BMI The Lincoln Hospital Quality Accounts April 2013 to March 2014

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BMI The Lincoln Hospital Quality Accounts April 2013 to March 2014

Chief Executive’s Statement �

Welcome to our Quality Accounts 2014, the fifth year we have published this data. The information presented here on a broad range of quality measures continues to grow in importance and usefulness for patients and commissioners. Quality accounts already provide a key metric for people to assess the strength of our 66 hospitals and clinics against other facilities - NHS and independent - from which they might receive their care.

For BMI Healthcare and every other private provider the importance of comparable quality data was recently reinforced by the conclusions of the Competition Commission’s market investigation into private healthcare. From the outset of the inquiry BMI Healthcare supported the principle that competition in the sector would be enhanced if private hospitals produced comparable quality data, and that competition amongst hospitals would drive up service standards. We were therefore fully supportive when the Commission announced in April that it is mandating the provision of greater information on the performance of hospital operators and consultants. We wholeheartedly agree when the Commission says that “a more transparent market with patients actively making choices will drive hospital operators to compete on the things that matter to patients”.

Whilst we are yet to see how the Commission will ensure that this is enacted, the private sector continues to take its own steps. Five years ago BMI Healthcare was at the forefront of the sector’s efforts to be more open about sharing comparable quality and pricing data when we sponsored the launch of the Hellenic Project. Today that work has been superseded by the Private Hospitals Information Network which is working towards publishing data that will allow patients and commissioners to make informed choices - a challenge that the sector must now rise to. We at BMI Healthcare will continue to play our part in these important developments, which we believe can have a significant role in driving higher quality standards.

I remain proud, but certainly not complacent, about the quality of care our hospitals provide. Last year BMI Healthcare invested £40m in our hospitals, supporting our committed staff and consultants to meet the challenge of providing consistently safe, high quality care. We constantly measure our patients’ experience, and I am pleased to note that in the three months to the end of March 2014, 97.3% of patients independently surveyed expressed satisfaction with their care and 97.9% said they would recommend us to others. There is however always room for improvement, and publication of comparable quality data across the independent sector can only help.

The information available in these quality accounts has been reviewed by the Clinical Governance Board and I declare that as far as I am aware the information contained in these reports is accurate. I thank all the staff whose energy and devotion to improvement is represented here and, more importantly, in the experiences of every patient who steps across our threshold.

Stephen Collier Chief Executive Officer�

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Hospital Information

The BMI Lincoln Hospital has 32 beds with all rooms offering the privacy and comfort of en-suite

facilities, TV and telephone. The hospital has 2 theatres including endoscopy.

The hospital provides services such as physiotherapy, pain management, cardiology clinics and

MRI scanning. These facilities combined with the latest in technology and on-site support

services; enable our consultants to undertake a wide range of procedures from routine

investigations to complex surgery. This specialist expertise is supported by caring and

professional medical staff, with dedicated nursing teams and Resident Medical Officers on duty

24 hours a day, providing care within a friendly and comfortable environment.

Choose and book NHS work is carried out at BMI The Lincoln Hospital with 35% of NHS

patients covering overall work.

BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the Health & Social Care Act 2008. BMI The Lincoln is registered as a location for the following regulated services:-

• Treatment of disease, disorder and injury

• Surgical procedures

• Diagnostic and screening

The CQC carried out an unannounced inspection on 11 and 12 February 2014 and found

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Summary of inspection

During our inspection we spoke with six people that used the service and four people’s relatives. One person we spoke with told us. “I think it’s absolutely outstanding. The staff are really friendly.” Another person said, “There’s not a single thing I could criticise. I’ve been consulted about everything.” We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw people’s care and treatment reflected relevant research and guidance. When we examined care records we found care and treatment was not always planned in a way that was intended to ensure people’s safety because assessments of risk were not always completed fully or correctly. We found there were arrangements in place to deal with foreseeable emergencies. We also found appropriate arrangements were in place in relation to obtaining, recording, storing and administering medicines. We spoke with seven members of staff and found they received appropriate professional development and were able, from time to time, to obtain further relevant qualifications. We found people were made aware of the complaints system and this was provided in a way they could understand.

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�Action plan following CQC visit feedback 11th&12th Feb 2014

Issue identified Action taken Date for review/completion

Risk assessments (particular around pressure area care) being completed but actions relating to score not documented in all cases.

