Abstract
The NW Advancing Quality programme is a regional one aimed at improving the delivery of evidence based care. Hip and knee replacement has been one of 5 clinical areas. Over a 3 year period performance at all 24 NW trusts has been measured. For hip and knee replacement patients the evidence based care has been delivery of antibiotic and thromboembolic prophylaxis. Robust data has been collected on the choice and timeliness of prophylaxis and readmission rates for each trust. The programme included financial and reputational (public reporting) rewards for top performing units. Sharing of data and collaborative working has been put in place to improve overall performance
Over the 3 years of the programme data has been collected on 47,825 patients. Across the region delivery of the measures has improved from 88 to 96%. Patients achieving all measures and avoiding readmission has improved from 64 to 85%. There has been reduced variation in performance. The biggest improvement in performance has occurred in the initially poorer perfoming trusts (year 1 range 54–97%, year 3 range 86–99%). All cause readmission within 28 days of discharge has fallen from 9 to 7%.
The progamme has demonstrated that it is possible to improve delivery of evidence based care and clinical outcomes on a regional basis. It has evolved from a stand alone programme to continue as a regional CQUIN. The programme has had wider benefits. Units report a change of culture producing improved delivery of other protocols. The collaboraive working has created a multidisciplinary network with improvement initiatives widened to include comparing PROMS data, Enhanced Recovery and Shared Decision Making. Challenges have included obtaining consensus regarding the initial and now soon to be introduced updated thromboembolic measures
