.1 Review of clinical priorities 2012/13 (looking back) 9

2.1.2 Clinical Priorities for 2013/14 (looking forward) 9

2.2 Mandatory statements relating to the quality of NHS services provided 10

2.2.1 Review of Services 10

2.2.2 Participation in Clinical Audit 11

2.2.3 Participation in Research 12

2.2.4 Goals agreed with Commissioners 12

2.2.5 Statement from the Care Quality Commission 13

2.2.6 Statement on Data Quality 13

2.2.7 Stakeholders views on 2012/13 Quality Accounts 14

PART 3 – REVIEW OF QUALITY PERFORMANCE 15-16

3.1 Patient Safety 17

3.2 Clinical Effectiveness 18-20

3.3 Patient Experience 21

3.4 Case Study 22

Appendix 1 – Services Covered by this Quality Account 23

Appendix 2 – Clinical Audits 24


Welcome to Ramsay Health Care UK

Rivers Hospital is part of the Ramsay Health Care Group

The Ramsay Health Care Group was established in 1964 and has grown to become a global hospital

group operating over 100 hospitals and day surgery facilities across Australia, the United Kingdom,

Indonesia and France. Within the UK, Ramsay Health Care is one of the leading providers of

independent hospital services in England, with a network of 22 acute hospitals.

We are also the largest private provider of surgical and diagnostics services to the NHS in the UK.

Through a variety of national and local contracts we deliver 1,000s of NHS patient episodes of care

each month working seamlessly with other healthcare providers in the locality including GPs, Clinical

Commissioning Groups and acute Trusts.

“Ramsay Health Care UK is committed to establishing an organisational culture that puts the

patient at the centre of everything we do. As Chief Executive of Ramsay Health Care UK, I am

passionate about ensuring that high quality patient care is at the centre of what we do and

how we operate all our facilities. This relies not only on excellent medical and clinical

leadership in our hospitals but also upon our overall continuing commitment to drive year on

year improvement in clinical outcomes.

“As a long standing and major provider of healthcare services across the world, Ramsay has

a very strong track record as a safe and responsible healthcare provider and we are proud to

share our results. Delivering clinical excellence depends on everyone in the organisation. It is

not about reliance on one person or a small group of people to be responsible and

accountable for our performance.”

Across Ramsay we nurture the teamwork and professionalism on which excellence in clinical

practice depends. We value our people and with every year we set our targets higher,

working on every aspect of our service to bring a continuing stream of improvements into our

facilities and services.

(Jill Watts, Chief Executive Officer of Ramsay Health Care UK)


Welcome to Rivers Hospital

The Rivers is a private hospital set in quiet landscaped grounds in Sawbridgeworth, Hertfordshire. It is one of the largest hospitals within Ramsay Health Care UK. It opened in March 1992, and has become popular with patients from the Hertfordshire and Essex region. It is easily accessible with free car parking.

The Rivers has 59 in patient bedrooms; all have en-suite bathrooms to ensure patient comfort and privacy. Additionally there is a dedicated day case suite with 9 bays, and a minor ops theatre. The hospital has four operating theatres, which are well equipped with the latest surgical technology.

The Outpatient Department has 15 Consulting rooms and 3 private treatment rooms, with a modern equipped physiotherapy department and gym, a well equipped imaging department with x-ray, ultrasound, CT & MRI scanning facilities, Digital Mammography and DEXA scanning (Osteoporosis).

All 200 plus Consultants are subject to strict vetting procedures to ensure only those with the appropriate experience and qualifications are granted Practising Privileges and hence can offer treatment at Rivers Hospital.

The Staff at the Rivers are professional and friendly, and deliver high levels of customer service. In 2010 the hospital won the Harlow and District Business Awards for Customer Care and has also been successful in achieving Top 10 places in the Healthcare 100 Best Employer Awards (IPSOS Mori) over recent years.

We provide fast, convenient, effective and high quality treatment for patients of all ages (children over the age of 3 years as inpatients), whether medically insured, self-pay, or NHS funded.

Patients may self refer for Vive Cosmetic Surgery consultation, and for Physiotherapy services.

