Knowledge Matters Volume 6 Issue 5

Volume 6 Issue 5 December 2012 Welcome to Knowledge Matters Hello everyone and welcome to another fun-filled festive edition of Knowledge Matters – I hope that you all like my very on-trend Christmas jumper!

The past few months have been somewhat challenging for the team with the soon approaching demise of the SHA at the end of March – and the associated uncertain future of the Quality Observatory. I am pleased to be able to let Knowledge Matters readers know that we are currently working through the process of securing a new host for the team and will announce details of this in the next edition. These new arrangements will of course mean that the team needs to generate enough income to cover costs. Therefore the freely available benchmarking tools previously provided by the team will need to be reduced in line with the funding received. The team already provides paid for services to organisations across England – we are keen to ‘cast the net’ wider over the coming year so please do get in touch if you are interested to learn about how the Quality Observatory could help you!

The other news for this edition is that I have obtained a new role with the Commissioning Board. I will soon be Director of Insight within the Patients and Information Directorate. As Director of Insight it is my role to put the patient voice at the heart of health and social care by developing leading-edge and inclusive customer insight strategies for the NHS to support commissioning and improvements in the quality of services. This is a challenge that I greatly look forward to and hope that I will be able to have a ‘guest slot’ in future editions of Knowledge Matters to update you on my progress.

Happy New Year everyone!

Inside This Issue : Dashboard your 2013 New Year resolutions

2

Intra-Operative Fluid Management Update

5

Christmas Crossword

12

Analysis Ancient and Modern—Think of a number

3

Skills Builder

6

News

14

Update on the Health Informatics Careers Framework

4

Enhancing Patient Safety on UK Military Operations in Afghanistan

8

Sharing the knowledge

5

Ask an Analyst

10

twitter.com/SECSHAQO issuu.com/SECQO http://www.networks.nhs.uk/nhs-networks/sec-qo www.QualityObservatory.nhs.uk

2

Dashboard your 2013 New Year resolutions!

By Katherine Cheema, Specialist Information Analyst What will your resolution for 2013 be? Every year for almost as long as I can remember, I've pledged, along with thousands of other Christmas indulgers, to lose weight. And generally failed utterly because when it comes to the tea trolley at QO Towers I have the willpower of the proverbial gnat. So in 2012, I decided to harness the power of data and use it to motivate me to at the very least ‘get fit’. Being a skinflint, except when it comes to gadgetry and Star Trek DVDs obviously, I eschewed the option of a gym and decided to build on my tentative attempts to be able to run other than for the bus. My starting point had been the excellent ‘Couch to 5k’ series of podcasts from NHS Choices (free to all at http:// www.nhs.uk/LiveWell/c25k/Pages/couch-to-5k.aspx) but how could I stretch this to a meaningful goal for the whole year……..? Inspiration, as with so many things, came from Twitter with the hashtag #1000for2012, created by a community of hardcore running types pledging 1,000 miles running in 2012. Unlikely that a beginner like me could do 1,000 miles, links to certain Proclaimers songs not withstanding, but 1,000 kilometres? Maybe.

Total distance travelled (km)

The 1,000km in 2012 challenge

Kate, you have run from Horley to Zurich, Switzerland! That's 1000km away! Wow, finished!

Without further ado, I set up a monitoring dashboard and, in typical NHS fashion, set myself an utterly unrealistic linear trajectory. This is what it looks like at the time of writing (I’m actually 1km over, with a week and half to go!): I know this probably seems unbelievably geeky, but it genuinely worked. I tracked my runs using various smartphone apps, but nothing really gave me the push that seeing my progress over time did.

