Sepsis and CQUINs Celia Ingham Clark Medical Director for Clinical - - PowerPoint PPT Presentation

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Sepsis and CQUINs

Celia Ingham Clark

Medical Director for Clinical Effectiveness NHS England

February 2019

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• Purpose is to incentivise improvements in clinical quality
• A small %age of the standard contract value is withheld and
• nly paid if certain criteria are met
• They work best where existing performance is already 40-60%
• Need valid and reliable and simple measurement - usually

process measures

• Example of VTE CQUIN

CQUINS: Clinical QUality INcentive Scheme

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• From Sepsis Six selected first dose antibiotics as key measure
• used clinical assessment for suspected Sepsis in high risk

groups (NEWS2) to identify cohort for measurement

• initially ED only
• added in-patients who deteriorate
• linked with AMR to ensure 3 day review and minimise

inappropriate antibiotics

• Right treatment, right person, right time

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Sepsis CQUINs

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Screening performance over time: ED

40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2 1 5 1 6 Q 1 2 1 5 1 6 Q 2 2 1 5 1 6 Q 3 2 1 5 1 6 Q 4 2 1 6 1 7 Q 1 2 1 6 1 7 Q 2 2 1 6 1 7 Q 3 2 1 6 1 7 Q 4 2 1 7 1 8 Q 1 2 1 7 1 8 Q 2 2 1 7 1 8 Q 3 2 1 7 1 8 Q 4 2 1 8 / 1 9 Q 1 2 1 8 / 1 9 Q 2 % of patients screened for sepsis

Proportion of emergency patients screened for sepsis having met the appropriate criteria from Quarter 1 2015/16 to Quarter 2 2018/19 The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data

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Treatment performance over time: ED

40.0% 45.0% 50.0% 55.0% 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 2 1 5 / 1 6 Q 1 2 1 5 / 1 6 Q 2 2 1 5 / 1 6 Q 3 2 1 5 / 1 6 Q 4 2 1 6 / 1 7 Q 1 2 1 6 / 1 7 Q 2 2 1 6 / 1 7 Q 3 2 1 6 / 1 7 Q 4 2 1 7 / 1 8 Q 1 2 1 7 / 1 8 Q 2 2 1 7 / 1 8 Q 3 2 1 7 / 1 8 Q 4 2 1 8 / 1 9 Q 1 2 1 8 / 1 9 Q 2 % of patients screened for sepsis

Proportion of patients that received intravenous antibiotics within 1 hour of arrival at Emergency Departments (Q2 2015/16 to Q2 2018/19)

*The dashed line refers to the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1 hour

• f arrival for emergency departments.

The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data

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Screening performance over time: Inpatients

40.0% 45.0% 50.0% 55.0% 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 201617 Q1 201617 Q2 201617 Q3 201617 Q4 201718 Q1 201718 Q2 201718 Q3 201718 Q4 % of patients screened for sepsis

Proportion of inpatients screened for sepsis having met the appropriate criteria from Quarter 1 2016/17 to Quarter 2 2018/19 The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data

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Treatment performance over time: Inpatients

40.0% 45.0% 50.0% 55.0% 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 2016/17 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q42017/18 Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 % of patients screened for sepsis

Proportion of patients that received intravenous antibiotics within 1.5 hours of recognition of detioration at Inpatient Departments (Q1 201617 to Q2 201819)

*The dashed line refers to the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1.5 hours of recognition of deterioration within inpatient departments.

The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data

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Outcome of 72 hour review

10 20 30 40 50 60 70 80 90 100 2016/17 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2017/18 Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 Percentage

Available from PHE AMR Fingertips https://fingertips.phe.org.uk/profile/amr-local-indicators

72h review Stop / IV / change IV AB Stop IVOS

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• The rate of inclusion of patients in ED as being at high risk of sepsis and

rate of exclusions very varied between trusts

• The trusts with electronic recording of vital signs and electronic

prescribing and drug administration systems are able to understand their data completely (thousands of patients not small samples, and no additional work in collecting the data)

• It is estimated that just from the sepsis CQUIN sample population at least

1000 deaths from Sepsis have been averted over the past three years

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Other learning from the Sepsis CQUIN

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• Systems for prompt recognition and treatment of sepsis have moved into standard

contracts from 2019

• No specific sepsis CQUIN for 2019/20 but anticipate something on AMR
• Opportunity to design potential CQUINs for following year that address:
• A significant problem that affects many patients
• Where the methodology has been tested in the real world already and shown

to make a difference in at least one Trust

• Where there is a straightforward and simple process measure, ideally based
• n data that is already routinely available
• Where there is some evidence that around half of trusts are already

achieving the standard set

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Where next?

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• To design and test potential candidates for 2020 CQUINs relating to

sepsis and AMR

• How about something on source control [the process of identifying

common presentations of sepsis where there is a focus of infection that requires source control e.g. drainage of an abscess]

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The challenge

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Thank you for listening