BMI Werndale Hospital Quality Accounts April 2013 to March 2014

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1 BMI Werndale Hospital Quality Accounts April 2013 to March 2014 Chief Executive s Statement Welcome to our Quality Accounts 2014, the fifth year we have published this data. The information presented here on a broad range of quality measures continues to grow in importance and usefulness for patients and commissioners. Quality accounts already provide a key metric for people to assess the strength of our 66 hospitals and clinics against other facilities - NHS and independent - from which they might receive their care. For BMI Healthcare and every other private provider the importance of comparable quality data was recently reinforced by the conclusions of the Competition Commission s market investigation into private healthcare. From the outset of the inquiry BMI Healthcare supported the principle that competition in the sector would be enhanced if private hospitals produced comparable quality data and that competition amongst hospitals would drive up service standards. We were therefore fully supportive when the Commission announced in April that it is mandating the provision of greater information on the performance of hospital operators and consultants. We wholeheartedly agree when the Commission says that a more transparent market with patients actively making choices will drive hospital operators to compete on the things that matter to patients. Whilst we are yet to see how the Commission will ensure that this is enacted, the private sector continues to take its own steps. Five years ago BMI Healthcare was at the forefront of the sector s efforts to be more open about sharing comparable quality and pricing data when we sponsored the launch of the Hellenic Project. Today that work has been superseded by the Private Hospitals Information Network which is working towards publishing data that will allow patients and commissioners to make informed choices - a challenge that the sector must now rise to. We at BMI Healthcare will continue to play our part in these important developments, which we believe can have a significant role in driving higher quality standards. I remain proud, but certainly not complacent, about the quality of care our hospitals provide. Last year BMI Healthcare invested 40m in our hospitals, supporting our committed staff and consultants to meet the challenge of providing consistently safe, high quality care. We constantly measure our patients experience, and I am pleased to note that in the three months to the end of March 2014, 97.3% of patients independently surveyed expressed satisfaction with their care and 97.9% said they would recommend us to others. There is however always room for improvement, and publication of comparable quality data across the independent sector can only help. The information available in these quality accounts has been reviewed by the Clinical Governance Board and I declare that as far as I am aware the information contained in these reports is accurate. I thank all the staff whose energy and devotion to improvement is represented here and, more importantly, in the experiences of every patient who steps across our threshold. Stephen Collier Chief Executive Officer

2 Hospital Information BMI Werndale Hospital is located in West Wales. The hospital serves the people of Carmarthenshire, Pembrokeshire and Cardiganshire, is easily accessible and parking is available on site. BMI Werndale Hospital has 27 beds with all rooms offering the privacy and comfort of en-suite facilities, satellite TV and telephone. The hospital has one operating theatre with laminar airflow a day care beds and a comprehensive outpatient department with minor surgery treatment area, X-ray, ultrasound, MRI, mobile CT and a physiotherapy department. The accommodation consists of 21 single en suite rooms and 3 en suite double rooms, which are designed to allow relatives to stay with the patient. We have recently had Wi-Fi installed into the ward area enabling patient s easy access. These facilities combined with the latest in technology and on-site support services; enable our consultants to undertake a wide range of procedures from routine investigations to complex surgery. This specialist expertise is supported by caring and professional medical staff, with dedicated nursing teams and Resident Medical Officers on duty 24 hours a day, providing care within a friendly and comfortable environment.

