How mortality figures were a catalyst for change

Blackpool Victoria Hospitals Urgent Care Centre and (below) Medical director Dr Mark ODonnell.

Blackpool Victoria Hospitals Urgent Care Centre and (below) Medical director Dr Mark ODonnell.

Part one of The Gazette’s in-depth look at how The Victoria Hospital is implementing its strict action plan.

In light of the recent mortality figures, which show more people are dying at Blackpool Vic than expected, The Gazette has been invited to see what Blackpool Teaching Hospitals NHS Foundation Trust’s key departments are doing to improve them.

But while work is being carried out across the trust to reduce infection and the length of stays in hospital, as long as Blackpool has some of the worst health figures in the country and the lowest life expectancy, bosses say more people are likely to die at Blackpool Vic than anywhere else in the country.

Blackpool suffers the country’s lowest life expectancy, a high population of elderly people and high levels of deprivation.

It also has a high suicide rate among young men, increasing cancer levels and high rates of chronic illness.

So it’s no wonder Blackpool has been highlighted as having a higher-than-expected death rate in its hospital when compared with national figures.

Those figures are something Blackpool Victoria Hospital’s doctors are working hard to reduce, but with so many health issues blighting people in the resort, it’s going to be an uphill battle. The Vic’s medical director Mark O’Donnell says people dying in the Vic doesn’t reflect the care they are given in hospital.

He said: “Say 100 people in the country attend hospital with a heart attack and 10 of them die, you’re looking at a one in 10 change of dying from a heart attack in hospital. If, on average, more than one in 10 die that’s reported as a high Standardised Mortality Rate (SMR), therefore a high death rate.

“That’s what they’re looking at to compile these figures. It doesn’t necessarily have anything to do with the care they were given.

“We have the lowest life expectancy in the country, an elderly population and a lot of social deprivation and we have a high SMR.

“I think people don’t understand the difference between a high SMR and excess deaths. Our SMR is above average, but that doesn’t mean anything was preventable.”

Because of The Vic’s high mortality rate, it was brought to the attention of NHS England’s medical director Professor Sir Bruce Keogh, who carried out a massive review of the hospital along with 13 other hospital trusts.

Blackpool was saved from special measures, but was given a strict action plan to improve its services.

A&E consultant Simon Tucker said: “Keogh, for us, was a catalyst for change. Blackpool has a high number of people with chronic illnesses and to a certain degree that is going to impact on the mortality index for the hospital, so we’ve looked at how we are doing things and at certain processes that need to be improved.”

One of the major changes at The Vic is the introduction of new pathways of care, which track a patient’s journey from coming into hospital to their discharge.

In particular, successful pathways are those drawn up for pneumonia, sepsis and stroke.

Dr O’Donnell explains: “A pathway is a prescription of care throughout the whole of a condition, and ensuring that our patients get absolutely the best possible care.

“Over the past three months we have launched a pathway team, and have launched a pathway for heart attacks and we are drawing up another one for heart failure.

“What we do know is that when you are on a pathway, you do better.

“It’s about looking at specific areas of care within each condition. So far, in the sepsis pathway for example, we know patients who are given antibiotics early on do much better than they would if they had them, say, an hour later.

“We have a group of senior clinicians and experts to review all the best available evidence, pull it all together and say this is absolutely what we should be giving to everybody and we put that into the pathway.

“It’s all about the critical bits that we feel should be delivered.”

Dr O’Donnell said auditors go around the wards on a daily basis to make sure the pathways were being followed.

He added: “We have already found, particularly with the pneumonia pathway, that we are seeing improvements in the outcomes for these patients.

“Undoubtedly survival comes out of these pathways. Our pneumonia group has certainly seen a reduction in deaths.”

Hospital chiefs are also reviewing all areas conditions which people are known to die from, particularly pneumonia, sepsis, stroke, heart attack and heart failure.

“This is where we are seeing our biggest number of deaths and so this is where we could see our best results,” Dr O’Donnell said.

“There aren’t specific pathways for alcohol and drugs, and other issues in Blackpool, but they will feature in other pathways where they are the contributing factors of the illness.

“For example, somebody with a drink problem, a drug problem or someone who is a heavy smoker is more susceptible to pneumonia.”

Mr Tucker said the pathways were a result of the hospital’s advancing quality plan, which sets a standard of care for chronic illness and interprets performance against the ideal standard.

He said: “It includes a feedback mechanism which means all mistakes are reported to me and I talk to the member of staff about what they did wrong and what they should to do ensure it doesn’t happen again.

“Sepsis and pneumonia are two of our biggest killers in the hospital, so when a patient presents with these conditions we make sure that within four hours they have had the necessary tests in the emergency department.

“It’s important that we do this, and it brings about change in the process.

“This is all for the patients’ benefit. Everything is happening in a more structured way in an appropriate time which reduces delays and improves patient management. Their length of stay in hospital is reduced and their recovery improves.

“We’ve seen a huge improvement – phenomenal.”

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