What’s the aim of the SLQMAPS project?
Following the development of service standards for acute general paediatric services, in 2014 we launched a programme of work with the intention of producing 5-10 universally applicable and practically measurable quality improvement measures for acute paediatric services. These would be used to indicate changes in the quality of care over time, which may result from service change.
Why are we doing this?
- To enable and support child health services to monitor the effect of service interventions at a local level.
- To provide a strong evidence base for the development and revision of service standards, such as the Facing the Future suite of standards.
- To identify and share examples of best practice, to aid the improvement of child health outcomes across the four UK nations.
The following is the executive summary from our Service Level Quality Improvement Measures for Acute General Paediatric Services (SLQMAPS) 2016 report. The full report and appendices can be downloaded below.
In 2014, following the development of service standards for acute general paediatric services, the RCPCH launched a programme of work with the intention of developing quality improvement (QI) measures for acute paediatric services. There is a clear lack of metrics specifically for acute general paediatrics, but significant interest in, and need for, their development. Similar sets of metrics exist for other specialty areas, including neonatology and surgical care.
The RCPCH is ideally placed to lead this work due its UK-wide reach, strong membership body and ability to bring together key stakeholders geographically and across interest areas. We have notable expertise in delivering a wide range of quality improvement projects and national clinical audits, and setting clinical standards for paediatric practice.
The primary objective of this programme of work is to enable and support child health services to monitor the effect of service interventions at a local level. By monitoring changes in metrics at an individual unit level, services will be empowered to assess the impact of meeting service standards, for example, Facing the Future Standards for Acute General Paediatric Services, to assess the impact of locally driven quality improvement initiatives, and to enable routine monitoring.
The development process to date has involved an initial call for evidence and consultation with children and young people, literature review and evidence synthesis, shortlisting of potential measures by an expert reference panel and stakeholder consultation followed by further shortlisting based on feedback provided.
Following the consultation process, proposed measures were re-aligned into five measurement domains, under which lie quality improvement measures for further development. These measurement domains are:
- Management of acute illness by inpatient general paediatric services
- Patient safety
- Activity and patient flow
- Patient and parent/carer experience
- Staff experience
Alongside the measurement domains, ten key principles have been set out for further development of the metrics. These principles are intended to ensure that the measures meet the needs of services and their users at a local level without causing undue additional burden to their workload. Key to this is ensuring that, wherever possible, measurement domains and measures will be aligned with existing standards and data sources. Where new data capture is required, the collection burden and financial impact of data collection will be a major consideration.
Recommendations under each measurement domain focus on where there is potential to align with existing standards and data sources.
Challenges have been identified with the use of local service level metrics for analysis at a national level, or for benchmarking of units. Consequently, an additional objective of this project is to identify research gaps and work towards a framework to compare quality of care between units in the future.
The report sets out 10 key principles for the further development of measures and recommends development of measures in five domains, with a focus on specific metrics under those domains:
1. Management of acute illness by inpatient general paediatric services
1.1. Process measure(s) encompassing one or more evidence-based aspect of the medical management of a group of acute paediatric presentations for infants, children and young people presenting to, or already admitted to, acute paediatric services.
1.2. Adherence and response to paediatric early warning system (PEWS) for infants, children and young people admitted to acute paediatric service.
2. Patient safety
2.1. Medication and treatment errors
2.2. Quality of response to and learning from adverse reported incidents relating to physical or mental health affecting infants, children and young people admitted to acute paediatric services.
2.3. Quality of clinical handover within the acute paediatric service.
3. Activity and patient flow
3.1. (a) Overall rate of admission to acute paediatric inpatient service.
(b) When present, rate of admission to paediatric ambulatory care unit.
3.2. Length of admission to paediatric inpatient services.
3.3. Unplanned re-admission within 24 hours/48 hours/7 days of discharge from hospital for infants, children and young people.
4. Patient and parent/carer experience
4.1. A patient reported experience measure (PREM) for infants, children and young people and their carers admitted to acute paediatric services, including questions related to management of pain.
5. Staff experience
5.1. Staff reported experience, including satisfaction with care provided, morale and attitudes toward safety.
We are playing an important role in the Collaboration for Quality Measurement in Children and Young People's Health, which comprises senior members of NHS England, Public Health England, the Care Quality Commission, NICE, and a range of research and quality improvement groups. The first meeting of this group was hosted by RCPCH in May 2017, led by Dr Dougal Hargreaves of University College London.
A report and recommendations from this group will be published separately.