Learning from ‘2222’ calls and leading an

Quality Improvement Project: A

Respiratory Experience

Sanjay Kumar, Respiratory ST7, LTHT

It may seem strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.

Florence Nightingale

1. Background

2. Aim

3. Method

4. PDSA interventions

5. Results

6. Conclusion

7. Lessons learned

Overview

As part of Leeds Teaching Hospital Trust Quality Agenda in 2014

wanted to work on : how do we reduce avoidable deterioration?

Themes LTHT: delayed decision-making and escalation as per

National Early Warning Score (NEWS) , learning only after incident

Collaborative with 16 wards, which includes one of the respiratory

wards

Background

Background

Cardiac arrest Respiratory arrest

Mortality prior to discharge

11% 46% 51%

Survival to discharge

89% 54% 49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total Cardiac arrest Respiratory arrest Medical assistance

Survival to discharge data for 2222 calls during 2013 and 2014 in the respiratory department

Survival to discharge Mortality

(103) (55) (13) (35)

Aim: “To improve the safety of patients on respiratory wards through increasing

the early recognition of patient deterioration, rapid decision making and appropriate escalation”

Reduce avoidable

deterioration by 50% on pilot wards by October

2015

Identify and Respond NEWS documentation NEWS escalation Reliable care for life-

threatening conditions

Culture of teamwork and accountability

Own the data Train for the basics Celebrate success

End of life care Identification of patients Ceiling of care

PRIMARY DRIVER SECONDARY DRIVER AIM

Method

1. Healthcare assistant questionnaire

2. Staff education and project board

3. NEWS calculation prompt sheet

4. Deteriorating patient stamp

5. “2222 call” debriefing

6. Safety huddle

PDSA Interventions

1. Healthcare assistant questionnaire

To investigative causative factors and prove hypothesis

NEWS calculation accuracy low (66.7%)

Hypothesis: temporary staff and lack of awareness of escalation policy

PDSA Interventions

PDSA Interventions

2. Staff education and project board

• One-to-one teaching to new and temporary staff

• Display of information on project board

3. NEWS calculation prompt sheet

• Simplify process of NEWS calculation

• Improve consistency of observations

• Targeted towards temporary and unfamiliar staff

PDSA Interventions

4. Deteriorating patient stamp

PDSA Interventions

Patient Deterioration Stamp

Target saturations 88-92% 94-98% OTHER

Escalation RCU HDU ICU

DNACPR YES NO

5. “2222 call” debriefing

Identify learning points following 2222 calls

Shared collectively with other wards

PDSA Interventions

6. Safety huddle

PDSA Interventions

Results – respiratory pilot ward

0

1

2

3

4

5

Nu

mb

er

of

22

22

cal

ls

All 2222 calls on a respiratory ward

All 2222 calls Mean

1 3 4 6

5

1.44

0.41

Conclusion

Overall reduction in total 2222 calls and cardiac arrest calls compared to other non-pilot respiratory wards

Improved NEWS calculation, escalation and decision-making

Teamwork and culture

Respiratory and other wards created a bundle of interventions proven to make a difference and supporting other wards now to scale up

Next step to look at change in survival

LEEDS Deteriorating Patient

Intervention Bundle

Version 1.0

Developed and tested by our

Collaborative Ward Teams

Continuous journey

High and low points

Highly dependent on staff engagement and ownership

Supportive senior management equally as important as front-line

staff in making sustainable change

Lessons learned

Success is not Final, Failure is not fatal: It is the courage to continue that counts. (W. Churchill )

Mathew Gittus

S. Miller

A. Cracknell

L. Boggs

D. Sedgwick

Collaborative work of Haelo team

All the staff of the respiratory ward

Acknowledgements

Leeds Teaching Hospital Trust. LEEDS Deteriorating Patient. Intervention Bundle.

Leeds: LTHT, Deteriorating Patient Collaborative; 2015. Report No.: 1.

Royal College of Physicians. RCP London. [Online].; 2012 [cited 2015 Aug 9th.

Available from: https://www.rcplondon.ac.uk/sites/default/files/documents/national-

early-warning-score-standardising-assessment-acute-illness-severity-nhs.pdf.

Langley Gl et al. The Improvement Guide: A Practical Approach to Enhancing

Organizational Performance (2nd Edition). 2nd ed. San Francisco: Jossey-Bass;

2009.

Images: https://www.google.at/search?q=mountain+range&es_sm=91&source

=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAWoVChMIp77mmoeYyAIVC_RyCh1iRw

pD&biw=1108&bih=637&dpr=2#imgrc=WMk5kVFF6L_ZoM%3A

References

Any Questions?

Many thanks