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PQIP Newsletter - 6 July 2018

06/07/2018


Dear <<First Name>>,

Welcome to the July 2018 edition of the PQIP newsletter. In this month's newsletter:

Collaborative events - massive thanks!
Please review your PQIP team members and leadership
Please lock your records!
Annual report
Sharing your local data
Dealing with local challenges
Robotic prostates OUT, complex orthopaedics IN!
Are we collecting the 'right' data? Your chance to feedback to us
Improvement opportunity focus: a 'how-to' guide for managing preoperative anaemia
pomVLAD sub-study launches!
Send us your stories
And finally ... please tell us how to run next year's collaborative events

Collaborative events - massive thanks!

Thank you all for your support and engagement at the recent collaborative events in London and Manchester. Over 250 PQIP collaborators attended the events which were fun and full of positive energy.

You can access all the PowerPoint talks we delivered here. In particular, you might want to look at (and potentially deliver locally yourself) the talks on how to make the most of your PQIP data, quarterly reports and the web tool. Do shamelessly steal these presentations to talk to your teams – pretty please!
Please review your PQIP team members and leadership

When you joined PQIP we asked you to provide a surgical, anaesthetic, management and improvement lead. It’s fine for people to double up in these roles as appropriate, but we really recommend that you identify people in your department who are engaged and interested in PQIP and improving quality of care and outcomes to take these important roles. In particular, having an engaged surgeon and an engaged manager (clinical or non-clinical) is really crucial. Please take this opportunity to review who is doing the work locally and let us know about any changes you want to make.
Please lock your records!

Please remember to lock your records on the web tool as soon as possible after patients leave hospital so we can send you your summary data in the quarterly reports. You do not need to wait for completion of post-discharge 6 and 12 month follow up data in order to lock your reports – you or the patient will still be able to complete these at 6 and 12 months while the record is locked.
Annual report

Just in case you missed it, our annual report can be accessed here.

We have highlighted five top improvement priorities nationally. You and your team should choose which areas you want to focus on, based on your local results, but we respectfully suggest you start with these, as they are:
  • Achievable
  • Important to patients
  • Linked with improved outcomes
We are emailing the reports to your CEO and Medical Directors and thanking them for your contribution. Another good reason to make sure that your local leads have capacity and interest to fulfil their important roles.

We have changed the format of our quarterly reports to help you with this. The most recent quarterly reports were issued at the beginning of June. Please send us feedback on PQIP reports and dashboards by emailing your comments to the PQIP Helpdesk. After you have logged in, your local report can be accessed from the Reports tab on the PQIP website.
Sharing your local data

Please don’t hide your PQIP data in a corner! You’ve worked so hard to collect it, please share the news with your colleagues, otherwise the whole exercise is a bit pointless :-(

Our top tips for circulation include:
  • Store it on your department’s shared server and then send a WhatsApp or other quick departmental message signposting colleagues to where they can find it
  • Forward the report by email (or if you are lucky enough to have a departmental administrator, ask them to do it!). If you are a surgeon, please make sure you do this for your anaesthetic colleagues and vice versa
  • Print and stick your infographic up in coffee rooms, theatre suites, toilets and kitchens
  • Use the PowerPoint slides to present at your next team / governance meeting
  • Talk to your colleagues about a couple of key improvement opportunities at the theatre team brief or during a quiet moment in theatre or clinic.

Dealing with local challenges

We know that some local investigators are having a slightly difficult reception when they present their local data. Some top tips here for dealing with challenges and queries:
  • Someone senior needs to distribute and present the data, or at least they should be present to support a junior member of the team in face-to-face presentations. Ideally it should be the PI or one of the other local leads. It is great for a junior member of the team to do a presentation, but please ensure that someone more senior is there to support them to deal with questions and challenges
  • Remember that the focus at the moment is on improving PROCESSES not necessarily looking at outcomes. We do not yet know if each individual hospital’s sample is representative of their whole population (but we will do in due course through linkage to HES and ONS data). However, even if the sample is not representative, it is reasonable to aim for high compliance with our suggested evidence based processes (eg enhanced recovery compliance, anaemia management, HbA1C measurement etc)
  • To that end, the outcome data (complications, PROMs etc) are currently provided as raw data – not adjusted for patient risk factors. This will come in due course, as will raw and adjusted mortality data
  • We are not interested in comparing every hospital against each other using funnel plots or RAG tables. We are interested in celebrating the successes of hospitals who have high reliability processes. Hence our “Positive Deviance” section at the end of the report. The comparison with national averages on each graph or table is provided for interest (people always want to know this information!)
  • Be positive in the way you present your data. Even if it all looks terrible try to emphasise opportunities for improvement and anything where you are doing well.
Do let us know about your experiences with presenting or sharing your local data – it is really valuable to us to be able to accumulate knowledge about the successes and challenges you are having locally.
Robotic prostates OUT, complex orthopaedics and plastics IN!