NEWS – Felt that actions from score not documented

Director of Clinical Services has met with Ward Lead to discuss training requirements and training schedule put in place to revisit training.

Template example developed and shared with ward and theatre teams.

Actions from the NEWS screen are documented within the general care plan with escalation process followed (additional evidence provided to inspector)

Complete – 12.02.14

Review for continued compliance by end of Feb 2014 – completed Feb 2014

Additional evidence shared with inspector 12.02.14

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The BMI Lincoln has a local framework through which clinical effectiveness, clinical incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to continuously improve the quality of care. This is through the work of a multidisciplinary group and the Medical Advisory Committee.

Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the quality improvements are operationalised. There has been development of

At corporate level the Clinical Governance Board has an overview and provides the strategic leadership for corporate learning and quality improvement.

There has been ongoing focus on robust reporting of all incidents, near misses and outcomes. Data quality has been improved by ongoing training and database improvements. New reporting modules have increased the speed at which reports are available and the range of fields for analysis. This ensures the availability of information for effective clinical governance with implementation of appropriate actions to prevent recurrences in order to improve quality and safety for patients, visitors and staff.

At present we provide full, standardised information to the NHS, including coding of procedures,

diagnoses and co-morbidities and PROMs for NHS patients.There are additional external

reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers

BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where

we produce a data set of all patient episodes approaching HES-equivalency and submit this to

PHIN for publication. The data is made available to common standards for inclusion in

comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website

gives patients information to help them choose or find out more about an independent hospital

including the ability to search by location and procedure.

1. Safety

1.1 Infection prevention and control �

The focus on infection prevention and control continues under the leadership of the Group Head of Infection Prevention and Control, in liaison with the link nurse in BMI The Lincoln Hospital.

The focus on infection prevention and control continues under the leadership of the Group Director of Infection Prevention and Control and Group Head of Infection Prevention and Control, in liaison with the Infection Prevention and Control Lead BMI The Lincoln Hospital

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We have had: -

• Zero cases of MRSA bacteraemia in the last year (NHS 1.17cases/100,000 bed days).

• Zero MSSA bacteraemia cases /100,000 bed days

• Zero E.coli bacteraemia cases/ 100,000 bed days

• Zero cases of hospital apportioned Clostridium difficile in the last 12 months.

• SSI data is also collected and submitted to Public Health England for orthopaedic surgical procedures. Our rates of infection are;

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Infection Prevention and Control (IPC) environmental and clinical practice audits are carried out within all departments of the hospital according to an annual audit schedule devised by the corporate IPC team. These are performed using the Infection Prevention Society’s (IPS) Quality Improvement Tools (QIT). QIT audit results are reviewed by the IPC team and areas of concern are re-visited at more regular intervals with action plans being devised for desired improvements. Challenges presented by the general hospital environment throughout the QIT audits have now been addressed to ensure a clinical environment fit for purpose. Changes to clinical practice have been implemented as a direct result of the QIT audits. These changes have been based on risk assessment, widespread clinical and non-clinical education from the IPC team, controlled change management and effective communication. On re-audit of the areas of concern highlighted in the QIT schedule qualitative and quantitative improvements in clinical practice and environment have been recorded and reported by the IPC team. Overall clinical knowledge regarding IPC, prevention of HCAIs and reduction of the risk of cross contamination has improved throughout the hospital. High Impact Intervention (HII) care bundles for peripheral cannulas, urinary catheters, and Surgical Site Infection (SSI) continue to be implemented by the IPC team

BMI The Lincoln Hospital mirror the guidelines Antibiotic Formulary and Prescribing advice for Adult Patients (Version 6.7 Effective May 2014) issued by the Northern Lincolnshire & Goole Hospitals NHS Foundation Trust (NLAG) and United Lincolnshire Hospitals NHS Trust (ULHT).

Environmental cleanliness is also an important factor in infection prevention and our patients rate the cleanliness of our facilities highly.

