ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 P16 | DOI: 10.1530/endoabs.66.P16

Improving the rate of completion of 7 care processes at a busy district general hospital by using quality improvement methodology

Ahmed Kassab, Sanjay Rawal, Birgit Van Meijgaarden, Shahida Ahmed, Ruth Francks, Lynn White, Elizabeth Daniel & Laura Hunt


Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon, UK


Background: The NPDA has been providing annual audit reports to paediatric units in UK from 2003 and a compliance report for 7 care processes since 2016–2017. Over the years the focus on the type of data and implications of data has changed and become more focused especially after introduction of BPT and PEER review. The paediatric diabetes services at Basildon and Thurrock University Hospitals (BTUH) were identified as negative outliers in 2016–2017 NPDA report. A QI programme was undertaken to improve care of diabetes patients 0–19 years at BTUH from November 2017 till April 2019. The paediatric diabetes team at BTUH is caring for around 220 patients with type 1 diabetes.

Methodology: The team started a QI project in November 2017 spanning over 18 months. After BTUH paediatric diabetic team received outlier status, the team took part in the RCPCH QI pilot initiative. We used learned QI techniques including pathway mapping exercise, driver diagram and PDSA cycles to implement several small changes. The clinic proforma was tailored to capture NPDA requirements and practical training sessions were organised for admin staff for accurate input of seven care processes data onto Twinkle. The default reminder letters were designed for patients who did not have their annual review bloods and other investigations performed. The live NPDA data was shared with team in MDT meetings and adjustments were made wherever necessary to improve data capture and recording.

Results: The changes implemented have shown significant improvements in seven care process completion rates. The Retinal screening improved from 55 to 82%, the albumin creatinine ratio increased from 24 to 72%, the foot examination increased from 65 to 80% and the TSH increased from 66 to 74%. The overall median HbA1c improved from 66 to 60 mmol/mol. The percentage of children who received all the seven care elements increased from 15% in 2016–2017 to 56% in 2018–2019.

Conclusion: The implementation of skills learned at RCPCH QI pilot have shown improvements in completion of 7 care processes. The key to success was to work together as cohesive team and to have ability to review our progress with regular ‘live’ data.