The Rivers offers a range of elective surgical, non-surgical and outpatient treatments across the following specialities: -

Allergy Clinic, Bariatrics, Breast /Reconstructive surgery, Cardiology (Cardio-thoracic Surgery at Orwell Suite), Colo-rectal surgery, Cosmetic surgery, Dermatology, Diabetes/Endocrinology, Diagnostic Services, Dietician, Ear, Nose and Throat, Endoscopy, Fertility services, Gastro-enterology, General Medicine, General surgery, Gynaecology, Haematology, Health Screening, Laparoscopic Surgery, Neurology, Neuro-Radiology, Oncology, Ophthalmology, Oral and Maxillo-Facial Surgery, Orthopaedic Surgery, Paediatric Services, Pain Medicine, Pharmacy, Physiotherapy, Plastic Surgery, Private GP & Practice Nurse service, Psychiatry, Psychotherapy, Rheumatology, Spinal Surgery , Urology including Brachytherapy, , Vascular, Weight loss Clinics (Bariatric surgery at Springfield Hospital).

The Hospital attracts referrals from sister hospitals within Ramsay Eastern region as a specialized centre for services such as Brachytherapy (Prostate Cancer), Chemotherapy services (Cancer), DEXA scanning (Osteoporosis), Phototherapy (Skin conditions), and on site CT scanning (Diagnostic Imaging).

The Rivers acts as a satellite for other centres to offer services through a hub & spoke system. These include Fertility services (Bridge Fertility Centre) and Cardio-thoracic surgery (Ramsay Orwell Suite).


Last Year the Rivers admitted a total of 12900.

An experienced Resident Medical Officer is on site 24 hours/day to provide high quality medical care to patients under the direction of their Consultants.

Permanent hospital staff include Registered Nurses, Health Care Assistants, Operating Department Practitioners, Physios, Pharmacists, Radiographers, administrative staff, caterers, housekeepers and porters.

All clinical and support staff have the relevant training and skills to fulfil their roles and this is an ongoing process. There is also a Rivers Hospital Staff Bank which provides extra support and flexibility to the service where needed.

The Rivers Hospital has worked closely with local Primary Care Trusts in Hertfordshire and West Essex, to support commissioning of healthcare services for the local NHS population. The hospital also has close links with Princess Alexandra NHS Trust (Harlow) and East and North Herts NHS Trust Hospitals (WGC and Stevenage), including histopathology services and emergency transfer provision. The hospital looks forward to working with the new Clinical Commissioning Groups (CCG’s) and other NHS bodies over the coming period.

The Rivers employs a GP liaison officer to ensure local GPs are well informed about the services offered at the hospital.

The hospital also provides a programme of educational seminars for healthcare professionals including specialist sessions and basic life support.

The Rivers is closely associated with the Helen Rollason Cancer Charity, which has a Holistic therapy centre and offices within the hospital site.

The hospital supports local schools, charities and associations through sponsorship and fund raising events throughout the year.

Introduction to our Quality Account

This Quality Account is the Rivers Hospital annual report to the public and other stakeholders about

the quality of the services we provide. It presents our achievements in terms of clinical excellence,

effectiveness, safety and patient experience and demonstrates that our managers, clinicians and

staff are all committed to providing continuous, evidence based, quality care to those people we

treat. It will also show that we regularly scrutinise every service we provide with a view to improving

it and ensuring that our patients’ treatment outcomes are the best they can be. It will give a

balanced view of what we are good at and what we need to improve on.


Part 1 STATEMENT ON QUALITY

1.1 Statement on quality from the General Manager, Mr Andy Haysman, Rivers Hospital

Rivers Hospital has a tradition of working closely with consultants and patients to ensure the best

quality healthcare is consistently being delivered. Our hospital staff are fully trained in the latest

procedures and thus maintain all areas to the highest standards. Working within the Department of

Health guidelines we focus on patient safety and cleanliness to minimize infection. Any patient who

wants to satisfy themselves on the quality of the hospital and its Consultants can be reassured by

the Care Quality Commission (CQC) Audits undertaken by the Department of Health which support

the hospital’s excellent reputation. As General Manager of Rivers Hospital, I take great pride in the

service we offer our patients and relatives; this is only achieved through a cohesive team effort and

approach.

