Introducing NQAIS: Improving Clinical

Performance

National Patient Safety Conference

Dublin Castle Thursday 26th October 2017

Kenneth Mealy National Clinical Programme in Surgery

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Why measure performance?

• Performance management o Process of care

o Bed management

o Cost/Pricing - HPO

o Quantity/Quality Indicators of outcome

• Demographic changes o Societal needs

o Planning configuration of services

• Professional responsibilities o Self reflection

o Clinical Audit

Dschrg per

Age Grp AvLOS InPat Dschrg BDU 000's Pop

85up 14.03 32,422 454,812 611.7

75-84 11.26 65,520 738,015 390.0

65-74 8.79 66,472 584,137 209.0

16-64 4.72 277,800 1,310,992 90.3

05-15 2.80 27,818 77,819 39.8

0-4 4.63 46,162 213,819 127.5

All 6.55 516,194 3,379,594 110.3

2013 Actuals from HIPE

Age profile change pushes AvLOS up Population increase pushes # inpat. up

Dschrg per

Age Grp AvLOS InPat Dschrg BDU 000's Pop

85up 14.03 105,830 1,484,575 611.7

75-84 11.26 168,480 1,897,753 390.0

65-74 8.79 136,916 1,203,175 209.0

16-64 4.72 332,681 1,569,987 90.3

05-15 2.80 29,648 82,937 39.8

0-4 4.63 44,759 207,322 127.5

All 7.88 818,314 6,445,749 110.3

2042 Pop changes on 2013 metrics

Will increasing population age impact on capacity?

Note: Population is growing and aging AvLOS increases with age band # discharges per 000 of population increase with age

NCPS use HIPE data for reports 4

Inpat # 69,391 DC # 121,053 Total # 190,444 % DC 63.6%

Dublin North East % of Nat 17.0%

West & NW % of Nat 18.1% Inpat 10,187 AvLOS 6.10

Inpat 13,596 AvLOS 5.13 DC 22,182 %DC 68.5%

DC 20,798 %DC 60.5% All 32,369

All 34,394

Dublin Midlands % of Nat 15.3%

Inpat 11,027 AvLOS 6.88

DC 18,194 %DC 62.3%

All 29,221

Mid West % of Nat 6.7%

Inpat 4,908 AvLOS 5.69 Dublin East % of Nat 21.5%

DC 7,912 %DC 61.7% Inpat 15,460 AvLOS 5.97

All 12,820 DC 25,437 %DC 62.2%

All 40,897

South & SW % of Nat 20.1%

Inpat 13,098 AvLOS 5.66

DC 25,185 %DC 65.8% Peadiatric Group % of Nat 1.3%

All 38,283 Inpat 1,115 AvLOS 6.14

DC 1,345 %DC 54.7%

All 2,460

(All)Nationally

General Surgeon discharged from All Model types in 2015 (Both those who had surgery & did not have surgery) HIPE 2015 – Clinician specialty 2600 - General Surgery, 2602 - Gastro Intestinal Surgery, 2603 - Hepatobiliary Surgery, 2604 - Vascular Surgery, 2605 -

Breast Surgery

Pop: 745,379

Pop: 330,315

Pop: 911,381

Pop: 974,514

Pop: 737,527

Pop: 889,126

Pop: 4,588,252

Elective Surgery – Bed Day Usage

2017

19,075

Acute Surgery - Bed Day Usage

2016

73,104

Acute General Medicine discharges in 2015 Inpat # 111,317 DC # 90,554 Total # 201,871 % DC 44.9%

Dublin North East % of Nat 15.8%

West & NW % of Nat 20.9% Inpat 16,742 AvLOS 8.86

Inpat 22,215 AvLOS 7.52 DC 15,116 %DC 47.4%

DC 20,006 %DC 47.4% All 31,858

All 42,221

Dublin Midlands % of Nat 14.2%

Inpat 22,011 AvLOS 9.37

DC 6,683 %DC 23.3%

All 28,694

Mid West % of Nat 10.4%

Inpat 8,657 AvLOS 8.14 Dublin East % of Nat 21.8%

DC 12,243 %DC 58.6% Inpat 22,360 AvLOS 7.53

All 20,900 DC 21,738 %DC 49.3%

All 44,098

South & SW % of Nat 15.9%

Inpat 17,741 AvLOS 8.30

DC 14,348 %DC 44.7% Peadiatric Group % of Nat 1.0%

All 32,089 Inpat 1,591 AvLOS 3.87

DC 420 %DC 20.9%

All 2,011

Nationally

Pop: 745,379

Pop: 330,315

Pop: 911,381

Pop: 974,514

Pop: 737,527

Pop: 889,126

Pop: 4,588,252

NCPS use HIPE data for reports

Medicine – Elective Admission

2016

31,973 BDU

PreAvLOS 0.2 – 1.2 hospital 0.2 – 2.7 consultant

Appendicectomy

2016

Hospitals

Hospitals

Hospitals

NQAIS Measuring Clinical Performance

• Individual

o Allows assessment of individual

performance

• Self-reflection

o Audit component of

Professional Competence

Scheme

• National

o National Reporting and

Benchmarking

o Pricing - HPO

• Hospitals

o Performance Metrics for

Medicine and Surgery

o Comparative figures for

diagnoses and procedures

o Supports efficient bed day usage

o Demand/Capacity planning