neonatal quality standards

Neonatal Quality Standards

Dr Sandra Calvert

Background

• 2009 NICE Commissioned by DoH to manage process for development of quality standards

• Initially pilot project running until April 2010• Four topics – dementia, stroke, VTE prevention

and neonatal care• Overtime a library of over a hundred topics will

be developed sequenced by NQB

Definition of Quality Standard

• A quality standard is a set of specific, concise statements that:– act as markers of high-quality, cost-effective

patient care across a pathway or clinical area;

– are derived from the best available evidence; and

– are produced collaboratively with the NHS and social care, along with their partners and service users

Components

• Qualitative statements

Descriptive statements (5 to 10) of the critical infra-structural and clinical requirements for high quality care as well as the desirable/expected outcomes.

• Quantitative measures

Measure of the expected degree

of adherence/achievement.

Overview of Quality standards process

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Professional groups on the TEG

• Academic x2• Allied health professional x2• Audit (RCM & NNAP) x2• Clinician x3• Commissioner x1• DH representative x1• NHS Information Centre representative x1• NQB shadow x1• Patient / lay representative x1• Surgeon x1• Technical x1

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VTE

• Specific diagnosis

• CG exist

• Evidence based research

Neonatal Care

• Broad topic

• No existing CG– No simple “gold” standard

• Very little or no evidenced based source or research– Input based on consensus or

opinion

Difficulties of developing QS for Neonatal Care

Overall Approach

• Need to define what a high quality specialist neonatal care service should look like– Tertiary, secondary and community care

• Need to use care pathway approach– Allows safety, effectiveness and experience to be

considered

• Ensure alignment with maternity services

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Documents used for Development of Standards

• Toolkit for high quality neonatal services

• BAPM standards for hospitals providing neonatal intensive and high dependency care

• Standards for maternity care: report of a working party

10 areas of care which QS should focus on

15 draft quality statements

Consultation and field testing

Final 9 statements for published quality standards

Is there a quantitative measureof adherence/achievement

• Is there a measurable outcome?

• Is there a standard for comparison?

• What is the evidence that this standard is “best”

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Quality Statement 1

% babies < 28 wks who receive IC in NICU within network

% babies with known fetal malformations requiring surgery delivered at designated network surgical centre

% babies transferred back to local NNU within 24hr of request

% babies undergoing surgery at designated network surgical centre

% mothers still requiring inpatient care transferred with baby

Quality Statement 2

% mothers whose babies required specialist neonatal care who received all perinatal care within network

% babies receiving specialist neonatal care in network who are from another network

Bed occupancy at each level of care

Quality Statement 4

With emergency transfers proportion of transfer teams that depart from base with 1hr of referring call

Quality Statement 6

% babies < 33 wks who are breast fed at discharge

% babies < 33 wks who remain in hospital and still receive MBM at 6 weeks

Quality Statement 8

Completion NNAP dataset

% babies whose parents invited to participate in research studies

Quality Statement 9

% babies < 30 wks who have 2 yr outcome form completed

% babies ≥ 30 wks receiving specialist neonatal care who have 2 yr outcome form completed

% babies < 32 wks and/or <1501g who have ROP screening

% babies < 32 wks and/or <1501g requiring laser surgery

% babies wks receiving specialist neonatal care who have culture +ve blood or CSF culture