The Rivers Hospital Vision Statement is to be a leading provider of health care services by delivering high quality outcomes for patients and ensuring long term profitability. This vision is reflected throughout the Quality Report in that the hospital will constantly strive to improve the quality and suitability of its services to patients by ensuring there are adequate core policies and skills, effective feedback mechanisms on the quality and efficacy of its activities and processes in place to affect improvement at all levels of the organisation. In preparing this report, the hospital has taken into account the views of a wide range of stakeholders in the hospital’s activities, including staff, consultants and the Ramsay organisation, but most importantly the views of patients and their families which have been sought though questionnaire survey, comment sheets and focus groups. Furthermore, you are invited to feedback on this document by sending any comments in writing to me at the hospital


1.2 Hospital Accountability Statement To the best of my knowledge, as requested by the regulations governing the publication of this document, the information in this report is accurate. Mr Andy Haysman General Manager Rivers Hospital Ramsay Health Care UK This report has been reviewed and approved by: Mr David McKiernan, Consultant ENT Surgeon MBBS FRCS, MAC Chair Medical Advisory Committee Chair Signature………………………………………………….. Date……………………….. Mr Richard Parsons, Regional Director East Signature………………………………………………….. Date……………………….. Siobhan Jordan, West Essex CCG Director of Nursing and Quality Signature…………………………………………………. Date………………………… Signature…………………………………………………. Date…………………………


Part 2

2.1 Quality priorities for 2013/2014 Plan for 2013/14 On an annual cycle Rivers Hospital develops an operational plan to set objectives for the year ahead. We have a clear commitment to our private patients as well as working in partnership with the NHS ensuring that those services commissioned to us, result in safe, quality treatment for all NHS patients whilst they are in our care. We constantly strive to improve clinical safety and standards by a systematic process of governance including audit and feedback from all those experiencing our services. To meet these aims, we have various initiatives ongoing at any one time. The priorities are determined by the hospitals Senior Management Team taking into account patient feedback, audit results, national guidance, and the recommendations from various hospital committees which represent all professional and management levels. Most importantly, we believe our priorities must drive patient safety, clinical effectiveness and improve the experience of all people visiting our hospital. Priorities for improvement

2.1.1 A review of clinical priorities 2012/2013 (looking back)

Reflection on priorities 2012/2013

The Doctor’s Laboratory (TDL) opened a lab on site in March 2012 to serve Ramsay East Region. Blood Audit Release System (BARS) and Point of Care Testing (POCT) training were introduced in March 2012, to ensure higher patient safety by the implementation of electronic and networked systems. There has been on -going training and audit of these systems throughout the year. Regular meetings have been held between TDL and the Hospital to ensure smooth processes and early identification and action of any matters arising.

Never Events – there were no “never events “during the year.

The Day Unit has continued to treat patients efficiently to high standards of care. We have continued to monitor this through a variety of methods such as patient / consultant feedback, returns to theatre and re-admission rates.

We have continued to monitor patient feedback. We have endeavoured to ensure patients receive written information on discharge and this remains an ongoing objective.

Allocate, an electronic rostering system, has been introduced and teams are working towards full implementation with the Head Office team.


2.1.2 Clinical Priorities for 2013/14 (looking forward)

Continue to maintain and improve standards of care and patient satisfaction levels.

Ensure robust systems in place to ensure full compliance with all training and development activities including e-learning. Ensure staff support through mentorship is more structured and evidenced.

To work further with Riskman, our new electronic incident and near-miss reporting system. Improvements anticipated including clearer analysis of trends and more involvement at department level in incidents / near miss handling.

To continue to make progress with Care of the Child competencies with our team caring for paediatrics within the Hospital.

To further promote Safeguarding awareness through training and development – to raise its profile and ensure all staff are fully aware of its importance and action to take if issues are raised.

Pulse (Staff satisfaction) survey A staff survey was untaken in March 2013 and the results are currently being compiled and analyzed.

Patient experience – informing patient choice Patient satisfaction scores are very high with an overall satisfaction score (excellent, very good, good) of 99.1% in Quarter 4 2012 and a recommendation score of 100%. Areas for improvement in 2013/14 are:

The provision of written information regarding proposed treatment and post discharge

Patients receiving copies of letters sent between Consultants and GPs

Ensuring patients/visitors are aware of staff always washing their hands or using alcohol gel

The waiting time from admission to procedure.

The Leadership Factor (TLF) working group which was formed in 2011/2012 has helped to increase our rate from 76 responses in Q1 2011 to 107 in Q4 2012. In January 2013 TLF surveys were discontinued and replaced by QA Research on-line and telephone surveys, and feedback from these is now emerging. It is anticipated that as the months progress and participation increases, a clearer picture of patient satisfaction across the Group and at individual sites will form. Our patient Group has continued to meet successfully and other patient feedback methods (e.g. we value your opinion leaflets) are also used to maintain and improve standards.


2.2. Mandatory Statements The following section contains the mandatory statements common to all Quality Accounts as required by the regulations set out by the Department of Health.