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1.2 Patient Led Assessment of the Care Environment (PLACE) � ��

CLEANLINESS FOOD AND HYDRATION

PRIVACY DIGNITY AND

WELLBEING

CONDITION APEARANCE AND

MAINTENANCE

BMI LINCOLN HOSPITAL 89.13% 94.18% 96.00% 85.53%

Introduced in April 2013 Patient Led Inspections of the Care Environment (PLACE) aims to strengthen and formalise the role of patients in both the content of the assessment and the delivery of inspections. It also provides an opportunity to review all aspects of the assessment and the supporting guidance with a view to producing more robust data and a more consistent approach

We believe a patient should be cared for with compassion and dignity in a clean, safe

environment. Where standards fall short, they should be able to draw it to the attention of

managers and hold the service to account. PLACE assessments will provide motivation for

improvement by providing a clear message, directly from patients, about how the environment

or services might be enhanced.

In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient

environment, replacing the old Patient Environment Action Team (PEAT) inspections.

The assessments involve patients and staff who assess the hospital and how the environment

supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It

focuses entirely on the care environment and does not cover clinical care provision or how well

staff are doing their job.

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1.3 Venous Thrombo-embolism (VTE)

BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its whole network of hospitals including, The BMI Lincoln Hospital. BMI Healthcare was awarded the Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the Runners up in the Best VTE Patient Information category.

We see this as an important initiative to further assure patient safety and care. We audit our compliance with our requirement to VTE risk assessment every patient who is admitted to our facility and the results of our audit on this has 100% compliance. We will continue to audit and monitor results to ensure continued compliance. BMI The Lincoln Hospital reports the incidence of Venous Thromboembolism (VTE) through the corporate clinical incident system. It is acknowledged that the challenge is receiving information for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE post discharge from the Hospital. As such we may not be made aware of them. We continue to work with our Consultants and referrers in order to ensure that we have as much data as possible. BMI Lincoln has a low rate of VTE and risk assessment and appropriate prophylaxis will continue to be a priority.

DVT Rate (per 100 admissions)

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2. Effectiveness

2.1 Patient reported Outcomes (PROMS)

Patient Reported Outcome Measures (PROMs) are a means of collecting information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves. PROMs is a Department of Health led programme.

For the current reporting period, the tables below demonstrate that the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing hip replacement and knee replacement at The BMI Lincoln Hospital.

For the current reporting period, the tables below demonstrate that the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing hip replacement at the Lincoln Hospital is marginally higher than the average for England. For knee replacement surgery Lincoln Hospital the outcome is above the average for England.

Oxford Hip Score average

April 12 – Mar 13

Q1 Q2 Health gain between reporting

periods

BMI The Lincoln

21.019 40.611 21.473

England 17.907 39.224 21.317

Copyright © 2011 Re-used with the permission of The Health and Social Care Information Centre. All rights reserved.'

Oxford Knee Score average

April 12 – Mar 13

Q1 Q2 Health gain between reporting

periods

BMI The Lincoln

21.884 38.274 17.60

England 18.893 34.902 16.01

Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved.

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2.2 Enhanced Recovery Programme (ERP)

The ERP is about improving patient outcomes and speeding up a patient’s recovery after

surgery. ERP focuses on making sure patients are active participants in their own recovery and

always receive evidence based care at the right time. It is often referred to as rapid recovery, is

a new, evidence-based model of care that creates fitter patients who recover faster from major

surgery. It is the modern way for treating patients where day surgery is not appropriate.

ERP is based on the following principles:-

1. All Patients are on a pathway of care a. Following best practice models of evidenced based care b. Reduced length of stay

2. Patient Preparation a. Pre Admission assessment undertaken b. Group Education sessions c. Optimizing the patient prior to admission – i.e HB optimisation, control co-

morbidities, medication assessment – stopping medication plan. d. Commencement of discharge planning

3. Proactive patient management a. Maintaining good pre-operative hydrationb. Minimising the risk of post-operative nausea and vomitingc. Maintaining normothermia pre and post operativelyd. Early mobilisation

4. Encouraging patients have an active role in their recovery

a. Participate in the decision making process prior to surgery b. Education of patient and family c. Setting own goals daily d. Participate in their discharge planning

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BMI Lincoln hospital currently utilise multidisciplinary team working to maximise patient outcomes. Group physiotherapy sessions are also utilised to increase patient participation and support and reduce average length of patient stay.

Following these principles BMI The Lincoln Hospital average length of stay (AVLOS) for hip and knee replacements are:

Total HIP Replacement 2013/14 3.1 days

Total KNEE Replacement 2013/14 3 days

The ERP Steering committee will continue to

• Review processes for the patient’s pathway at the BMI The Lincoln Hospital.

