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Introducing NQAIS: Improving Clinical
Performance
National Patient Safety Conference
Dublin Castle Thursday 26th October 2017
Kenneth Mealy National Clinical Programme in Surgery
RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn
Why measure performance?
• Performance management o Process of care
o Bed management
o Cost/Pricing - HPO
o Quantity/Quality Indicators of outcome
• Demographic changes o Societal needs
o Planning configuration of services
• Professional responsibilities o Self reflection
o Clinical Audit
Dschrg per
Age Grp AvLOS InPat Dschrg BDU 000's Pop
85up 14.03 32,422 454,812 611.7
75-84 11.26 65,520 738,015 390.0
65-74 8.79 66,472 584,137 209.0
16-64 4.72 277,800 1,310,992 90.3
05-15 2.80 27,818 77,819 39.8
0-4 4.63 46,162 213,819 127.5
All 6.55 516,194 3,379,594 110.3
2013 Actuals from HIPE
Age profile change pushes AvLOS up Population increase pushes # inpat. up
Dschrg per
Age Grp AvLOS InPat Dschrg BDU 000's Pop
85up 14.03 105,830 1,484,575 611.7
75-84 11.26 168,480 1,897,753 390.0
65-74 8.79 136,916 1,203,175 209.0
16-64 4.72 332,681 1,569,987 90.3
05-15 2.80 29,648 82,937 39.8
0-4 4.63 44,759 207,322 127.5
All 7.88 818,314 6,445,749 110.3
2042 Pop changes on 2013 metrics
Will increasing population age impact on capacity?
Note: Population is growing and aging AvLOS increases with age band # discharges per 000 of population increase with age
NCPS use HIPE data for reports 4
Inpat # 69,391 DC # 121,053 Total # 190,444 % DC 63.6%
Dublin North East % of Nat 17.0%
West & NW % of Nat 18.1% Inpat 10,187 AvLOS 6.10
Inpat 13,596 AvLOS 5.13 DC 22,182 %DC 68.5%
DC 20,798 %DC 60.5% All 32,369
All 34,394
Dublin Midlands % of Nat 15.3%
Inpat 11,027 AvLOS 6.88
DC 18,194 %DC 62.3%
All 29,221
Mid West % of Nat 6.7%
Inpat 4,908 AvLOS 5.69 Dublin East % of Nat 21.5%
DC 7,912 %DC 61.7% Inpat 15,460 AvLOS 5.97
All 12,820 DC 25,437 %DC 62.2%
All 40,897
South & SW % of Nat 20.1%
Inpat 13,098 AvLOS 5.66
DC 25,185 %DC 65.8% Peadiatric Group % of Nat 1.3%
All 38,283 Inpat 1,115 AvLOS 6.14
DC 1,345 %DC 54.7%
All 2,460
(All)Nationally
General Surgeon discharged from All Model types in 2015 (Both those who had surgery & did not have surgery) HIPE 2015 – Clinician specialty 2600 - General Surgery, 2602 - Gastro Intestinal Surgery, 2603 - Hepatobiliary Surgery, 2604 - Vascular Surgery, 2605 -
Breast Surgery
Pop: 745,379
Pop: 330,315
Pop: 911,381
Pop: 974,514
Pop: 737,527
Pop: 889,126
Pop: 4,588,252
Elective Surgery – Bed Day Usage
2017
19,075
Acute Surgery - Bed Day Usage
2016
73,104
Acute General Medicine discharges in 2015 Inpat # 111,317 DC # 90,554 Total # 201,871 % DC 44.9%
Dublin North East % of Nat 15.8%
West & NW % of Nat 20.9% Inpat 16,742 AvLOS 8.86
Inpat 22,215 AvLOS 7.52 DC 15,116 %DC 47.4%
DC 20,006 %DC 47.4% All 31,858
All 42,221
Dublin Midlands % of Nat 14.2%
Inpat 22,011 AvLOS 9.37
DC 6,683 %DC 23.3%
All 28,694
Mid West % of Nat 10.4%
Inpat 8,657 AvLOS 8.14 Dublin East % of Nat 21.8%
DC 12,243 %DC 58.6% Inpat 22,360 AvLOS 7.53
All 20,900 DC 21,738 %DC 49.3%
All 44,098
South & SW % of Nat 15.9%
Inpat 17,741 AvLOS 8.30
DC 14,348 %DC 44.7% Peadiatric Group % of Nat 1.0%
All 32,089 Inpat 1,591 AvLOS 3.87
DC 420 %DC 20.9%
All 2,011
Nationally
Pop: 745,379
Pop: 330,315
Pop: 911,381
Pop: 974,514
Pop: 737,527
Pop: 889,126
Pop: 4,588,252
NCPS use HIPE data for reports
Medicine – Elective Admission
2016
31,973 BDU
PreAvLOS 0.2 – 1.2 hospital 0.2 – 2.7 consultant
Appendicectomy
2016
Hospitals
Hospitals
Hospitals
NQAIS Measuring Clinical Performance
• Individual
o Allows assessment of individual
performance
• Self-reflection
o Audit component of
Professional Competence
Scheme
• National
o National Reporting and
Benchmarking
o Pricing - HPO
• Hospitals
o Performance Metrics for
Medicine and Surgery
o Comparative figures for
diagnoses and procedures
o Supports efficient bed day usage
o Demand/Capacity planning