Information for
Quality Improvement
ISD’s Quality Improvement Programme promotes the use of Scotland’s health data to improve quality of care. This bulletin series is designed to inform you about the programme as well as other work going on to support quality improvement in health care in Scotland.
National Audits
Clinical audit is essential to improving the quality of patient care. It has been part of good clinical practice for many years and mandatory throughout the NHS. The Quality Improvement Team and the National Audits have now integrated and we have recently expanded the number of Clinical Co-ordinators in ISD. The national audits establish robust national databases to evaluate each hospital’s ‘systems of care’ and guide local policy, as well as informing strategic planning by the Scottish Government. The audits also initiate and manage research to provide evidence to substantiate change in practice.
The audits below are a combination of new ventures and more established projects aiming to improve the clinical management of patients.
- STAG Sepsis
- Musculoskeletal Access
- Scottish Intensive Care Society Audit Group (SICSAG)
- Scottish Stroke Care Audit (SSCA)
- Multiple Sclerosis Registry
- Scottish ECT Accreditation Network (SEAN)
- Scottish Audit of Surgical Mortality (SASM)
- Scottish Renal Registry (SRR)
- Scottish Audit of Intracranial Vascular Malformations (SAIVMS)
Scottish Intensive Care Society Audit Group (SICSAG)
SICSAG maintains a national database of critically ill or injured patients admitted to intensive care and high dependency units to support the management of this complex group of patients. All general ICUs and around 85% of HDUs are part of this voluntary audit with more joining this year. SICSAG provides information on healthcare associated infection rates to Health Protection Scotland and the Scottish Patient Safety Programme and also enables monitoring of ICU ‘bundle’ compliance. The real-time bed management system in WardWatcher reports directly into the Government. The 2009 SICSAG Annual report is now available. Around 10,000 patients were admitted to ICUs in 2008 and the report shows a reduction in mortality and length of stay.
SICSAG, the Scottish Critical Care Trials Group (SCCTG) and the Evidence Based Medicine Group (EBMG) are hosting a combined Conference at the Stirling Management Centre, Bridge of Allan on 3-4 September 2009. Details are available on the SICSAG website.
Scottish Hip Fracture Audit (SHFA)
SHFA created a national hip fracture database (1998-2008) that continues to provide a valuable tool for audit, management and research of a frail and vulnerable group of patients. SHFA have also recently published detailed reports on rehabilitation and factors affecting theatre delay, and reported to hospitals to help them achieve the Scottish Government target that all patients should be operated on within 24 safe operating hours.
Further details on the SHFA website.
Musculoskeletal Access
The Musculoskeletal Access audit began in April 2009 and will provide data to compliment the work of the various hospital teams by identifying rate-limiting steps for orthopaedic treatment. This will help orthopaedic departments meet their December 2011 Referral to Treatment target of patients waiting no longer than 18 weeks from receipt of a referral (e.g. from a GP) until starting treatment.
STAG Sepsis
A Scotland-wide clinical audit of patients admitted to the Emergency Department with Sepsis has been launched. Sepsis, often referred to as blood poisoning or septicaemia, occurs when the body's normal reaction to inflammation or infection goes into overdrive. It is a leading cause of death in intensive care, with 200,000 cases occurring each year in the UK. This audit will report on compliance with sepsis ‘bundle’ (a collection of evidence-based clinical requirements) and the use of Early Warning Scoring systems.
Further details on the STAG website.
Scottish Arthroplasty Project (SAP)
To encourage the continual improvement in the quality of patient care, SAP audits joint replacement surgery (arthroplasty), monitoring the clinical outcomes of hip and knee arthroplasty patients. Hip and knee replacement is becoming more common in Scotland, with 6,312 hip and 6,160 knee replacements in 2007/08. The SAP annual report is now available. Orthopaedic surgeons are given individual reports with their results so they can monitor their activity and quality.
Further details on the SAP website.