As a motivational tool, it works! A few other bits were added in to make it more fun:

23/12/2012 16/12/2012 09/12/2012 02/12/2012 25/11/2012 18/11/2012 11/11/2012 04/11/2012 28/10/2012 21/10/2012 14/10/2012 07/10/2012 30/09/2012 23/09/2012 16/09/2012 09/09/2012 02/09/2012 26/08/2012 19/08/2012 12/08/2012 05/08/2012 29/07/2012 22/07/2012 15/07/2012 08/07/2012 01/07/2012 24/06/2012 17/06/2012 10/06/2012 03/06/2012 27/05/2012 20/05/2012 13/05/2012 06/05/2012 29/04/2012 22/04/2012 15/04/2012 08/04/2012 01/04/2012 25/03/2012 18/03/2012 11/03/2012 04/03/2012 26/02/2012 19/02/2012 12/02/2012 05/02/2012 29/01/2012 22/01/2012 15/01/2012 08/01/2012 01/01/2012

1,100 1,050 1,000 950 900 850 800 750 700 650 600 550 500 450 400 350 300 250 200 150 100 50 0

Milestone achievements

Week beginning Kate progress so far

Target

Trajectory

Navigate to the data entry sheet using the tabs below. Enter the date and distance of each run; don't worry about the week number, that calculates automatically. The dashboard will update automatically and let you know when you pass milestones. These are all set at 100k intervals.

• Initially it was set up for two of us to record our progress, nothing like the element of competition

• The milestone achievement helped put the distance travelled into context; 1,000km is the distance from QO Towers to Zurich. These updated each time 100km was completed.

Reviewing the data in a time series (rather than a cumulative format) revealed a few things as well, which have given me ideas on things to work on in 2013:

Total distance travelled (km)

35

Lots of variability over this period

30 25

Less variability, leading up to 10k event, developed more standard routes

20 15 10 5

Not very well, v cold!

23/12/2012 16/12/2012 09/12/2012 02/12/2012 25/11/2012 18/11/2012 11/11/2012 04/11/2012 28/10/2012 21/10/2012 14/10/2012 07/10/2012 30/09/2012 23/09/2012 16/09/2012 09/09/2012 02/09/2012 26/08/2012 19/08/2012 12/08/2012 05/08/2012 29/07/2012 22/07/2012 15/07/2012 08/07/2012 01/07/2012 24/06/2012 17/06/2012 10/06/2012 03/06/2012 27/05/2012 20/05/2012 13/05/2012 06/05/2012 29/04/2012 22/04/2012 15/04/2012 08/04/2012 01/04/2012 25/03/2012 18/03/2012 11/03/2012 04/03/2012 26/02/2012 19/02/2012 12/02/2012 05/02/2012 29/01/2012 22/01/2012 15/01/2012 08/01/2012 01/01/2012

0

India holiday!

If you want a (blank) copy of my 1000k dashboard for your 2013 sporting resolutions, let me know!

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

3

Analysis Ancient and Modern - Think of a Number

by Adam C. Cook, Specialist Information Analyst In previous issues we’ve written about scholars and mathematicians who have been pivotal in the development of new theories and ways of measurement and analysis, or in displaying data. This issue we’re going to take a different tack and look at someone who made numbers entertaining!

When I was a lad in the 70’s and 80’s you couldn’t easily record TV programmes, which meant if you wanted to watch something you had to prioritise and make sure you were in when it was on, and not have something more fun to do.

Someone who I always made sure that I stayed in and watched regardless was Johnny Ball. Now I know popular culture these days has him pegged down as little more than Zoe’s dad, but if you’re looking at mathematical inspiration then here’s someone who could provide it in bucket loads.

Why would any child come home from school after a hard day’s education to sit in front of the telly for half an hour and watch a programme that is basically about maths? I’ll be honest – it wasn’t ‘til years later that I realised I had been educated and that it was all about how numbers work, I thought it was just a fun programme. Sneakily in amongst all the fun and really wonderfully bad puns Johnny Ball had snuck in some education.

Johnny Ball’s enthusiasm for the intricacies of numbers and how this influences the world around us was childlike and contagious, and via studio participation and often very daft experiments helped a generation of kids appreciate that maths is important, and how we relate to numbers really impacts upon our day-to-day life.

