Housekeeping Todays meeting is being recorded Please put yourself on mute when not speaking we can do this centrally if there is a lot of background noise Please do not speak over other speakers raise your hand using the button in toolbar on the screen if you want to say something ID: 1045025
Download Presentation The PPT/PDF document "Spinal Standardising Care Programme" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Spinal Standardising Care Programme
2. HousekeepingToday’s meeting is being recordedPlease put yourself on mute when not speaking – we can do this centrally if there is a lot of background noisePlease do not speak over other speakers – raise your hand using the button in toolbar on the screen if you want to say somethingUse the chat box – write hands up in the chat or ask questions directly – this will be monitored throughout the eventWe hope today is a really interactive event but we do have a lot to get through so will be keeping speakers to timeMute/unmuteRaise handChat box
3. Agenda Item Lead IntroductionsSB/DC/MHOpening statement: Standardising Care Programme TB Specialised Commissioning opening remarks SB/DCObjectives of the Spinal Standardising Care Programme MHGIRFT Spinal overview (key priorities) - Standardised pathways - New GIRFT metrics Sentinel metrics Clinical metrics Model Hospital- Gateway framework MHQuestions AllNext Steps MHClosing Remarks MH/SB
4. To ensure equity of access to best practice outcomes so that together we can make London the healthiest global city This programme intends to support services to implement best practice in clinical outcomes and productivity. This will be delivered by: • Standardising pathways of care using GIRFT principles and best practice examples to strive to current top decile performance or better • Transition to a ‘one workforce, one estate’ mindset • Refreshed GIRFT clinical metrics, more frequently updated, accessible to all at all times via Model Hospital• Implementation of continuous improvement methodology to remove unwarranted variation in clinical outcomes Objectives of the Standardising Care Programme
5. Specialty gatewayWhat does ‘good’ look like?Where are we now?How do we get there?Model Health SystemBest practice pathwaysGIRFT Academy~40 metrics per specialty~10 Sentinel MetricsTop decile performanceData available at system & trust levelRegularly refreshed – data 1-2 months behindBenchmarking – transparency across all systems/trustsDeveloped by local clinical expert panel, signed off by regional CAGCo-badged/supported by professional societies
6. London Spinal Surgery Networks Funding arrangements Importance of GIRFT, NHSE/I and Network joint workingCovid pandemicInterdependences with other NetworksNeurosurgeryNeurosciences NetworkMajor TraumaSpinal Cord Injury Key areas of focus:Equity of accessReduction in waiting listsReduction in clinical variationPatient outcomesOptimum pathways of care
7. NHSE CRG Clinical Chair – Spinal ServicesRegional spinal networks previously funded using CQUINImplementation variable across EnglandFunding now distributed to a provider in each networkFunding to support network with clinical lead, network manager and administrative support.
8. Regional Spinal NetworksEssential to improve patient care. Clinician led to define and standardise elective and emergency pathways. Define who does what and where with low volume procedures.Share learning in regional meetings, discuss outcomes and variation.
9. Service SpecificationNew specialised spinal surgery specification awaiting approval. More emphasis on networks and collaborative working. Highlights the importance of defined pathway for low back and radicular pain.Standards of care for specialised spinal surgery
10. NHSE – CRG Working with GIRFT to standardise and improve careHappy to support and work with regions to advise on pathways and development of networksdavid.cumming@esneft.nhs.uk
11. SESWNWNELondon Spinal Networks
12. Spinal Programme PrioritiesBack/Neck & Radicular pain Workforce (e.g. Radiographers)Patient waiting timesLow volume/High Complexity procedures e.g. Adult Deformity CorrectionOutpatients Procurement Consent
13. National Back & Radicular Pain Pathway (Post Covid)Red FlagsUrgent Referral to Surgical ServiceCombined Physical & Psychological Rehabilitation Programme (CPPP)Spinal Surgical CentrePain ServiceOther Secondary Caree.g. Rheumatology/NeurologyFailed CPPP Diagnostic Medial Branch Facet Blocks in certain patients Failed CPPPSpinal Cord Stimulation in certain patientsMay requestPhysio Imaging/Bloods/Nerve Root Injections