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• Promote integration and partnership working across the departments

• Review top 10 procedures regularly against, best practice and local pathways.

• Implement changes to the patient’s pathway ensuring that the quality of care and good patient outcomes are improved or maintained.

• Monitor key performance indicators (KPI) monthly and make any recommendations and develop action plans and implement changes as required.

2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre per 100 admissions.

Unplanned readmissions and unplanned returns to theatre are normally due to a clinical complication related to the original surgery.

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BMI Lincoln Hospital has a low rate overall for unplanned readmissions and theatre returns per 100 admissions and reduction from year 2012/13.

There have been no trends of concern identified.

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3. Patient experience

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3.1 Patient satisfaction

BMI Healthcare is committed to providing the highest levels of quality of care to all of our patients. We continually monitor how we are performing by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third party.

BMI Lincoln Hospital analyses the monthly reports they receive, and implements appropriate action to address any issues of disatisfaciton or areas which have been scored lower than others. A project to improve on excellence has been ongoing over a number of years. The areas of focus have been based on our patient feedback e.g. admisison and discharge processes, nursing care and this has resulted in a year on year increase in patient satisfaction scores. Other areas of focus for this year are catering and departure

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There has been an increase in scores in all areas of patient satisfaction from last reporting period and this is evidence of the commitment and actions taken by the hospital to continually improve patients’ experience.

3.2 Complaints

In addition to providing all patients with an opportunity to complete a satisfaction survey BMI��

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supported through a robust complaints procedure, operated over three stages:

Stage 1: Hospital resolution Stage 2: Corporate resolution

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Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied with the outcome at the other 2 stages.

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Common theme to complaints identified around finance and billing. BMI The Lincoln hospital will continue to provide information to patients in written and verbal communication and to work with BMI Business Services to provide a clear and open process.

4. CQUINS

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The BMI Lincoln Hospital participated in:

FFT Implementation: achieving full implementation / phased expansion in line with national milestones FFT Response Rate - 20% by Q4 (current response rate) It will highlight priorities for local action. Safety Thermometer; Requires monthly surveying all appropriate patients to collect data on pressure ulcers, falls, UTI in patients with catheters and VTE. VTE Assessment: % of adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool Care Bundles: Number of patients who received catheters and were audited for insertion surgical care bundles (10 or actual number if less)Follow up calls: Number of patients who had received a post-surgical telephone follow-up call (or 3 attempts at contact) within 48 hours of discharge Lifestyle Interventions: Patients with BMI >30 offered advice and signposted to appropriate services

5. National Clinical Audits

The BMI Lincoln Hospital was only eligible to participate in National Joint Registry audit and all joint replacements are submitted to this

6. Research

No NHS patients were recruited to take part in research.

7. Priorities for service development and improvement

Ongoing engagement with CCG commissioners to enhance patient choice and service delivery to NHS patients to be measured by agreed quality indicators Ensure compliance with Care Bundles have been effectively implemented to be measured by infection rates.

Promote collection of PROMS for hip and knee replacement for private patients

Further develop and enhance engagement with Health Improvement Team with emphasis on dementia assessment and post-operative pain management

Improvement in patient satisfaction scores for catering and the discharge process.

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8. Mandatory Quality Indicators

8.1 The value and banding of the summary hospital-level mortality indicator (SHMI) for BMI The Lincoln Hospital for the reporting period.

Unit Reporting Periods (at least last two

reporting periods)

National Average

Highest National Score

Lowest National Score

0 Oct 13 – May 14 1.0006 1.1822 0.6735

SHMI data is not available from HSCIC therefore unable to provide figures on Summary of Hospital-level Mortality Indicators as this publication is not available until October 2014. However, whilst not a complete like for like comparison, number of mortalities at BMI The Lincoln Hospital have been included.

8.2 The BMI The Lincoln Hospital patient reported outcome measures scores for

(i) Groin hernia surgery


reporting periods)

National Average



* Apr 13 – Mar 14 0.083 0.157 0.014

* = less than 30 patients going through the process, meaning that the site cannot be scored

The BMI The Lincoln Hospital considers that this data is as described for the following reasons as less than 30 patients going through the process, meaning that the site cannot be scored

(ii) Varicose vein surgery


reporting periods)

National Average



** Apr 13 – Mar 14 -8.738 8.172 -15.918

Please note that the data provided by HSCIC did not give any data in terms of Varicose Veins and therefore none can be reported.

