Sepsis and CQUINs Celia Ingham Clark Medical Director for Clinical Effectiveness NHS England February 2019 www.england.nhs.uk
CQUINS: Clinical QUality INcentive Scheme • Purpose is to incentivise improvements in clinical quality • A small %age of the standard contract value is withheld and only 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 www.england.nhs.uk 2
Sepsis CQUINs • 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 www.england.nhs.uk 3
Screening performance over time: ED Proportion of emergency patients screened for sepsis having met the appropriate criteria from Quarter 1 2015/16 to Quarter 2 2018/19 100.0% 90.0% % of patients screened for sepsis 80.0% 70.0% 60.0% 50.0% 40.0% 1 3 4 1 2 3 4 1 2 2 1 2 3 4 Q Q Q Q Q Q Q Q Q Q Q Q Q Q 9 9 6 6 6 7 7 7 7 6 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 5 5 6 6 6 6 / / 5 7 7 7 7 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data www.england.nhs.uk 4
Treatment performance over time: ED Proportion of patients that received intravenous antibiotics within 1 hour of arrival at Emergency Departments (Q2 2015/16 to Q2 2018/19) 85.0% 80.0% % of patients screened for sepsis 75.0% *The dashed line refers to the 1617 CQUIN which measures 70.0% the proportion of patients that received 65.0% antibiotics and a 3-day review within 1 hour 60.0% of arrival for emergency departments. 55.0% 50.0% 45.0% 40.0% 1 3 4 1 2 3 4 1 2 2 1 2 3 4 Q Q Q Q Q Q Q Q Q Q Q Q Q Q 6 6 6 7 7 7 7 9 9 6 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / 5 / 5 5 6 6 6 6 / / / / 8 8 5 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data www.england.nhs.uk 5
Screening performance over time: Inpatients Proportion of inpatients screened for sepsis having met the appropriate criteria from Quarter 1 2016/17 to Quarter 2 2018/19 90.0% 85.0% % of patients screened for sepsis 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% 201617 Q1 201617 Q2 201617 Q3 201617 Q4 201718 Q1 201718 Q2 201718 Q3 201718 Q4 The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data www.england.nhs.uk 6
Treatment performance over time: Inpatients Proportion of patients that received intravenous antibiotics within 1.5 hours of recognition of detioration at Inpatient Departments (Q1 201617 to Q2 201819) 85.0% 80.0% *The dashed line refers % of patients screened for sepsis 75.0% to the 1617 CQUIN which measures 70.0% the proportion of patients that received antibiotics and a 3-day review within 1.5 65.0% hours of recognition of deterioration within inpatient departments . 60.0% 55.0% 50.0% 45.0% 40.0% 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 The CQUIN collection is not mandatory, but in Q2 2018/19, 99 trusts submitted data www.england.nhs.uk 7
Outcome of 72 hour review Available from PHE AMR Fingertips https://fingertips.phe.org.uk/profile/amr-local-indicators 100 90 80 70 60 Percentage 72h review 50 Stop / IV / change IV AB Stop 40 IVOS 30 20 10 0 2016/17 2016/17 2016/17 2016/17 2017/18 2017/18 2017/18 2017/18 2018/19 2018/19 www.england.nhs.uk 8 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Other learning from the Sepsis CQUIN • 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 www.england.nhs.uk 9
Where next? • 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 on data that is already routinely available • Where there is some evidence that around half of trusts are already achieving the standard set www.england.nhs.uk 10
The challenge • 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] www.england.nhs.uk 11
Thank you for listening www.england.nhs.uk 12
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