Analytics Reveal AAA Programme Improvement Success

As part of its efforts to improve the timeliness of care for patients undergoing abdominal aortic aneurysm (AAA) repair, Guy’s and St Thomas’ NHS Foundation Trust needed to collect data to guide care redesign, help assess the impact of specific interventions, and gauge progress toward desired outcomes. Guy’s and St Thomas’ implemented the Health Catalyst^®数据操作系统(DOS™)平台，包括一个转诊路径分析应用程序世界杯厄瓜多尔vs塞内加尔波胆预测，允许组织跨源系统聚合和标准化数据。改进的数据和分析使盖伊和圣托马斯医院能够分析、评估和监测整个AAA队列的结果，并评估操作性能和相关的患者结果。

STRIVING TO PROVIDE TIMELY CARE

Data is the foundation of healthcare improvement efforts because driving improvement depends on the ability to effectively monitor the impact of process changes on outcomes.^1,2Without meaningful, timely, and actionable data, improvement efforts stall—and many fail. Guy’s and St Thomas’ needed the ability to efficiently collect data to help guide its care redesign programme.

CARE REDESIGN YIELDS INNOVATION AND IMPROVEMENT

盖伊和圣托马斯医院的护理重新设计项目专注于一线的持续改进。该方案使各小组有权对其提供的护理的质量和效率提出质疑，并承担起改进和重新规划护理的责任。该计划的总体目标是开发最有效的护理途径和流程，为患者提供明显更好的结果，同时嵌入一种设计和管理护理系统的新方法。

Care redesign embeds a process of team based, clinically led, pathway design—and continuous redesign—that is evidence-based, reproducible, minimises unnecessary variation and makes the best use of available data.

MANUAL DATA COLLECTION AND ANALYSIS IMPEDES IMPROVEMENT

Guy’s and St Thomas’ identified the opportunity to improve the timeliness of care for patients undergoing AAA repair. The health centre’s AAA team engaged in the organisation’s care redesign programme to improve outcomes, efficiency, and patient experience, developing and implementing a new care pathway for these patients.

As part of the care redesign programme, the AAA team completed a manual audit of historical data for a small sample of 20 patients to determine the median time from referral to review and from referral to surgical repair, identifying the opportunity to eliminate waste and improve value for the patient.

该组织重新设计了接受AAA治疗的患者的临床路径和员工队伍，增加了一名注册护士协调员，以促进患者通过AAA护理重新设计路径的进展。注册护士协调员接收所有选择性AAA转诊，然后收集所需的各种信息，以确保患者得到及时、适当的护理。注册护士协调员联系每一位患者，帮助患者了解计划的下一步。注册护士协调员使用护理重新设计AAA途径来支持患者和更大的护理团队，通过各种护理阶段，确保患者在初始转诊后接受并完成预约。对于需要手术修复的患者，协调员加快完成所需的术前活动，确保手术准备和顺利的术后经验。

虽然组织已经收集了用于改进工作的基线数据，但评估改进工作的有效性是具有挑战性的。它通过手工流程收集数据，需要分析人员审查多个数据源和各种注释。

Guy’s and St Thomas’ could evaluate the patients’ progress through the care pathway and gather the outcomes data of interest, but the process was time-consuming, sometimes taking the analyst up to six months to complete the manual data review for a small sample of patients. The registered nurse coordinator who facilitated patient movement through the AAA care pathway manually tracked patient progression with a spreadsheet.

The organisation and the AAA team needed to evaluate if the care redesign efforts were making the desired impact on outcomes. It was particularly interested in evaluating the registered nurse coordinator’s impact on patient progression and outcomes, but burdensome, manual data collection processes were limiting its ability to use the data for improvement. To evaluate the effectiveness of the care redesign efforts, Guy’s and St Thomas’ needed better data and healthcare analytics.

HEALTHCARE ANALYTICS ENABLES CLINICAL IMPROVEMENT

The solution to Guy’s and St Thomas’ programme needs was to implement the Health Catalyst^®数据操作系统(DOS™)平台，包括一个转诊路径分析应用程序世界杯厄瓜多尔vs塞内加尔波胆预测。DOS将跨源系统的数据合并并标准化，从而在单一技术平台上提供可操作的见解。世界杯厄瓜多尔vs塞内加尔波胆预测

DOS使组织能够聚合和标准化跨源系统的数据，包括从转诊到与血管外科医生第一次预约的时间、从转诊到手术的时间、住院时间、患者通过AAA护理途径的进展，以及其他感兴趣的指标。

The organisation utilises the analytics application to visualise the duration of referrals. Using the analytics application, Guy’s and St Thomas’ can quickly and easily visualise the following:

• Total number of referrals.
• Outpatient and inpatient referral rate.
• Mortality rate.
• Average number of days:
  • To procedure, including provider-specific referral data.
  • From referral to first outpatient visit.
  • From referral to last outpatient visit.
  • Patients in surveillance prior to procedure.
  • From referral to first procedure visit.

Guy’s and St Thomas’ can also easily visualise data for various years and can quickly sort data by patient demographics, age groups, and procedures and diagnosis codes.

Rather than relying on manual, time-intensive tracking processes in excel spreadsheets, the organisation now uses a patient tracker analytics application. The registered nurse coordinator can use the analytics application to easily identify patients with a referral. The registered nurse coordinator can also use the data in the analytics application to monitor and facilitate patient progress through the AAA care pathway, ensuring patients receive care in a timely manner.

RESULTS

Improved data and analytics have enabled Guy’s and St Thomas’ to monitor and evaluate outcomes for the entire AAA patient cohort:

• 该组织审查的患者数量是之前图表审查的880倍。盖伊和圣托马斯医院轻松地分析了三年内所有血管转诊病例(17652例)。
• Rather than evaluating a sample of only 20 patients, the organisation is now able to review data for all patients with AAA.

Using the data platform, the organisation was able to visualise and confirm its AAA care redesign improvement efforts:

• 对于所有血管转诊患者，从转诊到手术的时间相对减少30%，由注册护士协调员协调护理的患者从转诊到入院的时间相对减少17.5%。
• 14 fewer days between the referral to admission for patients with AAA who received care coordinated by the registered nurse coordinator than for other vascular patients.
• 减少注册护士协调员花费在收集数据上的时间——这些时间现在可以用于改善患者进展、改善患者的体验和护理，等待数据质量改善和在适当的途径中管理患者。

The organisation is able to obtain and monitor data to evaluate operational performance and the associated patient outcomes.

“It’s incredibly powerful to have data. For the first time, we can ask and answer specific questions about patients.”

– Rachel Bell, Vascular Consultant, Clinical Director for Cardiovascular

WHAT’S NEXT

Guy’s and St Thomas’ plans to widely disseminate its newly available data, increase data literacy, and broaden its ability to use data to accelerate outcomes improvement. With a successful, scalable model to reference, other departments within the organisation can replicate the same—or similar—process improvement efforts that lead to better patient outcomes.

REFERENCES

1. Agency for Healthcare Research and Quality. (n.d.).Collect and Use Data for Quality Improvement.
2. Shah, A. (2019).Using data for improvement. BJM. 364:l189.