Outline SE Neonatal ODN data and trends Term admission audit 2015: - - PowerPoint PPT Presentation

ATAIN

• experience from South East Neonatal ODN

Vanessa Attrell Neonatal Network Manager 17th October 2018

South East Neonatal Operational Delivery Networks Hosted by Medway Foundation Trust

Outline

• SE Neonatal ODN data and trends
• Term admission audit 2015: process & results
• NHSE CQUIN 2015/16: process & results
• NHS South: collaborative working 2017/18
• 2018/19: ATAIN Improving Value scheme
• What can we do to avoid term admissions?
• Joint & collaborative working to share best

practice in reducing term admissions.

SENN data for 2010/11

• SE average rate of term admissions to live births 5% (variation

2-9%) includes NNU and TC:

• National Neonatal Audit Programme(NNAP) 2011

SE units rate of term admissions into NICU to live births 3-5% national average 4%.

• SEC % of admissions that were term babies:

Inborn, booked, 1st episode average 55%(43-66%)

• NDAU data national average admissions

2010/54% 2011/57% SEC 2010: 43-66% 2011: 47-70%

Work in 2011/12

• NHS Outcome Framework 2011/12: indicator 5.5.

Improving the safety of maternity services

• Shared the data widely with the Neonatal

Networks, SHA Maternity lead, Heads of midwifery, PCT maternity commissioners.

• Introduced 2 year QIPP programme with

measures to monitor term admissions.

• Neonatal data & analysis, presented at Neonatal

Network Boards.

• Undertook Transitional Care scoping process,

engaged with Trusts to produce SEC TC criteria.

SENN data 2013 – 2014

• July 2014 NHSE published national data.
• SE replicated NDAU data analysis
• Top reason for admission: Other 28% of babies
• Immediate request to Trusts to stop using ‘Other’ as a

reason for admission.

• SEC Respiratory 19% national data 30%
• SEC Infection 24% national data 9%
• SEC Hypoglycaemia10% national data 10%
• Suspected/confirmed infection appeared to be our

biggest problem.

SENN next stages: 2015 / 16

• September 2014, applied to the SEC Maternity SCN to

support a joint audit in 2015 on Term Admissions; based on the information we knew on the top five reasons for

• admission. The proposal was supported in January 2015,

audit across all Trusts June – August 2015.

• November 2014 several network members joined the national

work groups for reducing term admissions.

• Followed up with Trusts who were using ‘Other’ as a reason

for admission. ‘Other’ was removed from BadgerNet in January 2015 as a result of the national data report.

• Introduced additional graphs to the SEC Monthly reports for

2015/16 to raise awareness in teams on term admission numbers.

Network Monthly Quality Report 2015-16

Network Monthly Quality Report 2015-16

NHSE QIPP 2014-16 & CQUIN 2015/16

Collaborative working with NHSE area team & SE Neonatal Network

• Two year programme.
• Aim to reduce avoidable

admissions and increase term babies receiving care beside their mother.

• 2014/15 TA into NNU 53%

& beside mothers 47%

• 2015/16 TA into NNU 48%

& beside mothers 52%

• Increase of 200 babies

receiving care beside their mothers; with a decrease in LoS from 2.6 to 2.4 days.

• Rate of admissions to births

remained the same at 8%

• National CQUIN developed by NHSE.
• Maternity & neonatal leads had to review

all TA into NNU each month & report.

• Trusts were asked to identify avoidable

admissions and put process in place to manage these babies.

• 7 out of 11 Trusts participated
• One Trust introduced BAPM NEWTT
• One Trust implemented the Bobble Hat

Care bundle, based on a traffic light triage system. This was a joint project with maternity and neonatal staff with excellent results

• Another Trust established a

Hypoglycaemia Pathway that has been adopted across the SE NN.

What did we do about it?

• Created the Bobble Hat Care Bundle

– Every baby receives a bobble hat straight away after birth following a clinical assessment. – A way of assessing mother and baby holistically to identify those families who require extra support following delivery – RAG rated – Bobble Hats knitted by the local community and local Guide Group produces bobbles. – Presented at several national conferences and a Parliamentary meeting

Audit Results & learning: 1115 term admissions, 880 forms returned, 79% compliance rate.

Reasons National 2011-13 SEC 2013/14 SEC 2014/15 SEC 2015/16 SEC Audit 2015 Infection 9% 24% 25% 40% 36% Respiratory 30% 20% 20% 16% 20% Hypoglycemia 10% 10% 10% 12% 11% Jaundice 5% 6% 6% 6% 9% HIE 3% 1.7% 1.3% 1.6% 4% Poor Feeding 3% 3% 2% 2% 2%

Network Audit Results

Avoidable

• 72 babies (8%)
• Poor feeding
• Weight loss
• Social
• 257 days
• Potentially 1000

days a year

0bservation only

• 60 babies (7%)
• HIE/Asphyxia
• Maternal drug use
• Respiratory
• 231 days
• Potentially 900 days

a year could be beside mother

Audit Recommendations: Jan 2016

• Review the clinical management of avoidable

babies with Obstetric and Midwifery colleagues

• Review the Observation only babies; do they

require observation on the NNU?

• Review local guidelines on Infection and

Jaundice in accordance with NICE guidelines

• Share good practice and learning from audits
• Introduce a risk management tool: BAPM

NEWTT or Royal Surrey Bobble Hat Care bundle.