There were a number of series following “Think of a Number!” (mainly with the word Think in their name), all making maths, science and the history of science inveigle their way into the brains of a young population.

So to Johnny Ball, I can say a heartfelt “Thank You” for making maths something more than classroom bound lessons, and for making it into something that is tangible and matters.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

4

Update on the Health Informatics Career Framework The Health Informatics Career Framework (HICF) is a UK wide tool that was first launched in March 2008 and has been developed with the help of informatics professionals across England and Wales. The latest, enhanced version has been available for some time to NHS staff with an N3 connection, but the Department of Health Informatics Directorate has now announced that it is readily available to anyone with an internet connection. It can be accessed via the established HICF web address: https://www.hicf.org.uk.

The HICF can help individuals with career planning and managers/organisations with workforce planning, development and redesign and includes additional tools to aid individuals and managers in these areas. It now contains 120+ job roles, at least 75% of which have generic job descriptions attached, additional case studies, as well as qualifications and learning databases. It has proved to be particularly useful to NHS colleagues going through transition and reorganisation, as many are using it to plan their future health informatics workforce. Individuals can also use these new tools to identify how their skills and knowledge match other roles. A short user guide has been developed and is available for downloading from the Resources section on the HICF: https://www.hicf.org.uk/Resources.aspx.

This version of the HICF has delivered many improvements, including the addition of a new login facility that enables users to access additional tools, save work and bookmark items. However, users don’t have to register if they only wish to search and view job roles, job descriptions, qualifications, learning activities and more.

The Health Informatics Career Framework has already helped a multitude of people across the NHS, for example: Planning and Projects Lead, Helene Askarian uses its tools to help with workforce planning: “I found the HICF a very useful tool when we started our Health Informatics Workforce Capability and Capacity Programme. “It can be used to align the workforce capability with future activity demand and also for designing the future structure and workforce process mapping at organisational level. It also helps individuals to develop a structured career path, identifying relevant education, training and development opportunities. This tool is also helpful in ultimately leading to the recognition of Health Informatics in its own right. We have started to use the HICF for strategic planning and improving Health Informatics workforce capability and capacity.”

The HICF is just as valuable to individuals for career development.

Kate Cheema, Specialist Information Analyst finds it useful to use for career development: “My personal career pathway is illustrated very well on the HICF. I find it useful for recruitment and carrying out interviews. It is also very helpful to have it to explain what Health Informatics means both in my discipline and the other disciplines especially when staff are new to the field. In the NHS from an analytical perspective, there is a definite change afoot to ensure that no decision is made, and no process changed without robust supporting information to evidence it. This means that there is an enormous scope for career development for people with the right skills and an eye for detail and interpretation.

It might not be ‘front line’ but informatics and analysis is the best source of dispassionate evidence that can really make a difference to the service” A short introductory video has also been developed which provides an introduction and overview of the enhanced HICF. This is also available in the Resources section: https://www.hicf.org.uk/Resources.aspx.

If you have any questions, please contact Jackie Smith: jackie.smith10@nhs.net.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

5

Sharing the Knowledge Our colleagues over at the Library and Knowledge service at Brighton and Sussex University Hospitals Trust have been invaluable throughout the year in providing us with links to some of the most cutting edge opinion and research into a whole range of topics, including measurement, patient safety, service design, patient experience and even (heaven help us) healthcare finance. This has been via their KnowledgeShare service, which provides regular updates of the latest research, insights and opinion based on your stated interests, straight into your inbox.

In the latest newsletter to come from the KnowledgeShare service, something caught our eye relating to the Cochrane library, a source of many ideas in the development of appropriate measures and quality indicators. The Cochrane Library is the leading resource for systematic reviews in health care and is now available in an easy-to-navigate iPad edition. Systematic reviews provide a summary of medical literature using objective, systematic methods for finding all the high-quality papers that relate to the research question.

In this free app, available from the Apple App Store, you can easily access abstracts, read selected reviews and view full-page summary of findings tables.

