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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

Our judgement

People who use services benefit from care and treatment that is monitored to ensure it is safe and of high quality.

User experience

Some of the patients and visitors we spoke with told us they had been asked to provide comments about their care and the hospital in general. Most patients said they felt well informed and involved in decisions about their care, and were confident in the quality of treatment they received. There were eye-catching displays in the main corridors with thank you cards and letters of thanks from patients and relatives.

Other evidence

In August 2010, we reviewed compliance with this outcome across the trust. We found the trust had arrangements for clinical governance and audit systems across all of its services that help them deliver high standards of care and enable them to monitor improvements and progress. We published our findings in our report dated 21 September 2010.

In March 2011 the trust’s patient safety manager explained how it was developing its approach to mortality outliers, which look at how many patients have died after being admitted to hospital for a particular condition or procedure. An alert is generated when the number of deaths is much higher than expected for that type of hospital. The trust has developed a reporting template so that responses to mortality outlier alerts are standardised and carried out promptly. The trust also reviews the cases of patients who have survived so that interacting issues affecting illness as well as death can be addressed. Mortality outlier reviews must be reported to the trust clinical governance committee, and outcomes from the reviews are used to support proposals for service development. For example, improved management of the life-threatening condition “abdominal aortic aneurysm” and re-structuring wards to better manage patients with pneumonia. There is a monthly “quality scrutiny” meeting with the local primary care trust (PCT). This brings together issues from the acute hospital and the community so that better responses are developed, for example re-designing integrated plans of care for people with a given condition.

During our visit to Newark Hospital in April 2011, the hospital manager explained how various indicators of quality are used to monitor care and drive improvement. For example, the Patient Advice and Liaison Service (PALS) carries out brief patient experience surveys each month, complaints are reviewed for trends, and regular audits take place in line with the essence of care benchmarks as described previously in this report. Serious incidents and adverse events affecting patients are reported through a computerised database, and senior staff are required to investigate and respond with appropriate action that can only be confirmed as closed by the hospital manager or matron.

The hospital manager attends the trust’s clinical governance committee. Senior nursing staff receive weekly nursing bulletins from the hospital’s clinical governance adviser. We looked at the last two sets of minutes from the bi-monthly inter-departmental meetings (January and March 2011). We saw that these meetings discuss and report on cross-department issues such as strategy and improvement, training and clinical audit. Clinical governance is a regular item at meetings of ward leaders and medical staff groups. Lessons learned and changes to practice are shared and cascaded to ward staff via these meetings, and reviewed at divisional meetings. For example there was an unexpected death after routine surgery. The doctor had written “observe” but had not directed how frequently. Now there is a retrospective audit of notes to make sure terms like “observe” are clearly defined.