Regional ATAIN scheme 2017/18

• South Region Neonatal Networks Forum established, led by

NHSE South Clinical Director Specialised Commissioning.

• First meeting in June 2016, data analysts produced table to

show term admission rate into NNU against births and term admissions into NNU as a % of NNU admissions.

• Variation: TA into NNU 2-12%; % of admissions that were term

babies on NNU 38-70%.

• Feb 2017 agreed a South Region ATAIN Improving Value

scheme for 2017/18 applicable to all Trusts.

• Agreed target: below 6% rate of term admissions into NNU.
• NHS South ATAIN Dashboard: produced by South West
• Monthly Highlight progress reports to NHS South.

What we did in 17/18 across the South to achieve the target

• All Trusts to have named ATAIN leads;

maternity, obstetric, neonatal medical & nursing.

• Monthly graph to all ATAIN leads
• 2-3 monthly newsletter update
• Posters
• Engaged with LMS groups, Maternity Network,

AHSN, Safety collaborative.

• Encouraged sharing of local initiatives to

enable wide scale change.

SEC Monthly ATAIN graph 17/18

100 200 300 400 500 600 0% 5% 10% 15% 20% 25% Live births % of live births

ATAIN: Term Admissions % of live births target 4% for 2017/18

Term Admissions % of live births Term admissions into NNU % of live births Term Admissions target Term Admissions into NNU target

SEC Births v Term Admissions

200 400 600 800 1000 1200 1400 1600 1800 20 40 60 80 100 120 140 160 180 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2014/15 2015/16 2016/17 2017/18

Births

Admissions

Births v Term Admissions Quarterly Tracker

All Term Admissions Term Admissions into NNU Births

2017/18: South

% of admissions into NNU

1 2 3 4 5 6 7 South West Thames Valley Wessex South East Coast East Midlands Q1 Q2 Q3 Q4

14/15 15/16 16/17 17/18 (to Sept 17)

ATAIN South Dashboard 2017/18

Live Births All Live births delivered within the trust area (includes all gestational ages) Term Admissions ≥37 weeks gestation, 1st episode of care only, NNU as location

• f care for any part of the neonatal episode (includes cardiac

and surgical babies) Principal Admit Reason Total number of term admissions for each of the 6 most common principal admission reasons HRG 3-5 Only NNU 1 Day: Total number of term admissions receiving only HRG3-5 level care throughout neonatal episode with location

• f care NNU for 1 day only

NNU >1 Day: Total number of term admissions receiving only HRG3-5 level care throughout neonatal episode with location

• f care NNU for >1 day

Did we achieve our target?

Yes

NHS South ATAIN 2017/18

4.5% 5.3% 5.8% 4.2%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

TV W SW SEC

SENN Livebirths 2011-2018

50000 51000 52000 53000 54000 55000 56000 57000 58000

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

SENN Term admissions all areas 2011 - 2018

500 1000 1500 2000 2500 3000 3500 4000 4500 5000

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

East Midlands data

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 2014/15 2015/16 2016/17 2017/18 (to Sept 2017)

Term admissions to NNU (as % live births)

NICU LNU SCU Network

What made a difference in 2017/18

• NHS South ATAIN programme
• South ATAIN Dashboard
• Participation from clinical teams
• Maternity & obstetric involvement through

the Local Maternity System & Maternity Network.

• Acknowledgment this is not a ‘neonatal’

problem

• Maternal & Neonatal Health Safety

Collaborative; sharing of initiatives

National ATAIN scheme 2018/19

• National target below 6% by March 2019
• NHS South target below 5% by March 2019
• All Trusts should review South ATAIN Dashboard

each quarter; if your rates are increasing audit & review term admissions; national form for audit.

• E data collection form for Livebirths
• Exception reporting if above 5%

What have we learnt?

• Work together to make

the changes needed to keep mums & babies together.

• Involve infant feeding

team.

• Skin to skin
• Education; use the e-

learning module

• Know your highest

reason for admission

• Safety huddles
• Changes to Jaundice

referral Pathway; use of bilirubin meters; seen and assessed by midwives

• Start AB’s in delivery

suite; avoid NNU.

• Delivery packs with

hats.

• Gestation awareness

for planned sections

• Address delivery room

temp if necessary.

SEC NN 2011/13 High numbers of term admissions: Atlas of Variation NHSOF Network data Established reporting Clinical engagement SEC NN 2014/16 Levers for change: QIPP CQUIN Audit Measuring progress NHSE Safety lead National focus on reducing term admissions started in 2014 Safer Maternity Care Oct 2016 SEC NN 2016/17 Increased no of babies beside mothers Regional networking ATAIN part of national agenda Sharing local initiatives

2017/18

• nwards

NHS South ATAIN Programme of care Improving value

SEC NN Wider clinical engagement Trust ATAIN leads Commitment to Right Care, Right Place

ATAIN – network approach to change

Acknowledgements:

• Dr Aung Soe – SE NN Clinical lead
• Dr Peter Reynolds – SE NN Clinical lead
• Martin Webb – SEC NN Data administrator
• Pippa Griew – SW NN Data analyst
• All South Network Managers & clinical leads
• Royal Surrey County Hospital team & slide
• Contact details: vanessa.attrell@nhs.net