2.2.1 Review of Services During 2012/13 the Rivers Hospital provided and/or subcontracted 35 NHS services. Ramsay uses a balanced scorecard approach to give an overview of audit results across the critical areas of patient care. The indicators on the Ramsay scorecard are reviewed each year. The scorecard is reviewed each quarter by the hospitals senior managers and their teams, together with regional and Corporate Managers. The balanced scorecard approach has been an extremely successful tool in helping us benchmark against other hospitals and identifying key areas for improvement. In the period for 2012/13, the indicators on the scorecard which affect patient safety and quality were: Human Resources HCA Hours as % of Total Nursing Agency Hours as % of Total Hours % Staff Turnover % Sickness Total Lost Worked Days Appraisal % Mandatory Training % Staff Satisfaction Score Number of Significant Staff Injuries Patient Formal Complaints per 1000 HPD's Patient Satisfaction Score Number of Significant Clinical Events Readmission per 1000 Admissions Quality Workplace Health & Safety Score Infection Control Audit Score Consultant Satisfaction Score


2.2.2 Participation in Clinical Audit During 1 April 2012 to 31 March 2013, Rivers Hospital participated in all national clinical audits to which it was invited and was eligible. National Clinical Audits (NA = not applicable to the services provided)

Name of Audit Participation (NA, Yes, No)

% cases submitted

Long term conditions N/A N/A

Elective procedures Hip, knee and ankle replacements (National Joint Registry)

Yes

63%

Elective surgery (National PROMs Programme) Yes 65.9%

Clinical Outcome Review Programme

Medical & Surgical Programme National Confidential Enquiry into Patient Outcome & Death

No Deaths

Local Audit There is a local audit system in place, based on a Group-wide template, covering areas such as medical records, infection prevention and control, consent, controlled drugs and radiology. Further audits include paediatric care and cosmetics. The local Clinical Governance Committee reviews audit results and recommends/supports appropriate action. Actions have been identified to improve Audit Scores where necessary. E.g. Consent score rose from 92% to 98% with a focus on the 2nd stage Consent process, whereby the Consent Form is signed by the patient and a Health Care Professional for a 2nd time, to ensure there are not changes or questions left unanswered. Some areas remained consistently high 96 - 100% e.g. surgical site infection, hand hygiene. 2.2.3 Participation in Research There were no applications during 2012/13 to participate in research approved by a research ethics committee.


2.2.4 Goals agreed with our Commissioners using the CQUIN (Commissioning for Quality and Innovation) Framework

A proportion of Rivers Hospital’s income in from 1 April 2012 to 31 March 2013 was conditional on achieving quality improvement and innovation goals agreed between them and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. Measures in 2012/2013 were:

Patient experience (see Section 2.1.2)

NHS Safety Thermometer (100% completion rate)

Pressure ulcer elimination (no pressure ulcers to report)

VTE (Venous Thrombo-embolism – clots) (see below) VTE assessment The graph above demonstrates that Rivers Hospital achieved an “excellent” rate of VTE assessment (i.e. Identifying patients at risk of a thrombosis), at 97% with a target of 90%.

Going forward measures will include:

Dementia Screening

NHS Safety Thermometer

Alcohol screening


2.2.5 Statements from the Care Quality Commission (CQC) Rivers Hospital is required to register with the Care Quality Commission and its current registration status on 31st March is full registration without conditions. The Care Quality Commission has not taken any enforcement action against Rivers Hospital during 2012/2013. In March 2013 Rivers Hospital was inspected by the CQC and was found to be fully compliant in all areas inspected:

Consent to care and treatment

Supporting workers

Assessing and monitoring the quality of service provision

Safeguarding people who use services from abuse

Care and welfare of people who use services.

2.2.6 Data Quality Data Quality Statements NHS Number and General Medical Practice Code Validity The Ramsay Group submitted records during 2012/2013 to the Secondary Users Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data included: The patient’s valid NHS number:

99.98% for admitted patient care;

99.95% for outpatient care; and

0% for accident and emergency care (not undertaken at Ramsay hospitals). The General Medical Practice Code:

99.99% for admitted patient care;

99.99% for outpatient care; and

0% for accident and emergency care (not undertaken at Ramsay hospitals). Information Governance Toolkit attainment levels Ramsay Group Information Governance Assessment Report score overall for 2012/13 was 77% and was graded ‘green’ (satisfactory). This information is publicly available on the DH Information Governance Toolkit website at: https://www.igt.connectingforhealth.nhs.uk/

https://www.igt.connectingforhealth.nhs.uk/


Clinical coding error rate Results of the Clinical Coding audit during 2012/2013:

Hospital Site Audit

Date

Re Audit

Date

Primary

Diagnosis

Secondary

Diagnosis

Primary

Procedure

Secondary

Procedure

Rivers Jan 13 95.0% 94.04% 100% 100%

2.2.7 Stakeholders views on 2012/13 Quality Account A Draft copy of this document was sent to the Regional Director (Ramsay East), the Medical Advisory Committee Chair (Rivers Hospital) and the Director of Nursing and Quality (West Essex Clinical Commissioning Group). Their comments have been taken into consideration in the final version of this Quality Account. The Statement of Endorsement from the Director of Nursing and Quality (West Essex Clinical Commissioning Group) is embedded below.