With access to a range of topics each month, you can create a reading list tailored to your own interests.

Intra-Operative Fluid Management Update

By Fats Ogunlayi, Quality Innovation and Productivity Analyst The NHS Operating Framework has identified the use of Intra-Operative Fluid Management (IOFM) as a priority. IOFM is the use of various technologies and techniques in the operating theatre by Anaesthetists to optimise the perfusion of the patient’s vital organs during operation.

NHS Institute of Innovation and Improvement has reported benefits from adopting IOFM technologies, such as reduced length of stay and reduced post-operative complications, and have reported that these benefits would be even more achievable if introduced as part of the Enhanced Recovery Programme.

It has been agreed by the Kent Surrey and Sussex Regional Commissioning Board that the Enhancing Quality & Recovery (EQ&R) Programme can support local implementation of IOFM, delivery of some of the data and share learning across Kent, Surrey and Sussex.

The first such learning session for IOFM took place on Monday 3rd December 2012 with attendance from all relevant teams across Kent Surrey and Sussex. There were discussions about the benefits of IOFM technologies and improvements it can deliver to a patient’s outcome. There were also opportunities to discuss some of the concerns about the evidence base for some groups of patients.

For more information on IOFM and the outcomes of the event see: http://www.ntac.nhs.uk/Publications/ TechnologyAdoptionPacks/Technology_Adoption_Packs.aspx And: http://www.innovation.nhs.uk/pg/dashboard For more information on IOFM across Kent Surrey and Sussex, contact: fatai.ogunlayi@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

6

A short guide to resources for Mapping and Visualising 2011 Census data

By David Harries, Public Health Analyst With a steady stream of Census 2011 data being released or due for release in the New Year I thought it might be a good time to write a short guide to resources available for mapping and visualising Census data.

Perhaps the most effective presentation and dissemination of smaller area statistics from the Census is through geovisualisation. Using the Census statistics and digitalised boundary datasets in a Geographical Information System (GIS) allows for spatial analysis of the census attributes and its combination with other non-census geographically referenced datasets.

Mapping census datasets in this way allows for an exploration of the characteristics of census datasets geographically and may provide additional demographic, socio-economic and cultural insights into the census data.

What small area 2011 Census data are currently available?

Released on the 23 November, the 2011 Census population and household estimates for wards and output areas in England and Wales were the first release of small area statistics from the 2011 Census. The release provides estimates of: •

the usually resident population of England and Wales, by five-year age group and sex.

•

the number of households with at least one usual resident.

•

the number of household residents and residents of communal establishments.

•

average household size.

•

population density.

Further releases and future releases are available here: http://www.ons.gov.uk/ons/guide-method/census/2011/censusdata/previous-and-future-releases/index.html Where will I find digitalised 2011 boundaries The digital boundaries for 2011 output areas, super output areas (LSOAs and MSOAs) and workplace zones for England and Wales are available to download here from ONS: http://www.ons.gov.uk/ons/guide-method/geography/products/census/spatial/2011/index.html To add other boundaries and suitable backdrop raster there are a number of products available through Ordnance Survey OpenData and/or Public Sector Mapping Agreement (PSMA)* for example Boundary Line (Vector data set of GB administrative boundaries) and OS VectorMap District (Raster and Vector data set at a scale of 1: 25 000). http://www.ordnancesurvey.co.uk/oswebsite/public-sector/mapping-agreement/index.html * New Clinical Commissioning Groups (CCG) are eligible to apply for the PSMA. Lookups Lookups between 2011 output areas and other geographies are available to download here: http://www.ons.gov.uk/ons/ guide-method/geography/products/census/lookup/index.html Whilst changes were kept to a minimum, modifications were made to the original 2001 boundaries using 2011 Census populations. where populations changed significantly since 2001, where LA boundary changes required output area realignment, or in a few exceptional cases where output areas were considered unsuitable for reporting statistics. This example shows LSOA boundary changes within Ashford District where a number of LSOA have been split, the 2001 boundary is represented by the green polygons with the red lines illustrating the split to form the 2011 boundaries.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

7

ONS have put together a very useful split screen interactive map showing 2011 Census data at Lower Super Output Area (LSOA) compared against 2001 which can be accessed at this link: http://www.ons.gov.uk/ons/interactive/censusmap-1-4/index.html What about geographical information system (GIS)?

