Quality Assurance (London) Abdominal Aortic Aneurysm Screening SQAS (London) Network Day 27 November 2015 Jan Yates Regional Head of QA,SQAS(London) Public Health England is responsible for the NHS Screening Programmes
Housekeeping • Fire exits – no drills planned • Mobile phones etc. silent • Wifi: hesura • Toilets • Breaks at 11.30, 1pm • Close 4pm • Active, learning style • Hopefully fun! 2 Presentation title - edit in Header and Footer
AAA Network Day Aim To improve quality through the achievement of national pathway standards across all London AAA Screening Programmes Objectives • To support London programmes in the delivery of safe and effective screening to their populations • To provide a forum for disseminating knowledge and sharing good practice on relevant topics Programme Highlights • National and regional overview of AAA Screening – successes and challenges • Define national training requirements for AAA personnel • Focus on key roles and responsibilities within AAA screening teams • Establish vigorous and standardised reporting for London AAA screening 3 London AAA Screening Programme Network Day 27 November 2015
Icebreaker - Month of birth - One hobby or pastime - Your role in the AAA programme 4 Presentation title - edit in Header and Footer
NHS AAA Screening Programme AAA screening is making a difference to the health of men in England and London NHS AAA Screening Programme should It is estimated that reduce ruptured 4 out of 5 men AAA mortality with a ruptured AAA by up to 50% will die before getting to hospital or fail to through early survive emergency detection, appropriate surgery monitoring and treatment 5 1 Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ, 2009, vol./is. 338/(b2307), 0959-535X;1468-5833 2 Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm. A report from The Vascular Society March 2012
National AAA Screening Programmes Total 41 Cohort men 2014/15 London 5 34,633 North 8 85,205 South 11 79,688 Midlands 17 94,723 and East NHS AAA Screening Programme 2014/15, www.gov.uk/topic/population-screening-programmes/abdominal-aortic- 6 aneurysm
AAA National and Regional- similarities Uptake Timely % of subjects about Referrals with AAA ≥5.5cm 8 in 10 97% referred within men who one working day receive a letter attend Self Men screened Referrals with an outcome 1 in 10 of an aneurysm ≥3cm screened men made detected 1 in 100 1 st contact 7 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data
AAA National and Regional-variations AAA-PS-2: % Percentage of eligible subjects who are tested (Coverage) 90.00 80.00 70.00 60.00 50.00 Coverage % 40.00 30.00 20.00 10.00 0.00 1 2 3 4 5 London England London AAA programme AAA Screening Programmes Acceptable ≥75% Achievable ≥85% 8 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data,
AAA National and Regional-variations % of men eligible for abdominal aortic aneurysm screening who had an initial offer of screening in London by area (2013/14) London achieved better proportions than England in inviting men for screening however, there are Compared to London areas in London where more men did not benefit from a screening offer compared with the rest of the region http://www.phoutcomes.info 9 http://www.fingertips.phe.org.uk/
AAA National and Regional-variations AAA-PS- 12: % of subjects with aorta ≥5.5cm seen by vascular specialist within 2 weeks. 160.00 Highlights data 140.00 quality issues 120.00 100.00 80.00 London AAA programme % 60.00 Acceptable >90% 40.00 Achievable >95% 20.00 0.00 1 2 3 4 5 London England AAA Screening Programmes Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data, 10
AAA – The Journey So Far 2009 2013-2015 On-going Full service roll-out National Developments and and established implementation of improvements abdominal aortic national policies and -Utilise local, regional intelligence to quality standards aneurysm (AAA) review screening pathway standards screening (6 areas) -Start of the process of developing new NICE guidelines on diagnosis and management of AAAs Development of QA Prioritisation process, Self- assessment, Desk top review of self- assessment and evidence, External quality assurance review. QA Visit pilots roll-out 2014-2015 11 London AAA Screening Programme Network Day 27 November 2015
Successes detected more than 10,000 aneurysms requiring monitoring referred and more than treatment 1.3 million 2,500 men men invited for treatment for large aneurysms Large preventing aneurysms premature perioperative deaths in mortality rate men aged 65 <1.5% years and over one millionth 65-year-old man screened Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data 12 https://phescreening.blog.gov.uk/2015/11/11/hear-all-about-it-aaa-screenings-successes-and-challenges/
Challenges Data reporting Accountability Timely requires treatment of consistency in large resource aneurysms allocation for impacted by up QA image to 4 months review (CST) delay in and clinical elective non- leadership screen detected aneurysms Establishing >20% of surveillance invited men thresholds for decline or rupture risk, DNA and this mortality and is associated other Screening with social outcomes technician deprivation staff low retention (London ONLY) Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data 13 https://phescreening.blog.gov.uk/2015/11/11/hear-all-about-it-aaa-screenings-successes-and-challenges
Timely Treatment of Large Aneurysms Taking into account patient choice • 20 programmes (49%) reached the acceptable threshold and of those, 5 programmes (12%) reached the achievable threshold Taking into account both patient choice and patient comorbidity • 34 programmes (83%) reached the acceptable threshold and of those 15 (37%) reached the achievable threshold Taking into account patient choice and comorbidities • 7 programmes (17%) have yet to meet the acceptable threshold- 2 of these are in London 14 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data
AAA Current and Future work Quality Data reporting Communication Improvements • KPIs Standard letters Regional • Improving Nurse 2015/16 - AA1: familiarisation visits specialist role Completeness of • Reducing treatment Offer National Helpdesk delays 2016/17- 3 new KPIs • National study to All external queries – Guidance on ascertain whether our effective from 1 April threshold for referring reporting death 2015; men for surgery is at PHE.screeninghelpdesk Regional work on the right level @nhs.net • Incident reporting identifying and • Regional feedback on • QA visits Phase One improving on data enquiries and PACA training quality Executive summaries • Screener training and of QA visit reports will retention be published on the • CST role GOV.UK website • Reducing inequalities 15 London AAA Screening Programme Network Day 27 November 2015
Improving Access and Reducing Inequalities - Uptake in Kensington, Chelsea & Westminster Variations in uptake of AAA screening in the KCW region (3 clinic locations indicated) NHS AAA Screening Programme 2015 https://phescreening.blog.gov.uk/wp-content/uploads/sites/152/2015/10/Nurse- 16 Specialist-update-slides-30.09.2015.pdf
AAA Regional Matrix Working • Commission and • Provides and performance delivers monitor local screening to AAA providers eligible men in as agreed within accordance with Section 7A National Local NHS National Service guidance England Specifications AAA London Screening Other QA Service Stakeholders • contribute to the London (GPs, LA) accountability • Supports and and governance advises on arrangements for screening ensuring quality pathway and risk screening to the management population 17 London AAA Screening Programme Network Day 27 November 2015
Screening QA Service (London) 18 London AAA Screening Programme Network Day 27 November 2015
Purpose of Quality Assurance To help ensure that local screening services are safe and effective Quality Assurance (QA): » Checks that national programme standards are met » Encourages continuous improvement » Delivered through a programme of QA activities A systematic programme of activities to monitor performance against pre-set quality standards and support improvement A Bowling (2002) Research Methods in Health: Investigating Health and Health Services 19 London AAA Screening Programme Network Day 27 November 2015
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