Statement of Endorsement - The Rivers Hospital.pdf


Part 3 REVIEW OF QUALITY PERFORMANCE 2012/2013 Introduction

‘Our overriding commitment is to provide safe and effective care; the guiding principle is to put our patients’ interests first and key to this is our capacity to listen, be responsive and to act on their feedback. We already take patient views and ratings into account in any assessment of our performance but now we will increasingly draw on effective real-time information and this includes on-line patient surveys. Added to which there are more opportunities to use new measures of quality of care and patient safety and be able to make a difference to improvements in future practice. Importantly these new metrics should ensure performance which needs improving, can be quickly identified and fixed’.

(Jane Cameron, Director of Safety and Clinical Performance, Ramsay Health Care UK)

Ramsay Clinical Governance Framework 2012/2013 The aim of clinical governance is to ensure that Ramsay develop ways of working which assure that the quality of patient care is central to the business of the organisation.

The emphasis is on providing an environment and culture to support continuous clinical quality improvement so that patients receive safe and effective care, clinicians are enabled to provide that care and the organisation can satisfy itself that we are doing the right things in the right way. It is important that Clinical Governance is integrated into other governance systems in the organisation and should not be seen as a “stand-alone” activity. All management systems, clinical, financial, estates etc, are inter-dependent with actions in one area impacting on others.

Several models have been devised to include all the elements of Clinical Governance to provide a framework for ensuring that it is embedded, implemented and can be monitored in an organisation. In developing this framework for Ramsay Health Care UK we have gone back to the original Scally and Donaldson paper (1998) as we believe that it is a model that allows coverage and inclusion of all the necessary strategies, policies, systems and processes for effective Clinical Governance. The domains of this model are:

• Infrastructure • Culture • Quality methods • Poor performance • Risk avoidance • Coherence


Ramsay Health Care Clinical Governance Framework The diagram below demonstrates the key elements of the Clinical Governance Framework within Ramsay Health Care. These areas are addressed within local teams, centrally and across both through effective communication channels. For example, a Group Clinical Governance Committee exists with representation from local and Head Office teams, including the Consultant body.

NICE / NPSA guidance Ramsay also complies with the recommendations contained in technology appraisals issued by the National Institute for Health and Clinical Excellence (NICE) and Safety Alerts as issued by the NHS Commissioning Board Special Health Authority. Ramsay has systems in place centrally for scrutinising all national clinical guidance and selecting those that are applicable to our business and thereafter monitoring their implementation.


3.1 Patient Safety We are a progressive hospital and focussed on stretching our performance every year and in all performance respects, and certainly in regards to our track record for patient safety. Risks to patient safety come to light through a number of routes including routine audit, complaints, litigation, adverse incident reporting and raising concerns but more routinely from tracking trends in performance indicators. There have been no “Never Events” and no unexpected deaths during 2012-2013. 3.1.1 Infection Prevention and Control Rivers Hospital has a very low rate of hospital acquired infection (0.04%) and has had no reported MRSA Bacteraemia for at least 6 years. We comply with mandatory reporting of all Alert organisms including MSSA/MRSA Bacteraemia and Clostridium Difficile infections and have had none to report during the year. Ramsay participates in mandatory surveillance of surgical site infections for orthopaedic joint surgery and these are also monitored. No concerns have been raised during the year. Infection Prevention and Control management is very active within our hospital. An annual strategy is developed by a Corporate level Infection Prevention and Control (IPC) Committee and group policy is revised and re-deployed every two years. Our IPC programmes are designed to bring about improvements in performance and in practice year on year. A network of specialist nurses and infection control link nurses operate across the Ramsay organisation to support good networking and clinical practice. We have excellent links with the IPC team at the local Trust and these assist us in all our IPC practices. Programmes and activities within our hospital include:

Training (e.g. Handwashing awareness), audits, campaigns.

