QUALITY AND BEST PRACTICE XXXX
Quality improvement through peer review: how ACSA can change clinical practice in two years instead of a decade
Dr Sade Okutubo, clinical lead in Perioperative, Critical Care and Chronic Pain Services at Homerton University Hospital, talks to NHE about quality improvement through peer review in anaesthesia.
H
omerton University Hospital NHS Foundation Trust’s
anaesthetics
department has become the first in the UK to receive the Royal College of Anaesthetists’ (RCoA) peer-reviewed Anaesthesia Clinical Services Accreditation (ACSA).
ACSA, launched in 2013, lets NHS and independent sector anaesthetics departments measure their performance against particular standards and clinical guidelines. Accreditation proves their quality of patient care and service delivery.
Every ACSA standard is based on ‘Guidelines for the Provision of Anaesthetic Services’ (GPAS), which in turn come from national recommendations.
The voluntary scheme, developed by the RCoA Quality Management of Service Committee and the Clinical Quality Directorate, is backed by the Care Quality Commission (CQC).
RCoA vice-president Dr Peter Venn, chair of ACSA, told NHE: “The CQC has really taken a lot of notice and [chief inspector of hospitals] Professor Sir Mike Richards is extremely bought into the process.
“We’ve mapped all our ACSA standards to what are known as key lines of enquiry (KLOEs) that are used by the CQC in their inspection process. The CQC has also asked if it can adopt some of our standards as part of its standard regulatory information.”
Engaging with ACSA
Engagement entails detailed self-assessment against the ACSA standards, with areas for improvement identified, across five ‘domains’: 1) the care pathway; 2) equipment, facilities and staffing; 3) patient experience; 4) clinical governance; and 5) sub-specialties.
Each standard is categorised by priority: priority 1 standards are absolute requirements for accreditation, while priority 2 are more aspirational. Priority 3, as yet un-used, will
36 | national health executive Nov/Dec 14
be relevant only to the highest-performing departments.
Departments apply with the RCoA, and there is then a teleconference to discuss the practicalities and costs, followed by a self- assessment form. After departments self- classify at 100% compliance with ‘priority 1’ ACSA standards, a two-day on-site review takes place.
Dr Sade Okutubo, lead for the ACSA Homerton process and the clinical lead in Perioperative, Critical Care and Chronic Pain Services at the hospital, told us: “When we started the department back in 1998 we based our standards on the GPAS document, which the College produces.”
The department therefore knew it already met most standards, but prepared for its review by going through each with a fine-tooth comb. It was asked to send audit results and randomly- chosen anaesthetic charts from the previous six weeks to the RCoA in advance.
The review itself was by two medical reviewers, a patient representative, and an administrator, looking at 12 specific standards (about which the department was warned in advance) and evidence for compliance with a further 42 standards revealed only during the review.
“It was quite a gruelling process, and shouldn’t be taken on lightly,” Dr Okutubo told us, with ACSA’s inspection at departmental level being comparable to CQC inspection at trust level. The CQC recognises ACSA-accredited departments as low-risk.
Accreditation will give patients confidence and be a source of staff pride, Dr Okutubo said.
About 50 anaesthesia departments are engaged with ACSA, at various stages of the accreditation process.
Changes to clinical practice ACSA itself is evolving. A 2014 revision
added seven new standards, 28 amendments to existing standards, four amendments to existing evidence, and 55 adjustments to the underlying GPAS references. In total, there are now 172 ACSA standards for 2014.
National reports and documents can affect the programme. “Take NCEPOD, for instance,” said Dr Venn, referring to the National Confidential Enquiry into Patient Outcome and Death. “They publish two major audits a year but they admit that the recommendations [from them] may take up to 10 years to embed into changes in clinical practice. That seems a ridiculous length of time.
“Once their latest document is published the recommendations will be fed into GPAS 2015, and in turn the ACSA standards. Initially these recommendations will be priority 2 – an aspiration – but in 2016 they will become priority 1 standards, which departments must adhere to if they are to remain accredited.”
This “short-circuits” the process, he said, meaning changes to clinical practice come about in two years, not 10. “We’re getting national recommendations into clinical practice much more quickly than just allowing them to come in by default.”
The College wants the peer-review process to become the norm to drive up standards.
Dr Okutubo said regulation, payment by results and surgeons’ performance results being published are all signs of the times we live in.
She said: “This is the equivalent, specifically for anaesthesia.
“It is difficult to measure outcomes in anaesthesia because people have an operation, they go to sleep, they wake up and then they go home. This, however, goes some way to comparing services across the UK and working out if it is a good quality service.”
FOR MORE INFORMATION W:
www.rcoa.ac.uk/acsa
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