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(iii) Hip replacement surgery


reporting periods)

National Average



21.437 Apr 13 – Mar 14 21.280 24.684 17.214

The BMI The Lincoln Hospital considers that this data is as described for the following reasons

• Development of ERP within BMI The Lincoln Hospital

The BMI The Lincoln Hospital intends to take the following actions to improve this score, and so the quality of its services

• raise standards through sharing best practices

• develop corporately care pathways that achieve the best possible results for the patients

(iv) Knee replacement surgery during the reporting period.


reporting periods)

National Average



17.60 Apr 13 – Mar 14 15.99 20.37 12.2

The BMI The Lincoln Hospital considers that this data is as described for the following reasons

• Development of ERP within BMI The Lincoln Hospital

The BMI The Lincoln Hospital intends to take the following actions to improve this score, and so the quality of its services

• raise standards through sharing best practices • develop corporately care pathways that achieve the best possible results for the patients

8.3 (i) The percentage of patients aged 0-14 readmitted to a hospital which forms part of BMI

The (Lincoln Hospital) within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period.

Unit Reporting Periods (at least last two reporting periods)

National Average



N/A 11.45 14.35 7.96

BMI The Lincoln Hospital considers that this data is as described for the following reasons: 0-14 years not treated at BMI The Lincoln Hospital.

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8.3. (ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of the BMI The Lincoln Hospital within 28 days of being discharged from a hospital which forms part of the hospital during the reporting period.


reporting periods)

National Average



0.42% Apr 13 – Mar 14 10.01 14.51 5.54

8.4 The BMI The Lincoln Hospital responsiveness to the personal needs of its patients during the reporting period.


reporting periods)

National Average



95.72% 2013-2014 68.1 84.4 57.4

BMI The Lincoln Hospital intends to take the following actions to improve this percentage, and so the quality of its services, by reviewing menus with corporate teams, continued programme of refurbishment and review of discharge process.

8.5 The percentage of patients who were admitted to�BMI The Lincoln Hospital and who were risk assessed for venous thromboembolism during the reporting period.


reporting periods)

National Average



100% Apr 13 – May 14 96 100 79

The BMI The Lincoln Hospital will take the following actions to maintain this score, and so the quality of its services, by continued audit and interventions where required.

8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the BMI The Lincoln Hospital amongst patients aged 2 or over during the reporting period.


reporting periods)

National Average



0 Apr 13 – Mar 14 17.3 30.8 0

The BMI The Lincoln Hospital intends to maintain this rate by continuing to undertake IPC audit, deliver and share best practice.

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8.7 The number and, where available, rate of patient safety incidents reported within the BMI The Lincoln Hospital during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

Number of patient safety incidents reported


reporting periods)

National Average



9.6 Apr 13 – Mar 14 44.55 1,810 0

Rate of patient safety incidents reported


reporting periods)

National Average



4.1 Apr 13 – Mar 14 7.76 30.95 1.68

Number of patient safety incidents that resulted in severe harm or death


reporting periods)

National Average



0 Apr 13 – Mar 14 0.64 28 0

Percentage of patient safety incidents that resulted in severe harm or death


reporting periods)

National Average



0% Apr 13 – Mar 14 0.9 2.9 0.0

The BMI The Lincoln Hospital has taken the following actions to maintain this score and so the quality of its services, by continual audit and review to ensure best practice.

8.8 The percentage of staff employed by the BMI The Lincoln Hospital during the reporting period, who would recommend BMI The Lincoln Hospital as a provider of care to their family or friends.


reporting periods)

National Average



89.64% 2014 64.58 96.43 33.73

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Non-Mandatory Quality Indicators

9.1 The percentage of patients who received care as inpatients or discharged from A &E during the reporting period, who would recommend the (name of hospital) as a provider of care to their family or friends.

Unit Reporting Periods (at least last two reporting periods)

National Average



89.63% Jun 13 – Jan 14 66.23 94.38 35.63

BMI The Lincoln Hospital intends to take the following actions to improve this percentage, and

so the quality of its services, by reviewing menus with corporate teams, continued programme

of refurbishment and review of discharge process.

Documents

BMI The Lincoln Hospital Quality Accounts April 2013 to March 2014