Surveillance of all infections including the participation in hip/knee studies with the Health Protection Agency.

Close monitoring of any infections including causes, trends and actions.


3.1.2 Cleanliness and Hospital Hygiene Assessments of safe healthcare environments also include Patient Environment Assessment Team (PEAT) audits. These assessments include rating of privacy and dignity, food and food service, access issues such as signage, bathroom / toilet environments and overall cleanliness. In 2012 the results for Rivers Hospital were:

Environment – good Food – good Privacy and dignity – excellent PEAT Audits are to be replaced nationally by Patient Led Assessment of the Care Environment (PLACE) and the first inspection at Rivers Hospital will be held in May 2013.

3.1.3 Safety in the workplace Safety hazards in hospitals are diverse ranging from the risk of slip, trip or fall to incidents around sharps and needles. As a result, ensuring our staff have high awareness of safety has been a foundation for our overall risk management programme and this awareness then naturally extends to safeguarding patient safety. Our record in workplace safety as illustrated by 1.1 Safety Incidents per 1000 Admissions demonstrates the results of safety training and local safety initiatives. The Ramsay Group figure is 1.7. Effective and ongoing communication of key safety messages is important in healthcare. Multiple updates relating to drugs and equipment are received every month and these are sent in a timely way via an electronic system called the Ramsay Central Alert System (CAS). Safety alerts, medicine / device recalls and new and revised policies are cascaded in this way to our General Manager which ensures we keep up to date with all safety issues. 3.2 Clinical Effectiveness Rivers Hospital has a Clinical Governance Committee that meets regularly through the year to monitor quality and effectiveness of care. Clinical incidents, patient and staff feedback are systematically reviewed to determine any trend that requires further analysis or investigation. More importantly, recommendations for action and improvement are presented to hospital management and medical advisory committees to ensure results are visible and tied into actions required by the organisation as a whole. Incident and near-miss reporting is encouraged to ensure effective learning in a no-blame culture. There were no “Never Events” during the year at Rivers Hospital. In August 2012 an electronic reporting system, Riskman, was introduced in Ramsay Hospitals to replace existing systems. This has been embedded and implemented. Going forward, it is anticipated that reports generated will provide a robust method with which to gain an overview of incident and near-miss types and trends.


3.2.1 Return to Theatre Ramsay is treating significantly higher numbers of patients every year as our services grow. The majority of our patients undergo planned surgical procedures and so monitoring numbers of patients that require a return to theatre for supplementary treatment is an important measure. Every surgical intervention carries a risk of complication so some incidence of returns to theatre is normal. The value of the measurement is to detect trends that emerge in relation to a specific operation or specific surgical team. Ramsay’s rate of return is very low consistent with our track record of successful clinical outcomes. During the period the rate of patients returning to Theatre at Rivers Hospital was 0.14%. 3.2.2 Readmission to Hospital Monitoring rates of readmission to hospital is another valuable measure of clinical effectiveness. As with return to theatre, any emerging trend with specific surgical operation or surgical team in common may identify contributory factors to be addressed. Ramsay rates of readmission remain very low and this, in part, is due to sound clinical practice ensuring patients are not discharged home too early after treatment and are independently mobile, not in severe pain etc. However we encourage patients to contact us with any queries or concerns post-discharge should they arise and where appropriate ensure they are re-admitted in order for any issues to be resolved. At Rivers Hospital during the year, the re-admission rate was 0.17%. 3.3 Patient Experience All feedback from patients regarding their experiences with Ramsay Health Care are welcomed and inform service development in various ways dependent on the type of experience (both positive and negative) and action required to address them. All positive feedback is relayed to the relevant staff to reinforce good practice and behaviour and kept on their file. Positive comments are shared widely via the Head of Department team, in written format for sharing, with the patient’s details anonymised. Managers ensure that positive feedback from patients is recognised and any individuals mentioned are praised accordingly. All negative feedback or suggestions for improvement are also shared with the relevant staff. All staff are aware of our complaints procedures should our patients be unhappy with any aspect of their care. Patient experiences are fed back via the various methods below, and are regular agenda items on Local Governance Committees and HODs meetings for discussion, trend analysis and further action where necessary. Escalation and further reporting to Ramsay Corporate and Department of Health (DH) bodies occurs as required and according to Ramsay and DH policy.


