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Trusted, timely and accurate information on health service quality and safety performance can be used to stimulate and drive improvements in care. VAHI aims to help clinicians better use their data and easily interpret information about where they are performing well and where they can improve.

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Providing clinicians with quality and safety data

During the year, VAHI released four issues of Inspire to Victoria’s public health services. VAHI, working with SCV, has published the Inspire report series quarterly since July 2017. Inspire is our core information product for lead clinicians in Victorian public hospitals and designated mental health services. It aims to improve the flow of information within the health system and support identification and analysis of variation in care.

The Inspire reports provide information on measures of quality and safety performance within health services at a level of detail not found in other VAHI reports. This allows clinicians to more easily identify variations and target relevant improvement opportunities.

For selected measures, results are complemented by clinician-focused information developed by SCV or the Chief Psychiatrist depending on the measure. These messages highlight areas for clinicians to consider when reviewing their health service’s results, such as how variations could be interpreted or relevant resources and training opportunities to improve clinical practice.

VAHI continues to seek feedback on Inspire to ensure that it is useful and actionable for clinicians.

In June 2018, VAHI released the first issue of Inspire: mental health to Victoria’s 18 designated mental health services. The report allowed mental health services to see, for the first time, how their results compare with similar services. Following positive feedback from the sector, we committed to release two issues of the report each year. The second issue was distributed in February 2019.

Spotlight

Data driving changes at Peninsula Health

The data presented in Inspire: mental health can act as a starting point for important conversations about the quality and safety of care. After reviewing the report, the mental health team at Peninsula Health found that while their overall results were positive, in some areas their results didn’t match up to some of their peers. The team identified three areas to focus on – bodily restraint, falls and electroconvulsive therapy (ECT).

Peninsula Health set up committees, carried out research and visited other services to see how the issues were being tackled elsewhere. They took a holistic approach to their solutions; for example:

  • For bodily restraint, they looked at factors ranging from the environment, such as noise levels and how to make the ward less stimulating for some patients, to setting up behaviour management plans more consistently.
  • For falls, the staff feel that small changes they have made to environmental factors, such as increasing the lighting, have had a big effect. Using behavioural management plans and reducing use of the medications most likely to cause falls were also important. The ward now has a champion of falls prevention and conducts weekly falls rounds to mitigate risks that could lead to a fall.
  • For ECT, Inspire: mental health confirmed that their identified practice improvements were on the right path and there was an opportunity to lower their rate of ECT. The team has made some changes to processes relating to maintenance ECT, such as including a proposed end date for treatment in the patient’s treatment plan.

A vital part of Peninsula Health’s response to Inspire: mental health is getting staff involved. Team members at different levels reviewed the report and sought to understand what it was showing them about their service. The coordinated effort promoted buy-in from executives and nursing staff. Dr Carmel Peavey, Aged Inpatient Consultant Psychiatrist, Peninsula Health, stressed the importance of nursing staff having a sense of ownership of the initiatives for them to be successful. She is proud of the team’s achievements and the positive effect it is having for patients:

‘It’s a better way, a smoother way. It’s better for the patients. It’s always about the patient and aiming to make the best possible practice.’

Dr Carmel Peavey and her team
Dr Carmel Peavey and her team.

Increasing the utility of clinical quality registries

A clinical quality registry (CQR) collects data, including clinical outcomes and process measures, for a defined clinical condition. The data are then risk-adjusted and provided back to contributing clinicians who benchmark their performance against their peers. This feedback loop informs improvements in the quality and value of health care.

VAHI has been working on a strategy that will bring, for the first time, a consistent approach to managing CQRs in Victoria. We have developed governance arrangements for CQRs and a process to guide the Victorian Government’s investment decisions.

VAHI has standardised CQR arrangements in Victoria, which now include requirements for registries to provide regular reports to health service CEOs and SCV, and to provide registry data to VAHI for developing quality and safety measures. These improved reporting arrangements will enable Victorian public health services to access and use registry data, where previously the main benefits had been for researchers.

The new arrangements include an outlier policy and escalation procedure, developed by VAHI in consultation with SCV, its clinical networks and the Department. The policy and procedures ensure that registries have clearly documented the measures that will be tracked for possible outliers. CQRs can identify when performance on a particular risk-adjusted measure deviates from the average in a clinically significant way. If the agreed threshold is reached, it will trigger local efforts to improve care or escalate the issue, if necessary. This means relevant people will be alerted to areas of concern in a more consistent and timely manner.

During the year, VAHI agreed on new reporting arrangements with:

  • Monash University, for the Victorian Cardiac Outcomes Registry
  • The Florey Institute, for the Australian Stroke Clinical Registry
  • Australian & New Zealand Society of Cardiac & Thoracic Surgeons, for their national database
  • Australian and New Zealand Intensive Care Society, for their registry
  • University of Wollongong, for the electronic persistent pain outcomes collaborative
  • Australian Rehabilitation Outcomes Centre, for their databases
  • Monash University, for the Victorian state trauma registry.

We will continue to work with registries approaching the end of their current contract period so they can be transitioned to the new arrangements.

Improving collection of patient-reported outcomes

Patient-reported outcomes (PROs) are data from questionnaires completed by patients about their health-related quality of life. PROs can be used to measure the improvement in quality of life associated with treatment or management of a disease. Benchmarking PROs data can help to identify variations in clinical practice and lead to improvements in care.