14. Why Pathways ?
15. National Back/Neck & Radicular Pain Pathway (Post-Covid) What Do We Need ?Single/Common Point AccessNo Direct Referral for Non Red Flag/Emergency CasesESP Lead for each NetworkNetwork ManagerGIRFT ICS Coordinators. Kia Rezajool, RNOH North West Matt Crocker, St. Georges South West David Bell & Gordon Grahovac, Kings South East Suresh Pushpanathan, Barts/Royal London North EastLondon Expert Advisory Panel including input from National Clinical Reference Group, Spec Com, Physios and primary careLink with the London Neurosurgical NetworksFunding NHS England
16. Spinal Pathways Posterior Lumbar Decompression / DiscectomyOne or Two Level Posterior Fusion surgery (PLF / TLIF / PLIF)Lumbar Nerve Root Block/EpiduralLumbar Medial Branch Block/Facet Joint InjectionsOne or Two Level Anterior Cervical Discectomy & Fusion/Disc Replacement (ACDF/CDR), Posterior Cervical Foraminotomy
17.
18. GIRFT metrics Sentinel MetricsSpecialist surgery rate for spinal surgery% of HES records also recorded in BSR (recording compliance)Proportion of procedures on cervicothoracic & lumbar pathway that has EQ5D at 3 months on BSRNo procedure for elective back or radicular pain admissions (On the Day Cancellation)No procedure for emergency back or radicular pain admissions with length of stay greater than 3 daysPatients with three or more facet joint injections within 12 monthsPatients with three or more epidural injections or nerve root blocks within 12 monthsDaycase rate for spinal discectomy for young adultsOutpatient attendances in 12 months prior to posterior lumbar decompressionOutpatient attendances in 12 months prior to cervical discectomy, disc replacement or decompression/fusionOutpatient attendances in 12 months following posterior lumbar decompressionOutpatient attendances in 12 months following cervical discectomy, disc replacement or decompression/fusion
19.
20. New GIRFT metrics Back & Radicular PainFacet joint injection for back pain activity (monthly)Nerve root ablation for back or radicular pain activity (monthly)Sacral Iliac injection for back or radicular pain activity (monthly)Epidural injection or nerve root block for radicular pain activity (monthly)Denervation of lumbar facet joint for back or radicular pain activity (monthly)Denervation of cervical or thoracic facet joint for back or radicular pain activity (monthly)Other intervention for back or radicular pain activity (monthly)Cervical SurgeryCervical disc replacement as a percentage of total anterior cervical spinal surgery (excluding corpectomy)Emergency readmission in 30 days following anterior cervical decompression and/or fusionReturn for cervical surgery following anterior cervical decompression and/or fusion within 2 yearsMedian length of stay for anterior cervical decompression and/or fusionReturn for cervical surgery following anterior cervical decompression and/or fusion within 90 daysLumbar DecompressionEmergency readmission in 30 days following primary posterior lumbar decompressionReturn for lumbar surgery following primary posterior lumbar decompression between 90 days and 2 yearsMedian length of stay for primary posterior lumbar decompressionReturn for lumbar surgery following primary posterior lumbar decompression within 90 daysPosterior Lumbar FusionLumbar fusion as a percentage of total lumbar spinal surgeryEmergency readmission in 30 days following primary posterior lumbar fusionReturn for lumbar surgery following primary posterior lumbar fusion within 2 yearsReturn for lumbar surgery following primary posterior lumbar fusion within 90 daysAdult Deformity CorrectionAdult deformity correction >55 years age surgery activityReturn for spinal surgery following older adult deformity correction surgery within 90 daysReturn for spinal surgery following older adult deformity correction surgery between 90 days and 2 years
21. Model Hospital
22. Model Hospital
23.
24. GIRFT Spinal Gateway Framework
25. GIRFT Spinal Gateway FrameworkSelf Assessment
26. Questions? * Network introductory meetings
27. Spinal GIRFT ICSco-ordinatorsClinical Reference Group Introductory network meetingToday!Gateway framework (expected)(23/11)Network gateway review meetings(11/01-05/02)Next Steps and Timelines
28. Closing remarks
29. Appendix
30. North West London Spinal network
31. North East London Spinal networkHistorical that Broomfield, Basildon, Southend and Chelmsford part of East of England Network
32. South East London Spinal network
33. South West London Spinal network
34.
35.
36.
37.
38.
39. Any comments or questions please contact :Mike Hutton mike.hutton-girft@nhs.net GIRFT Spinal National Clinical Lead Rebecca Gouveia r.gouveia@nhs.net GIRFT Regional Manager, LondonVictoria Osbourne-Smith vickie.osborne-smith@nhs.net Regional Programme of Care Manager – Trauma, Specialised Commissioning London