There is a wide choice of OpenSource (free) GIS software to choose from. Quantum GIS (QGIS) is probably the most popular OpenSource desktop GI application with a range of tools for use in analysing spatial data. Ordnance Survey have recently published a series of OpenSource GIS guides covering implementation of OpenSource spatial data infrastructure, installation and Introduction to using QGIS. https://www.ordnancesurvey.co.uk/psma/support/how-to/opensource-gis-guides.html Example of linking spatial and attribute data from the 2011 Census at LSOA level is shown below created in QGIS.

Best practice guide for statistical Maps Finally if you are intending to produce any statistical maps then a read through the best practice guide on Neighbourhood statistics website will provide advice on design principles to follow, how to choose an appropriate classification for your data as well as alert you to some of the pitfalls in the way maps maybe interpreted. http://www.neighbourhood.statistics.gov.uk/dissemination/Info.do?page=userguide/detailedguidance/ statisticalpresentation/statisticalmaps/best-practice-statistical-maps.htm

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

8

Enhancing Patient Safety on UK Military Operations in Afghanistan Background The United Kingdom Defenc e Medical Services (DMS) Medical Group provide primary and sec ondary health c are and health advice to military and eligible local national personnel embroiled in military operations in Afghanistan. The Healthcare Commission (HCC) review of the DMS published in Marc h 2009, whilst positive in respect of trauma care on military operations, considered that the DMS needed to ensure consistency and quality in service provision. Given the intent to deliver comparable care on military operations, there was a need to develop processes by which patient safety could be monitored and enhanced from point of wounding to air evacuation out of theatre for military personnel or transfer to the local healthcare system for local nationals.

Objectives This project was about providing an enduring framework for patient safety ensuring sustained improvements to healthcare delivery within the UK military medical treatment facilities in Afghanistan. Specific objectives were: • To enhance current health care governance reporting mechanisms with the intent of improving Patient Safety Incident Reports (PSIRs) from both a quantitative and qualitative perspective.

• To highlight areas of good practice for dissemination and areas for improvement to form the basis of a Quality Improvement programme and future benchmarking activity.

...a long way from the UK

The Programme Approach – The ‘3 Es’

•

Enthuse the Culture by developing an induction programme for medical personnel on arrival in Afghanistan.

•

Embed the Cult ure by means of ongoing training and creating a non-blame culture.

•

Exploit the Culture by using patient safety data to inform Quality Improvement and provide a positive patient experience.

Patient Safety Incident Reporting Patient Safety Incident Reporting is seen as a key pillar in the DMS Patient Safety strategy.

The DMS utilise a streamlined version of the World Health Organisation’s Conceptual Framework for the International Classification for Patient Safety (V1.1). Whilst currently not automated, this has the advant age of allowing completion of a PSIR in areas that have limited computer infrastructure support.

Number of PSIRs Recorded per year (Apr—Apr)

Comparison of FY 2009-10 and FY 2010-11 (Q1-3) PSIR Rates

Quality.Observatory@southeastcoast.nhs.uk

PSIR Tot als FY 2009-2011

www.QualityObservatory.nhs.uk

9 Healthcare Governance Structure UK Military Medical Operations in Afghanistan Headquarters Surgeon General Surgeon General

Permanent Joint Headquarters (based at Northwood UK) Commander Medical (based at Joint Force Support Headquarters Camp Bastion) Deployed Medical Director

Healthcare Governance Lead (based at Joint Force Support Headquarters Camp Bastion)

Senior Primary Health Care Medical Officer (Based at Camp Bastion)

Individual Primary Health Care Medical Treatment Facility Healthcare Governance lead

Bastion Hospital Healthcare Governance Lead Bastion Hospital Departmental Healthcare Governance Leads

Primary Health Care

Secondary Health Care

Primary health care is delivered by UK medical personnel on a multi-disciplinary basis. Provision is in a variety of buildings. Some are purpose built others adapted for medical use.