Targeting zero included a recommendation for a statewide pilot of PROs collection, with a view to increasing other statewide collections. VAHI devised a PROs pilot that includes the following three projects focused on the collection and feedback of PROs data:

  • Utility of PROs cancer care: this project involves trialling the collection of PROs data using the EQ-5D-5L instrument in the ‘Victorian Cancer Patients’ Experiences of care – chemotherapy module’. The EQ-5D-5L is a standardised generic tool to measure health status developed by the EuroQol Group. This project is being developed with the Department’s Cancer Strategy and Development unit.
  • Closing the data feedback loop – PROs: the main objective of this project is to apply a new organisational, multifaceted intervention known as STELAR (Shared Team Efforts Leading to Adherence Results). STELAR feeds back clinical and PROs data to clinicians to help them understand and use the data to improve patient outcomes. This project is being developed with SCV.
  • PROs in joint replacement – a national collection: VAHI is contributing funding toward the Australian Orthopaedic Association National Joint Replacement Registry pilot for the collection and use of PROs data. The aim of the pilot is to more fully understand the major challenges in effectively collecting and using information in a population-based setting. Three public and three private health services are participating in this project.

These projects are now underway and the pilot will be evaluated in 2020. The outcomes will guide VAHI’s future investment in this area.

Managing incident data

The Victorian Health Incident Management System (VHIMS) is a standardised dataset for the collection and classification of clinical incidents, occupational health and safety (OH&S) incidents, hazards and patient feedback (complaints, compliments and suggestions) in Victorian public health services. The information collected in the VHIMS is important in driving local and statewide improvements in the quality and safety of health care and overall patient experience.

Spotlight

Increasing staff safety through incident reporting

Dingee Bush Nursing Centre (BNC) was one of the first sites to adopt the new VHIMS Central Solution as part of the initial system pilot.

Dingee BNC services a community of around 1,200 people within a 20–30km radius. They partner with other health services in the region and provide emergency and first responder support to their region alongside the Victorian Ambulance Service.

Due to the time and complexity of reporting with the old incident management system, the centre, like many others, had rarely captured occupational health and safety (OH&S) and hazard data formally. Typically, they had only been reporting serious clinical incidents. However, the nature of their work means staff can often find themselves in situations in which they feel unsafe or uncomfortable. While policies and practices were in place, the centre felt there was more that could be done to support their staff to feel safe at work.

Dingee Bush Nursing Centre
Dingee Bush Nursing Centre.

Under the encouragement of their Centre Manager to use the new VHIMS Central reporting system, Dingee BNC staff started recording these incidents in the OH&S category. In just a few months after implementing the VHIMS Central Solution, the evidence created via the incident reports enabled the centre to access funding to purchase two-way personal safety communication devices to support their staff to feel safe in the work that they do.

Centre Manager Claire McGregor says, ‘The new VHIMS Central has made reporting all incidents, near miss events and feedback simpler and quicker. It is intuitive and allows all staff to feel comfortable in reporting events.’

 

Since 2017, VAHI has led a suite of reforms in this area in consultation with Victorian public health services, the Department and SCV. We replaced the previous VHIMS reporting arrangement for a small group of public and community health services with a new incident management and feedback system. The system, known as VHIMS Central, was built in-house with input from 150 VHIMS ‘critical friends’ and public health service representatives.

VAHI piloted the system with four bush nursing sites and one community health service in August 2018, followed by a roll out to all eligible health services by May 2019. All public health services were given training before going live with the new system. Feedback has been overwhelmingly positive, with the key benefits being a 75% reduction in data entry time and better access to the system on mobile devices.

In partnership with the Department, VAHI is completing a statewide tender for suppliers of incident and feedback management systems for those Victorian public health services not covered by VHIMS Central. In June 2019, we held a well-attended information forum for Victorian public health services impacted by the tender, to advise of the arrangements moving forward and to seek their feedback on options under consideration.

In June 2019, VAHI finalised the new VHIMS minimum dataset. The dataset will be used to support statewide reporting, with all Victorian public health services required to report these data. The dataset was developed with advice from key stakeholders in the sector and the VHIMS Analytics Working Group, comprising representatives from Victorian public health services, the Department and SCV. The VHIMS minimum dataset will be reported by VHIMS Central public health services from July 2019. Remaining Victorian public health services will progressively submit the new VHIMS minimum dataset as their preferred incident and feedback management systems are put in place.

As part of the reforms, in September 2017 VAHI put in place interim reporting arrangements for VHIMS. Since then, Victorian public health services have been contributing quarterly data extracts through the Department’s Secure Data Exchange. We are using the data to produce the first ever statewide VHIMS report, which will be distributed to Victorian public health services in 2019.

Spotlight

Reducing complications of care

The CHADx (Classification of Hospital Acquired Diagnoses) system was developed in Australia and identifies every complication of care for patients admitted to hospitals.

VAHI produces CHADx reports and makes them available to all Victorian public and private hospitals so that they can track their complication rates over time and compare them to other hospitals. The reports are used by program and quality improvement staff to prioritise and track quality improvement activities and to directly improve patient outcomes.

CHADx image

Hospitals are using CHADx to help to reduce red blood cell transfusion rates. While red blood cell transfusion is sometimes a necessary, life-saving treatment it is also associated with increased rates of complications and increased length of hospital stay. Through the CHADx reports, VAHI shares information that helps doctors and nurses to better prepare patients for, and manage patients after, surgery to minimise the need for transfusion. This work is already having an impact, with one leading surgeon saying ‘I have already modified my public and private practices’.

Page last updated: 13 Nov 2019

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