3 BMI Healthcare Werndale is registered as a provider with the Health Inspectorate Wales (HIW) under the Health & Social Care Act BMI Werndale is registered as a location for the following regulated services:- Treatment of disease, disorder and injury Surgical procedures Diagnostic and screening The HIW carried out an unannounced inspection on 28 TH March 2014 and measured outcomes relating to the following standards Patient Experience Clinical outcome Healthcare Governance Public Health All recommendations related to the above have been actioned and implemented, leading to an increased level of quality of care for the patients. BMI Werndale has a local framework through which clinical effectiveness, clinical incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to continuously improve the quality of care. This is through the work of a multidisciplinary group and the Medical Advisory Committee. Regional Clinical Quality Assurance Groups monitor and analyses trends and ensure that the quality improvements are operationalized. At corporate level the Clinical Governance Board has an overview and provides the strategic leadership for corporate learning and quality improvement. There is an appropriate structure of reporting and escalation in place to enhance the effectiveness of this group. There has been ongoing focus on robust reporting of all incidents, near misses and outcomes. Data quality has been improved by ongoing training and database improvements. New reporting modules have increased the speed at which reports are available and the range of fields for analysis. This ensures the availability of information for effective clinical governance with implementation of appropriate actions to prevent recurrences in order to improve quality and safety for patients, visitors and staff. BMI is a founding member of the Private Healthcare Information Network (PHIN) UK where we produce a data set of all patient episodes approaching HES-equivalency and submit this to PHIN for publication. The data is made available to common standards for inclusion in comparative metrics, and is published on the PHIN website This website

4 gives patients information to help them choose or find out more about an independent hospital including the ability to search by location and procedure. BMI Werndale is currently undergoing an ongoing programme of refurbishment which includes the following upgrades and replacements- Replacement of medical equipment in all departments New hand wash sinks throughout Patient room upgrades, replacing carpets with hard floors Patient room air-conditioning units BMI Werndale Hospital clinical team liaises with the local NHS Trust specialist groups in relation to Blood Transfusion, recording and traceability of blood and blood products. 1. Safety 1.1 Infection prevention and control The focus on infection prevention and control continues under the leadership of the Group Head of Infection Prevention and Control. There is a Director of Infection Control in the hospital that is accountable for the implementation of Infection Control Policies and IPC requirements. The Infection Prevention and Control Lead and Link nurses in BMI Werndale Hospital are responsible to ensure these are implemented appropriately. BMI Werndale Hospital We have had: - Zero cases of MRSA bacteremia in the last year (NHS 1.17cases/100,000 bed days). Zero cases MSSA bacteremia cases /100,000 bed days Zero cases E. Coli bacteremia cases/ 100,000 bed days Zero cases of hospital apportioned Clostridium difficile in the last 12 months. SSI data is also collected and submitted to The Welsh Healthcare Associated Infection Prevention Programme o Hips o Knees BMI Werndale Hospital has an annual programme of infection control audits which cover each department in the hospital, continuous monitoring ensures all actions have been implemented.

5 High impact Care Bundle audits cover Intravenous Cannulation, Hand Hygiene and Urinary catheter insertion and directives to prevent surgical site infection. Conducted by auditing of Findings have provided the evidence to change clinical practices to come into line with best practice guidelines. A programme of education related Aseptic Non-Touch Technique ANTT is currently underway in BMI Werndale and our Infection Control Lead Nurse is cascading throughout the clinical departments. Practical Hand Hygiene training is carried out annually and the process is audited on a there monthly basis, we consistently have 100% compliance, all new staff undertake an induction with the IPC lead, we have also undertaken training in local schools. Environmental cleanliness is also an important factor in infection prevention and our patients rate the cleanliness of our facilities highly. Bathroom Cleanliness

6 Room Cleanliness 1.2 Venous Thrombo-embolism (VTE) BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its whole network of hospitals including, BMI Werndale. BMI Healthcare was awarded the Best VTE Education Initiative Award category by Lifeblood in February 2013 and was the Runners up in the Best VTE Patient Information category. We see this as an important initiative to further assure patient safety and care. We audit our compliance with our requirement to VTE risk assessment every patient who is admitted to our facility and the results of our audit on this has shown we achieve 100% compliance on a regular basis. BMI Werndale reports the incidence of Venous Thromboembolism (VTE) through the corporate clinical incident system. It is acknowledged that the challenge is receiving information for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE post discharge from the Hospital. As such we may not be made aware of them. We continue to work with our Consultants and referrers in order to ensure that we have as much data as possible.. We have had no incidence of VTE during the year 2013/2014