Secondary health care is delivered by a multi-national team. Governance is led by a UK Nursing Officer supported by a multi-national patient safety working group.

This forms the basis of a number of initiatives including a patient experience questionnaire that involves Afghan nationals.

A Patrol Base Treatment room.

A Forward Operating Base Medical Treatment Facility entrance.

The Camp Bastion hospital front entrance.

A Patrol Base medical Triage area.

An ITU bed at Camp Bastion

Outcome and Evaluation A key success factor was the assumption of shared and common goals with patient safety actively seen as a tool by which the individual practitioner could enhance and learn from their own and others practice. The quantitative meas ure adopted was the increase of PSIRs. Notably in the period April 2009 – April 2010 some 187 PSIRs were submitted. In the 9 month period since this project was initiated 474 PS IRs have been submitted, more than doubling patient safety incident reporting. Recurring themes can now be identified providing the basis for the development of a continual range of Quality Improvement programmes, including medicines management and improving cross boundary communication between primary and secondary care. Qualitatively practitioners were also actively involved in revising the PSI reporting form. This is facilitating greater analysis at a lower managerial level allowing ownership of themes raised and impacting directly on improving patient care in a timely manner.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

10

Kaplan-Meier (burial) plots Application: MS Excel, basic biostatistics Dear QO, I’ve been recording data from my clinical practice in general surgery and want to look at the differences between two different operation types. Specifically I want to get a graphical representation of whether there are any differences in the survival of the patients that undergo each type of operation. Someone has mentioned something called a ‘Kaplan-Meier’ plot as being a useful tool, but I don’t really know how to create one. Can you help?

- General Surgery Registrar

Solution: Complexity 2/5 — Creating a basic Kaplan-Meier plot

Okay, so it’s not very festive, but I’ve found these useful over the past couple of months and we do like to share the knowledge round here! In the last edition of Knowledge Matters we met Paul Meier who was partly responsible for the development of the Kaplan-Meier plot, a key tool in the understanding of survival. For example if we were to look at the impact on survival for two types of gene, or different types of procedure, we would want to look at them side by side, and assess the probability of survival in each condition. If we did this simply by taking a sample of patients in each group at a particular point in time, we would have to have a relatively large number of patients to account for drop outs. This would be less of an issue if we were looking at some time immediately following a treatment (e.g within 24 hours) but over a longer period of months and years, the cohort of patients you wish to study will dwindle through drop out and the tendency people have to move about and become lost to follow up. The Kaplan Meier survival plot is a relatively simple plot that not only indicates potential differences in survival probability between different groups, but also allows estimation of survival over time even when patients drop out or, crucially, are studied over different lengths of time.

Let’s start with a data set where we know the group the patient belongs to (in this example we’ll be using operative procedure A and B) and how long they survived post-operatively in months, or alternatively the date of their most recent follow-up where they were alive. An example might look like this: The survival in months is either the time between the operation and their death (if they are dead) or the time between the operation and their most recent follow-up (presumably alive).

From this point (and obviously with more patients in the data set) we are able to count the number of patients alive at each month post their operation date. Remember that it doesn't matter if they had the operation at the same time as anyone else or not, we don’t need a big single cohort to follow in order to achieve our data plot.

Once we have counted the number of deaths in each subsequent month we need to sum them up cumulatively, so we can see the total number of ‘at risk’ patients who have died at any given month. This then might look a bit like this:

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

11

From our data then, using the cumulative number of deaths we can calculate what equates to the chance of survival at any given month (or whatever units you choose to use). By repeating the exercise for the second group of patients, those undergoing operation type 2, we end up with two columns of data which both give us the chance of survival at each month, split by type of operation. Once you have the two columns of data it is a simple task to plot a line chart which illustrates the data over time. Have a look at the diagram below to see what this might look like.