We would like to clarify a couple of dataset / inclusion queries:

Patients having a planned robotic prostatectomy are not eligible for inclusion. This is because they are usually discharged within 24 hours of surgery and therefore do not really fulfil the broad ‘spirit’ of the types of surgery we are including – eg procedures which are likely to have a significant length of stay and have a substantial risk of perioperative complications. If you have already recruited patients who are having robotic prostatectomies, don’t worry, no action required (follow them up as normal) but please don’t recruit anymore!

However, we have expanded our inclusion criteria to include complex orthopaedics (revision joints and complex spinal surgery) and complex plastic procedures. Please go to the list on the study documents section of the website for further information.
Are we collecting the 'right' data? Your chance to feedback to us

We used the collaborative events to engage with you about possible changes to the dataset. Just in case you missed them…

We’re thinking about adding questions about:
  • Management of anaemia pre-op
  • Transfusion peri-op
  • Anaesthetic technique (TIVA vs Inh)
  • More detailed definitions of complications to be completed on discharge from hospital
  • Some stuff about opioid and other strong analgesic prescribing.
What are your thoughts? What are we missing / what do you think we could drop from the dataset? Take a minute (literally one) to email us your thoughts – we want the data to be useful to you, so let us know what you think.
Improvement opportunity focus: a 'how-to' guide for managing preoperative anaemia

Detection and management of preoperative anaemia is one of PQIP’s top priorities for 2018-19. There is a simple ‘how-to’ guide for developing an anaemia management pathway on the PQIP website. Do also look at the PQIP annual report and contact hospitals who are doing well with preoperative anaemia management.
pomVLAD sub-study launches!

A new embedded PQIP project has launched. The Post-Operative Morbidity Variable Life-Adjusted Display project (pomVLAD) is being led by PQIP Fellow James Bedford, and provides continuous near real-time risk adjusted data to help hospitals monitor morbidity and improve their processes and outcomes through focus on an evidence-based enhanced recovery bundle. Ten PQIP hospitals across the country are taking part in this exciting pilot, which if of benefit, will be rolled out to all PQIP hospitals in due course. Follow updates on the project blog at www.pomvlad.blog

Send us your stories

We are really keen to spread good news. Here is a vignette from the Royal Salford Hospital about how PQIP has been working locally.

At Salford Royal NHS Foundation Trust, we were lucky to be one of the early adopters of PQIP. We are a large teaching hospital based just outside Manchester.Across Greater Manchester we are the Major Trauma Centre, a tertiary neurosurgical and complex spines centre, one of two nationally funded intestinal failure centres and are due to acquire all the major upper gastrointestinal surgery.Salford is one of the four sites identified for acute major abdominal surgery under the Healthier Together initiative, and also undertakes major pelvic urology surgery.

Click here to read the full story
And finally ... please tell us how to run next year's collaborative events

Here are some photos to the collaborative events. Please give us your thoughts on what we should do next year by casting your vote on the options below:
  • Same same: Two events in London and Manchester
  • Big splash: One event in London
  • Big splash plus smaller ripples: One event in London plus several regional events (likely linked to other national (probably surgical) meetings – e.g. ACPGBI, BAUS, Preop Association, etc.
Thanks for your support – keep up the brilliant work!
That's it for now folks. Please follow us on Twitter @PQIPNews andget in touch with any queries. Have a great week!

The PQIP Team
"Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible."
Francis of Assisi
Copyright © 2018 PQIP, All rights reserved.

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