7 2. Effectiveness 2.1 Enhanced Recovery Programme (ERP) Is an evidence based, multi-modal approach to care and all professionals are part of the patient s journey, without them all Enhanced recovery would not work. Enhanced recovery is a new approach to pre-operative, intra operative and post-operative patient care for those patients undergoing surgery. In simple terms; it improves the quality of care and supports patients to get better sooner after major surgery. BMI Werndale carried out 75 Hip replacements and 47 Knee replacements procedures over the last 12 months all patients were pre-assessed prior to admission and fully prepared for discharge following surgery. ERP is based on the following principles:- All patients are on a pathway of care Following best practice models of evidenced based care. Reduced length of stay Patient Preparation Pre-Admission assessment undertaken Optimising the patient prior to admission Commencement of discharge planning Proactive patient management Pre-operative carbohydrate drinks, ensuring good pre-operative hydration Minimising the risk of post-operative nausea and vomiting Maintaining normal temperature pre and post operatively Early mobilization Encouraging patients to have an active role in their recovery Participate in the decision making process prior to surgery Patient and Family education Setting daily goals Participate in their discharge planning

8 2.2 Unplanned Re-admissions within 31 days and unplanned returns to Theatre BMI Werndale had 1 readmission during 2013/2014 and 6 returns to theatre which were due to a clinical complication related to the original surgery. There is a full Theatre team available on an on call system 24 hours a day to provide access to theatre and prompt treatment. BMI Werndale Hospital had 6 unplanned transfers to local NHS Trust Hospital due to complications related to the original surgery. Graph below showing unplanned transfers to NHS Facilities, this has only been measured since January 2014.

9 3. Patient experience 3.1 Patient satisfaction BMI Healthcare is committed to providing the highest levels of quality of care to all of our patients. We continually monitor how we are performing by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third party. The questionnaire also asks how the patients rated their overall quality of care (which takes into account all area of their care and treatment as outlined below) This is measured across two caagories VERY GOOD and EXCELLENT Overall Rating of Qulaity of Care During the period October 2012 to October 2013 BMI Werndale Hospital received 331 completed patient questionnaires. All our staff are dedicated to providing the best possible patient care and patients are particularly appreciative of their efforts, 100% of respondents rated their Overall Quality of Care as good, very good or excellent. We asked patients to tell us if they were treated with respect and dignity at all times:- 100% said yes always We are proud to report that 100% said that we met or exceeded their expectation 99% said they would recommend BMI Werndale Hospital

10 On other key issues the patient ratings for the Hospital were as follows (all % good, very good or excellent) Overall impression of the arrival process 96.5% Overall nursing care 97.5% Consultant Surgeon 99.7% Diagnostic imaging 97.4% Physiotherapists 94.5% Pharmacy 97.4% Theatre staff 100% Accommodation 96.8% Catering 98.4% Discharge Procedure 96.7% 3.2 Complaints In addition to providing all patients with an opportunity to complete a satisfaction survey BMI Werndale actively encourages feedback both informally and formally. Patients are supported through a robust complaints procedure, operated over three stages: Stage 1: Hospital resolution Stage 2: Corporate resolution Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied with the outcome at the other 2 stages. There were 14 written complaints during 2013/2014, this has only been measured in this way since January 2014.

11 We ensure that all patients are given the information via the please Tell Us leaflet which outlines the complaints procedure. We ensure our complaints are readily available for HIW inspection as required. We make every effort to fully resolve complaints within 20 working days. 4. National Clinical Audits BMI Werndale was only eligible to participate in National Joint Registry audit and all joint replacements are submitted to this. BMI hospital data is from page 196 onwards in attached latest NJS report. Use this if appropriate with your narrative on the data and any improvement plans. 5. Research No NHS patients were recruited to take part in research. 6. Priorities for service development and improvement The following are our priorities from a clinical perspective To continue with the development of the Enhanced Recovery Programmme (ERP) with its positive outcomes for patient care, using the multi-disciplinary team To continue to develop the BMI Clinical Strategy this was launched during To continue to develop market and promote our services by working closely with our marketing team, hosting GP training days. To continue auditing our clinical practice and compliance with patient safety tools to improve the quality of service to our patients. Patient safety is the uppermost priority of BMI Werndale Hospital.

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