We can clearly see that the survival curve for the group 2 patients is steeper and more prolonged than that for the group 1 patients and that overall, the chances of survival are greater in group 1 (just over 70% as opposed to 60%). I know which group I would rather be in on this basis. Of course it’s not always that simple, there are other factors to consider and in any case, we all know that single measures shouldn’t be viewed in isolation.

110% 100% 90% 80%

% patients alive

70% 60% 50% 40% 30% 20% 10% Group 1

Group 2

135 133 131 129 127 125 123 121 119 117 115 113 111 109 107 105 103 101 99 97 95 93 91 89 87 85 83 81 79 77 75 73 71 69 67 65 63 61 59 57 55 53 51 49 47 45 43 41 39 37 35 33 31 29 27 25 23 21 19 17 15 13 11 9 7 5 3 1

0%

Months survival

What we have done is effectively calculate the survival probability at any point in time as:

Note that as time goes on, the more robust our estimates of the chances of survival are, because each month we are adding more and more patients into our cumulative count.

In this particular example, we are fortunate not to have any patients that have been ‘lost to follow-up’, so the calculation of a relatively simple proportion of all patients is appropriate. However, if patients do drop out, it is important that they are accounted for by removing them from the denominator at the point in time in which they dropped out or were lost to follow-up.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

12

Knowledge matters 2012—Know it all crossword This crossword is designed to test your knowledge of Knowledge Matters in the last year. All answers can be found in previous editions of Knowledge Matters! (answers in the next issue)

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

13

Quick Christmas Quiz Our resident poet Adam Cook has come up with eight Christmas related quiz questions. See how well you do. Answers will be given in the next edition of Knowledge Matters.

1. What country did the original Saint Nicholas come from?

2. Christmas Island is a territory of which country?

3. In It's A Wonderful Life, what two friends share their names with two Sesame Street characters?

4. How many Lords are a-leaping in the carol "The 12 Days of Christmas"?

5. Two Santa's Reindeers have names starting with a 'C', what are they?

6. "Merry Xmas Everybody" was Christmas Number One Single in 1973. Who sings it?

7. One Coronation took place on Christmas Day - this was William the conqueror in 1066 where did this take place?

8. The young of which bird, traditionally associated with Christmas is called a Poult?

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

14

NEWS National Diabetes Audit 2010-11 Report 2: Complications and Mortality published

NHS Safety Thermometer CQUIN Year 2

The Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK and Diabetes Health Intelligence has published findings from the 2010/11 National Diabetes Audit, one of the largest in the world. The data show that people with diabetes are at much higher risk of suffering heart failure than the general population.

The NHS Safety Thermometer has almost completed it’s first year as a mandatory national CQUIN. In 2013/14 the focus will move away from data collection towards an improvement focus. The guidance for the 2013/14 NHS Safety Thermometer CQUIN, including all the technical appendices, is published on the Harm Free care website from Friday 21st December.

Further information including the full report is available on the HSCIC website here :

http://harmfreecare.org/m easurement/nhs-safetythermometer/

http://www.ic.nhs.uk/Article/1806

Self Harm Hospital Admissions

EHE ‘Is your ward dementia friendly?’ environmental assessment tool You can now register and download the EHE ‘Is your ward dementia friendly?’ environmental assessment tool: http://www.kingsfund.org.uk/projects/enhancing-healingenvironment/ehe-design-dementia

The Information Centre recently issued figures on selfharm hospital admissions; the rate per 100,000 population in North East is almost triple the rate in London. Drug poisoning is the most common reason for self-harm admission in England. Nationally, hospitals admitted 110,960 self-harm cases in the 12 months to August 2012, a 0.4 per cent increase on the previous 12 month period (110,490). This compares to a 1.9 per cent increase in admissions overall (for all conditions). See for more information:

Funding to improve care environments for people with dementia http://www.ic.nhs.uk/news-and-events.