Feedback regarding the patient’s experience is encouraged in various ways via: Patient satisfaction surveys ‘We value your opinion’ leaflet Verbal feedback to Ramsay staff - including Consultants, Matrons/General Managers whilst

visiting patients and Provider/CQC visit feedback. Written feedback via letters/emails Patient focus group Patient Reported Outcome Measures (PROMs) surveys Care pathways – patient are encouraged to read and participate in their plan of care Staff appraisal system 3.3.1 Patient Satisfaction Surveys In Q4 2012 97.8% of patients said that they would recommend Rivers to others. During 2012 / 2013 we have continued to focus on areas for improvement such as providing written information and the visibility of hand hygiene measures. In the forthcoming year we will also aim to increase the number of patient receiving copies of letters from hospital doctors to GPs by liaising with consultants and medical secretaries. Our patient satisfaction surveys have been managed by an independent company called ‘The Leadership Factor‘(TLF). In January 2013 this role was allocated to QA Research and the process of feedback collection has been reviewed accordingly. Patient satisfaction scores for overall quality show the majority of patients feel they receive excellent quality of care and service in Rivers Hospital. To record a satisfaction index over 90%, a very high proportion of our patients have scored 9 or 10 out of 10 for their satisfaction with all the requirements. This is underlined by comparing our hospitals Satisfaction Index against those achieved by other organisations across all sectors of the UK economy where the full range of customer satisfaction is 50% to 95% with the median just below 80%. With an overall satisfaction score of 94.5%, Rivers Hospital has continued to be rated in the top 2-3% of organisations in the UK. 3.3.2 Patient Reported Outcome Measures (PROMs) Rivers Hospital participates in the Department of Health’s PROMs surveys for hip and knee surgery, hernias and varicose veins for NHS patients. This is a survey to identify health and lifestyle benefits gained by patients after their surgery. Outcomes are published openly and benchmarking can take place with other facilities. For example, those published overleaf show results for England overall, Rivers Hospital and the local Trust. As a Group, Ramsay also conducts its own hip, knee and cataract PROMs surveys specifically for private patients.


To access Rivers Hospital PROMs scores: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295

Provider Hernia Hip-HG

Hip-SD

Knee-HG

Knee-SD

England -0.432 20.094 8.998 15.146 9.612

RIVERS HOSPITAL 2.916 18.774 8.86 * *

THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST

-0.946 18.945 9.838 15.268 10.102

-2

-1

0

1

2

3

4

England RIVERS HOSPITAL THE PRINCESS ALEXANDRA HOSPITAL

NHS TRUST

Average health gain EQ-5D VAS - casemix adjusted

Groin Hernia

0

5

10

15

20

25

30

35

England RIVERS HOSPITAL THE PRINCESS ALEXANDRA HOSPITAL

NHS TRUST

Adjusted average health gain

Oxford Hip Score

http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295


3.4 Rivers Hospital Case Study A report by the Pharmacy Manager on an approach to painkillers which enable a good post-operative recovery by keeping pain to a minimum.

Peri-operative Multimodal Analgesia in Hip and Knee Replacement Multimodal analgesia has been developed as a means to resolve issues encountered with traditional pain management in hip and knee replacement which is associated with considerable post operative pain, judged to be severe in 60% and moderate in 30% of patients. Good pain relief is important and may affect outcome. A number of types of before, during and after operation analgesia have been reported in the literature. Spinal analgesia is of proven benefit but may be associated with headache, bladder problems, low blood pressure, respiratory depression, pulmonary hypertension, heart problems as well as the risk of spinal infection. Morphine type pain relief which is patient controlled (PCA) is useful but may be associated with nausea, vomiting, respiratory depression, drowsiness, pruritus, reduced gut motility, urinary retention. Peri-operative local analgesia has minimal systemic side effects and analgesia injected directly into joints is also proven to reduce post operative pain relief requirements. A multi-drug approach therefore has a number of advantages with synergistic pharmacological activity. It is known that surgical trauma during knee replacement modifies the responsiveness of the nervous system in two ways: - (a) peripheral sensitisation by reduction of the threshold of the nerve pain receptors and also by increasing the excitability of spinal nerves. Together these contribute to postoperative pain sensitivity; Peri-operative use of Morphine, Ketorolac, Levobupivacaine and Adrenaline as a multi-drug “around the joint” injection reduces post operative analgesia requirements and reduces pain on early mobilisation. Morphine is known to bind to peripheral opiate receptors expressed (within hours) at the site of surgery, within inflamed tissues and widely in the brain, spinal cord and digestive tract. Ketorolac, like all anti-inflammatory drugs, inhibits the production of prostaglandins which are key mediators of peripheral nerve sensitisation. Levobupivacaine, a local anaesthetic, has anaesthetic and analgesic effects and compared to an earlier version, Bupivacaine, is associated with fewer side effects. Adrenaline, is used to constrict blood vessels to slow local absorption and potentially reduce systemic toxicity by maintaining a localised action. There are a number of different multi-drug “mixtures” reported in the extensive published scientific literature. A common thread indicates generally improved post operative pain control, with a reduction in the use of conventional (morphine like) post operative pain relief. The reduction in use of morphine type medicines leads to a reduction in post operative nausea, constipation and therefore the need for anti-sickness and laxative medication. Improved pain control leads to earlier and easier mobilisation and reduced length of hospital stay. This may in turn lead to a reduction in the incidence blood clots as a complication of surgery. David Houghton Pharmacy Manager


