Sepsis and CQUINs - IPC2019 London · Sepsis and CQUINs Celia Ingham Clark Medical Director for Clinical Effectiveness NHS England February 2019. •Purpose is to incentivise improvements

www.england.nhs.uk

Sepsis and CQUINs Celia Ingham ClarkMedical Director for Clinical EffectivenessNHS England

February 2019

www.england.nhs.uk

• 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

CQUINS: Clinical QUality INcentive Scheme

2

www.england.nhs.uk

• 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

3

Sepsis CQUINs

www.england.nhs.uk 4

Screening performance over time: ED

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

20151

6 Q1

20151

6 Q2

20151

6 Q3

20151

6 Q4

20161

7 Q1

20161

7 Q2

20161

7 Q3

20161

7 Q4

20171

8 Q1

20171

8 Q2

20171

8 Q3

20171

8 Q4

2018/1

9 Q1

2018/1

9 Q2

% o

f pat

ient

s sc

reen

ed fo

r sep

sis

Proportion of emergency patients screened for sepsis having met the appropriate criteria from Quarter 1 2015/16 to Quarter 2 2018/19

The CQUIN collection is not mandatory, but in Q2 2018/19, 103 trusts submitted data


Treatment performance over time: ED

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

2015/1

6 Q1

2015/1

6 Q2

2015/1

6 Q3

2015/1

6 Q4

2016/1

7 Q1

2016/1

7 Q2

2016/1

7 Q3

2016/1

7 Q4

2017/1

8 Q1

2017/1

8 Q2

2017/1

8 Q3

2017/1

8 Q4

2018/1

9 Q1

2018/1

9 Q2

% o

f pat

ient

s sc

reen

ed fo

r sep

sis

Proportion of patients that received intravenous antibiotics within 1 hour of arrival at Emergency Departments (Q2 2015/16 to Q2 2018/19)

*The dashed line refersto the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1 hourof arrival for emergency departments.



Screening performance over time: Inpatients

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

201617 Q1 201617 Q2 201617 Q3 201617 Q4 201718 Q1 201718 Q2 201718 Q3 201718 Q4

% o

f pat

ient

s sc

reen

ed fo

r sep

sis

Proportion of inpatients screened for sepsis having met the appropriate criteria from Quarter 1 2016/17 to Quarter 2 2018/19



Treatment performance over time: Inpatients

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

2016/17 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2017/18 Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2

% o

f patie

nts

scr

eened for

sepsi

s

Proportion of patients that received intravenous antibiotics within 1.5 hours of recognition of detioration at Inpatient Departments (Q1 201617 to Q2 201819)

*The dashed line refersto the 1617 CQUIN which measures the proportion of patients that received antibiotics and a 3-day review within 1.5 hours of recognition of deterioration within inpatient departments.



Outcome of 72 hour review

0

10

20

30

40

50

60

70

80

90

100

2016/17Q1

2016/17Q2

2016/17Q3

2016/17Q4

2017/18Q1

2017/18Q2

2017/18Q3

2017/18Q4

2018/19Q1

2018/19Q2

Perc

enta

ge

Available from PHE AMR Fingertipshttps://fingertips.phe.org.uk/profile/amr-local-indicators

72h review

Stop / IV / change IV AB

Stop

IVOS

www.england.nhs.uk

• 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

9

Other learning from the Sepsis CQUIN

www.england.nhs.uk

• 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

10

Where next?

www.england.nhs.uk

• 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]

11

The challenge


Thank you for listening

Documents

Sepsis and CQUINs - IPC2019 London · Sepsis and CQUINs Celia Ingham Clark Medical Director for Clinical Effectiveness NHS England February 2019. •Purpose is to incentivise improvements