The Department of Health is now inviting expressions of interest for funding to improve care environments for people with dementia. The information can be found together with a letter from David Flory, Deputy NHS Chief Executive which has been sent to all NHS and Foundation Trust Chief Executives and Directors of Finance at: h t t p : / / www. d h . g o v . u k /h e a l t h / 2 0 1 2 / 1 1 / d em e nt i a environments-ei/ There is a £50 million pound fund to be split equally between health and social care. Timing is tight as expressions of interest need to be in to the DH by 16th January 2013.

Sharing Innovation The innovation.nhs.uk website has been developed to support the spread of new ideas and practices across the NHS. Proposals are sought for a second wave of high impact innovations for 2013/14: www.innovation.nhs.uk

Ratings System The Health Secretary Jeremy Hunt has instigated a review of the way that information on NHS and Social Care services is given to patients and the public. The study will assess the merits of an ‘Ofsted-style’ system of ratings for hospitals and care homes. See for more information:

http://www.dh.gov.uk/health/2012/11/new-ratings/

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

15

NEWS Referral to Treatment Data

Our latest twitter feed……

From April 2013 there is a requirement for general and acute providers to collect allied health professions referral to treatment (AHP RTT) information as set out in the new commissioning data set (CDS) v. 6.2. It is expected that AHP RTT data will be included in version 5 of the mental health minimum data set planned to be published in October 2013, and collected from October 2014. community AHP RTT data to be collected from April 2014, Data can be collected on a voluntary basis from October 2013. These dates are still subject to change. Referral to treatment waiting times is seen as key indicators of service performance and patient experience. Data needs to be collected consistently according to national standards.

See the Information Standards Notice at: http:// www.isb.nhs.uk/library/release/465 More baby news!

We are pleased to announce that Simon Berry’s wife Helen gave birth to their baby girl on Sunday 23rd December. Jasmine Mary Berry was born at 10:18 am and weighed 9lbs 10oz. Congratulations Simon and Helen!

Trolley Dolly Update As usual we have been filling the tea trolley with snacks (healthy and not so healthy!). We have had a tin of biscuits, a box of apples, a box of satsumas, some nice coffee, wild mice, white mice, Jazzles, lollipops, nuts and chocolates.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Christmas Poem (Analysts are coming to town)

By Adam C Cook You'd better watch out, you'd better not cry

Quality data, showing rates that are high,

You'd better not pout, I'm telling you why

Data from SUS, or extracts of UNIFY

The analysts are coming to town

The analysts are coming to town

The analysts are coming to town

The analysts are coming to town

The analysts are coming to town

The analysts are coming to town

They're making a chart, and checkin' it twice

They know what lines are trending

They're gonna find out if outcomes are nice

They notice each mistake

The analysts are coming to town

They know what makes up bad or good

The analysts are coming to town

(You know)

The analysts are coming to town

They're fuelled with tea and cake They're fuelled with tea and cake

They know if you're performing They measure every ache

You'd better watch out, you'd better not cry

They know what makes up bad or good

You'd better not pout, I'm telling you why

(So you'd)

The analysts are coming to town

Better be good for goodness sake

The analysts are coming to town

Better be good for goodness sake

The analysts are coming to town

Simon says….

The highest spot on earth is not Mt. Everest. If we define the "highest spot" as that which is closest to the moon, stars, etc., then Mt. Chimborazo in Ecuador is an incredible 1.5 miles higher due to the oblate spheroid shape of the earth.

Fascinating Fact

Norwegian scientists have hypothesized that Rudolph’s red nose is probably the result of a parasitic infection of his respiratory system.

Knowledge matters is the newsletter of NHS South East Coast’s Quality Observatory, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone:

01293 778899

E-mail: Quality.Observatory@southeastcoast.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk