South East Neonatal Operational Delivery Networks Hosted by Medway Foundation Trust ATAIN - experience from South East Neonatal ODN Vanessa Attrell Neonatal Network Manager 17 th October 2018
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, 1 st 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 • National CQUIN developed by NHSE. • Two year programme. • Maternity & neonatal leads had to review • Aim to reduce avoidable all TA into NNU each month & report. admissions and increase • Trusts were asked to identify avoidable term babies receiving care beside their mother. admissions and put process in place to manage these babies. • 2014/15 TA into NNU 53% • & beside mothers 47% 7 out of 11 Trusts participated • • One Trust introduced BAPM NEWTT 2015/16 TA into NNU 48% & beside mothers 52% • One Trust implemented the Bobble Hat • Increase of 200 babies Care bundle, based on a traffic light receiving care beside their triage system. This was a joint project mothers; with a decrease in with maternity and neonatal staff with LoS from 2.6 to 2.4 days. excellent results • • Rate of admissions to births Another Trust established a remained the same at 8% 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 SEC SEC SEC SEC 2011-13 2013/14 2014/15 2015/16 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 0bservation only • 72 babies (8%) • 60 babies (7%) • HIE/Asphyxia • Poor feeding • Maternal drug use • Weight loss • Respiratory • Social • 231 days • 257 days • Potentially 900 days • Potentially 1000 a year could be beside mother days a year
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 ATAIN: Term Admissions % of live births target 4% for 2017/18 25% 600 500 20% 400 15% % of live births Live births 300 10% 200 5% 100 0% 0 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 Births v Term Admissions Quarterly Tracker 180 1800 160 1600 140 1400 120 1200 Admissions 100 1000 Births 80 800 60 600 40 400 20 200 0 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2014/15 2015/16 2016/17 2017/18 All Term Admissions Term Admissions into NNU Births
2017/18: South % of admissions into NNU 7 6 5 4 17/18 (to Sept 17) 3 2 15/16 14/15 16/17 1 0 South West Thames Valley Wessex South East Coast East Midlands Q1 Q2 Q3 Q4
ATAIN South Dashboard 2017/18 All Live births delivered within the trust area (includes all Live Births gestational ages) ≥37 weeks gestation, 1st episode of care only, NNU as location of care for any part of the neonatal episode (includes cardiac Term Admissions and surgical babies) Principal Admit Total number of term admissions for each of the 6 most Reason common principal admission reasons NNU 1 Day: Total number of term admissions receiving only HRG3-5 level care throughout neonatal episode with location of care NNU for 1 day only HRG 3-5 Only NNU >1 Day: Total number of term admissions receiving only HRG3-5 level care throughout neonatal episode with location of care NNU for >1 day
Did we achieve our target? Yes
NHS South ATAIN 2017/18 7.0% 5.8% 6.0% 5.3% 5.0% 4.5% 4.2% 4.0% 3.0% 2.0% 1.0% 0.0% TV W SW SEC
SENN Livebirths 2011-2018 58000 57000 56000 55000 54000 53000 52000 51000 50000 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
SENN Term admissions all areas 2011 - 2018 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
East Midlands data Term admissions to NNU (as % live births) 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 2014/15 2015/16 2016/17 2017/18 (to Sept 2017) 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%
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