Swansea Bay University Health Board is placing quality and safety at the centre of its service. This publication illustrates how mortality and life expectancy are measured and scrutinised.
One of the key elements of our Quality Improvement programme is analysing and understanding all available information we have about people who die in our hospitals.
Almost half of the deaths of people in our communities take place in hospital, mainly because many people who are at the end of their lives come into hospital during their final days.
Just over 2,000 people died in hospital in Swansea, Neath and Port Talbot in 2018, accounting for 49% of all deaths. In addition, 223 people died in our hospices. In total, 52.5% of deaths took place in SBU hospitals or hospices.
However, we are aware that in some cases, people died in hospital when it may have been better for them and their families if they had been able to die at home, in familiar surroundings.
For this reason, we are supporting Care Pathways to be used at the end of life which enable more people to have the choice to die at home, if it is their wish.
Patient feedback is collected in 376 areas across Swansea Bay. Collection numbers can range from 850 to 1,000 per week.
The patient experience department records and reports the number of ward areas providing feedback from each of the four main hospital sites.
Each of the Service Delivery Units receives a monthly detailed report identifying the themes and develop action plans for improvement at SDU level.
The patient experience friends and family system had 10,926 responses overall during the three months September, October and November. 95% of people said they were extremely likely/likely to recommend the service to friends or family who need similar care or treatment.
Also during September, October and November Swansea Bay received 665 responses to the All Wales Patient Experience Survey. Communication is at 92%, Cleanliness 92%, Dignity 96%, Privacy 94% and Overall Satisfaction was 83%.
Swansea Bay UHB falls policy is now live, ensuring we offer our patients the very best care. All the evidence shows if the steps in this new policy are followed, it will not only help prevent falls in the first place, but if a fall does occur, we can ensure the quickest and best outcome for the patient.
When a patient falls there can be both physical and psychological implications for both the patient and their family. There is the risk the patient will need surgery, long term care, and suffer loss of mobility. Even if they recover, their confidence could be damaged because they are frightened of falling again. Sadly, in the worse cases some patients can die following a fall.
We are aware that falls can be catastrophic. However this new falls policy provides the knowledge and guidance to aim to prevent falling in the first place. It also provides in-depth falls insights to enhance the chances of a good recovery.
The provision of a patient portal is a key component of the National and Health Board Digital strategy and is an enabler for the delivery of a Healthier Wales, empowering patients with their own online patient controlled record, to support their health and well-being. PKB went live on 10th July 2018 initially in Princess of Wales Hospital and has now extended to Morriston, Singleton and Neath Port Talbot Hospitals.
Swansea Bay is the first Health Board in Wales to offer patients access to their electronic online information, which currently allows patients access their pathology results. Development work is underway to send a copy of SBUHB clinic documents and appointment events to the patient’s record.
SBUHB are now live in 15 services with 1200 patients sign up across the Swansea Bay, including Princess of Wales hospital.
As well as having 24/7 access to their records, patients can now choose who they want to share the information with, and work much more closely and easily with clinicians to manage their future care as a team. Care plans can be created digitally with input from patients and clinicians, and videos and other media content to help patients better understand their condition and manage care are also available.
By making it simpler for patients to choose who can see their information, patients can easily share it with other agencies or healthcare professionals, smoothing the way for much easier cross-boundary or multi-agency care. They can also share the information with relatives and carers.
As an example of where benefits have been introduced through the introduction of Swansea Bay Patient Portal (PKB), the dermatology team in Singleton hospital are using the portal to work closely with the systemic patients who need regular blood monitoring. Each of these patients would normally come to hospital every 12 weeks for an outpatient appointment. With the introduction of the portal patients can be reviewed virtually without the need to attend a clinic appointment and will allow the team to free up 3 appointment slots per patient per year. These slots can be allocated to patients that need a face to face appointment.
Swansea Bay Senior Leadership Team have also approved the rollout of Swansea Bay Patient Portal to all Swansea Bay Health Board staff should they wish to register. It is anticipated that by having access to their own patient online portal not only will it help towards enhancing their own health and well-being, but it will also enable them to be aware of the functionality available in order to promote this for new ways of working with their patients. To date 277 members of staff have registered. The implementation to staff commenced on 30th September allowing staff to register through a dedicated page on the intranet. Promotional stands have been held on all major hospital sites and community settings informing staff how to sign up for the patient portal.
A total therefore of 1480 patients/staff have registered to use the Swansea Bay Patient Portal to date.
In order to provide assurance that the best possible care has been provided to our patients at the end of their lives and to identify any areas for potential improvement, we are required by Welsh Government to undertake Mortality Reviews on all in-hospital deaths.
We currently use a three-stage approach and our own electronic Mortality Review Application, or e-MRA, to support the information that is generated. The doctor certifying the death responds to a number of All-Wales Universal Mortality Review (UMR) questions. These first stage questions (UMRs) are presently the only mandated aspect of the Mortality Reviews process and we are consistently the best in Wales in terms of compliance.
For us, the responses to some of the UMR questions could trigger a local second stage and more in-depth review of the case, by a consultant who was not involved with the patients care. After a number of years, the All-Wales Steering Group is now very close to releasing the final version of an All-Wales Stage Two which we will adopt, rollout and monitor as required. This will allow us to benchmark ourselves against other Trusts and Health Boards in Wales, supported by the development of a Once for Wales electronic system which we have been involved in designing and piloting.
In the meantime, we continue to use our own three stage approach. We felt it was important to have a third stage to pull together all of the information gathered in order to generate any themes for learning and action. This stage is currently undertaken at a high level, by the Unit Medical Directors.
An independent review of hospital mortality indicators was undertaken by Professor Stephen Palmer, professor of epidemiology at Cardiff University, which examined whether risk-adjusted mortality, which is used in hospitals across Wales, is reliable and how it is being interpreted. The review found that mortality data can be misleading and does not provide an accurate measure of the quality of care.
Prof Palmer concluded that the current risk adjusted mortality index (RAMI) is not a meaningful measure of hospital quality. He believed the process of reviewing the medical records of all patients who died in hospital in a standardised way – a system pioneered in Wales – provided a better, more robust way of assessing safety and quality of care at a hospital. (Please see 'Mortality Reviews' section above)
A written statement published in July 2016 by The Welsh Government acknowledged the work undertaken by Prof Palmer and concluded that, following the implementation of a range of actions previously recommended in the Palmer review (2014), the publication of RAMI indicators was no longer required.
Whilst these indicators will no longer be published, the Health Board will continue to monitor and scrutinise all available mortality information on a regular basis to identify and investigate any unusual patterns or clusters which may be a cause for concern.