Quality Improvement Posters 1034 – 1039
1034 Participation of patients and carers in quality improvement: lessons learnt from the ASSIST-CKD (Chronic kidney disease) project
Background The ASSIST-CKD project, managed by a leading medical research charity, focuses on scaling-up an intervention that reports kidney function (eGFR) graphs over time to primary care, to identify patients at highest risk of CKD progression. Using this system, one Trust has reduced the number of patients starting dialysis by 16% and has the lowest percentage of patients presenting late for dialysis in the UK (associated with poor outcomes and greater cost). The involvement of a Patient Project Team (PPT) in this UK-wide quality improvement project is integral to spreading and sustaining this intervention.
Methods The PPT members all have personal experience of kidney disease and offer unique, invaluable insights. One member, a retired career banker, is helping develop a cohesive business case to local commissioners, enabling participating renal units apply for ongoing funding to support the intervention. Another shared his personal story of the impact late referral has had on his family, to practitioners at a project learning event. A locum GP who is also a dialysis patient, gives practical guidance on what happens, day to day in Practices which may impact the success of the project.
Discussion As a charity, we recognise that giving patients and carers a ‘voice’ in our many approaches to research, including quality improvement projects, means we have input from the people who matter most. Other projects can learn from our approaches to successful patient participation, including role descriptions for PPT members, payment and full integration of the PPT into project activities.
1036 A service evaluation of non-pharmacological health interventions to improve health outcomes in patients with poorly controlled diabetes.
Aims/objectives: To evaluate an innovative workshop for Pakistani patients with poorly controlled diabetes and make suggestions to develop further.content of presentation: a local CCG and a local BME health charity have collaborated with the local diabetes centre in developing a workshop to educate poorly controlled Pakistani patients. they were recruited from a specific locality in the CCG where there was a high diabetes prevalence. The workshop was evaluated by questionnaire and suggestions for change made based on the findings and a comprehensive literature review.
Relevance/impact: diabetes is increasing in prevalence, particularly in the south asian population. lifestyle interventions have been known to reduce morbidity in patients with poorly controlled diabetes.
Outcomes: 3 patients were recruited to the workshop. the questionnaire results suggested that the workshop was positively received, with improved awareness of diabetes, and also increased understanding of diet and exercise adjustments to improve quality of life.
Discussion: this workshop has shown to improve knowledge and attitude to diabetes in poorly controlled Pakistani patients. the main barrier identified was the small number of participants. measures to improve recruitment have been advised. based on the literature, an innovative workshop has been proposed which will explore diet and exercise measures further with practical interventions.
1038 Improving out of hours handover of the most frail and vulnerable patients
Aims To develop a “Special Message” for improved communication between routine and out-of-hours GPs, facilitating effective handover of frail and vulnerable patients.ContentA “Special Message” form was developed following a survey to all GPs working for the urgent care service (UCS). This was designed for handover of salient information regarding patients with an admissions avoidance care plan (AACP). Electronic integration of the will allow communication between systems, ensuring key information reaches clinicians irrespective of location or time of clinical contact.
Relevance/Impact Today’s NHS demands proactive, responsive care for frail and complex patients. Effective care planning is an essential tool in this process (NHS 5 year forward view). Access to care plans (already established in 2% local population) by urgent care clinicians can be limited. However, 69% of temporal GP access is not provided by patients’ own GPs. Access to information to allow out-of-hours clinicians to make appropriate and collaborative clinical decisions is essential.
Outcomes A survey of urgent care service GPs questioned the value and content of the “Special Message” (uptake 23%). Existing special notes are referred to by 100% of respondents. 30% have never referred to an AACP whilst working for the UCS. Results indicate that readily available information regarding functional status, resuscitation status, existence of current AACP and next of kin details would be valued.
Discussion A vignette of salient information made available to out-of-hours clinicians would be a valuable resource in managing complex and frail patients out of routine hours. A Special Message could be integrated into current IT systems, and would provide a powerful adjunct to information sharing for patients with an admissions avoidance care plan in place.
1039 Securing improvement together, through innovation, co-production, systems thinking and measurement
Our institute is a partnership between the university, all NHS organisations across the city and the city council, developing shared expertise in innovation and improvement across primary and secondary care, and a rigorous approach to professional accountability using data to explore variation to improve outcomes for patients, service users and communities.
The methodology we use, combines ideas from high-performing systems on practice and improvement and our strength in engaging with service-users, and working across health and social care organisational boundaries. Clinical Priorities are collectively selected where there is significant variation, involving citizens in decisions about their own care will secure better quality we can harness passion and enthusiasm within professionals for change.We bring together change agents across health and social care with an ethos of co-production, applying Quality Improvement theory and techniques, leadership and whole systems thinking.
Our work has yielded results having completed a first prototyping year in 2014/15. To date we are enabling health and social care professionals to create change across cardiology, COPD, fractured neck of femur, cancer, diabetes and dementia. Examples of Improvement work underway include the piloting of a falls clinic in Primary Care, improving self-management in diabetes and co-production with GPs to improve referral pathways for patients with CVD. We will further embed city-wide change through focusing on neighbourhood localities and Primary Care to ensure sustained improvements across the system have the maximum impact for service users and supporting our change agents to continue their work.