Annual Report and Accounts 2012/13 - Hillingdon Hospital NHS Trust

Infection control
The Trust continued to drive forward the
infection prevention and control agenda
and met the performance targets for both
MRSA and Clostridium difficile (C-diff) in
2012/13. One MRSA bloodstream infection
was reported against a threshold of three,
which is a significant improvement from
the previous year’s performance when we
finished with four reported cases of MRSA.
The Trust reported 23 cases against a
threshold of 24 for C-diff infections. Whilst
this meant we met the target, the Trust saw
an increase in reported cases from quarter
three resulting in the Trust remaining close
to the target.
All C-diff patients had detailed multidisciplinary
root cause analysis (RCA)
undertaken involving the Microbiologists,
the patient’s clinical team (Consultant and
nursing staff), the infection control team and
other members of the multi-disciplinary team
(MDT) as required. Key learning from RCAs
undertaken for 2012/13 cases included:
• Antimicrobial prescribing: clinical
indication must be documented and
the antimicrobials reviewed at every
ward round.
• Documentation (both nursing &
medical) needs to be thorough and
contemporaneous.
• There is a need for improved
communication between teams,
especially when the patient is an
outlier with regard to specialty.
• Specimen results are checked as soon
as possible by ward staff after sending
to the laboratory.
• There should be senior clinical
decision-making in sending samples.
• Patients with diarrhoea on admission
require specimens and isolation at the
earliest opportunity.
These themes were shared widely across the
organisation to ensure that the key learning
was shared and used to shape future
practice.
The Trust faces an increased challenge for
the new financial year with a target of zero
for MRSA and 14 for C-diff. We do however
believe that the learning from the root cause
analysis and the continued work around
education and close monitoring will enable
the Trust to meet these more stringent
targets.
Cancer
A comprehensive action plan was
implemented in 2011/12 to strengthen
management arrangements within the
cancer services. As a result of which, the Trust
delivered strong performance on all cancer
targets in 2012/13.
Referral to Treatment waiting times
All 18 week targets for both admitted and
non-admitted patients were achieved and
exceeded. The strong performance across
elective (planned treatment) waiting time
standards continues to ensure that the Trust
remains one of the top performing hospitals
in North West London on these targets which
seek to minimise patients’ waiting time for
treatment.
Accident and Emergency (A&E)
waiting times
The Trust achieved the target for 95% (all
types) of patients to have a total time in
A&E of less than four hours, with a mean
performance throughout the year of 96.6%.
A majority of Trusts in London have been
challenged in delivering the A&E standard
throughout the last quarter of the year.
Unprecedented numbers of ambulance
arrivals and increased acuity of patients
made delivery of the target particularly
challenging. Ambulance arrivals increased
6 Directors’ report