Appendix 1

Services covered by this quality account Regulated Activities – Rivers Hospital

Regulated Activities – Rivers Hospital Services Provided Peoples Needs Met for:

Treatment of Disease, Disorder Or injury

Bariatrics, Breast care, Cardiology,

Clinical neuro physiology, Colorectal,

Continence care, Cosmetics,

Dermatology, Dietetics, Elderly care,

Endocrinology, Fertility,

Gastroenterology, General Medicine,

Haematology, Manual lymphatic

drainage, Medicine, Nephrology,

Neurology, Nurse led sclerotherapy,

Oncology, Ophthalmic, Orthoptics,

Orthopaedic, Out patient satellite

clinics, Paediatrics, Pain management,

Physiotherapy, Podiatry, Private GP

services, Prosthetics services,

Psychiatry (OPD only), Psychology,

Psychotherapy, Renal medicine,

Rheumatology, Sexual health, Speech

therapy, Sports medicine

All adults 18 yrs and over Children - 3 -12 yrs ambulatory and day surgery only. 12 yrs and above, inpatients included. Children 0-3 yrs, outpatients only.

Surgical Procedures

Breast surgery, Brachytherapy,

Colorectal, Cosmetics inc laser, Day

and Inpatient Surgery, Dermatology,

Ear, Nose and Throat (ENT) inc laser,

Gastrointestinal, General surgery,

Gynaecology inc laser, Neurosurgery,

Ophthalmic inc laser, Oral

maxillofacial, Orthopaedic, Plastic

Surgery, Sentinel node biopsy,

Urological inc laser, Vascular

All adults 18 yrs and over and children 3 yrs and above excluding:

Patients on renal dialysis

Patients with history of malignant hyperpyrexia

Patients who are likely to need ventilatory support post operatively

Patients who are above a stable ASA 3.

Any patient who will require planned admission to ITU post surgery

Dyspnoea grade 3/4 (marked dyspnoea on mild exertion e.g. from kitchen to bathroom or dyspnoea at rest)

Poorly controlled asthma (needing oral steroids or has had frequent hospital admissions within last 3 months)

MI in last 6 months

Angina classification 3/4 (limitations on normal activity e.g. 1 flight of stairs or angina at rest)

CVA in last 6 months

Patients with serious mental health illness

However, all patients will be individually assessed and we will only exclude patients if we are unable to provide an appropriate and safe clinical environment. Children - 3 yrs and above ambulatory and day surgery only. 12 yrs and above, inpatients included.

Diagnostic and screening

Allergy testing, Audiology, Aortic

aneurysm screening, CT (inc heart

scan), Dexa scanner, Echocardiology,

Endoscopy, GI physiology, Health

screening, Imaging services,

Mammography, MRI, Nerve conduction

and EMG, Neuroradiology, Nuchal

scans, Obstetric Ultrasound,

Pathology, PET and CT scanner,

Phlebotomy, Urinary Screening Aortic

aneurysm screening, and Specimen

collection, Urodynamics

All adults 18 yrs and over All children 0-18 yrs, outpatients appointments only

Termination of Pregnancy

Surgical Termination of Pregnancy

All patients aged 16 yrs and over


Appendix 2 – Clinical Audit Programme Each arrow links to the audit to be completed in each month. This Appendix demonstrates the topics and the frequency of the Ramsay Audit Programme.


Rivers Hospital Ramsay Health Care UK We would welcome any comments on the format, content or purpose of this Quality Account. If you would like to comment or make any suggestions for the content of future reports, please telephone or write to the General Manager Andy Haysman using the contact details below. For further information please contact: 01279 600282 www.rivers-hospital.co.uk

rivers hospital - nhs€¦ · urology including brachytherapy, , vascular, weight loss clinics...

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