Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

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36 2. Statement of Assurance from the Board Royal Devon and Exeter NHS Foundation Trust Quality Report 2012/13 Clinical research participation Participation in clinical research demonstrates the Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement. Our clinical staff stay abreast of the latest treatment possibilities and their active participation in research leads to successful patient outcomes. The number of patients receiving health services provided or subcontracted by the Royal Devon & Exeter NHS Foundation Trust in 2012/13 that were recruited during that period to participate in research approved by a research ethics committee was 7,900. The Royal Devon & Exeter NHS Foundation Trust is one of the highest recruiting NHS organisations to clinical trials in the South West Peninsula. The Trust was involved in conducting 577 clinical research studies in a wide range of specialties during 2012/13. During this period there were over 300 clinical staff participating in research approved by a research ethics committee. Over 95% of studies were approved within 30 days of receiving valid application. The Royal Devon & Exeter NHS Foundation Trust hosts the Peninsula Comprehensive Research Network, the South West Research Design Service and the Cancer, Stroke and Diabetes Local Research Networks and the Peninsula Collaboration for Applied Health Research and Care, thus playing a significant role in the region for the National Institute of Health Research (NIHR). The Royal Devon & Exeter NHS Foundation Trust collaborates with Exeter Medical School, hosting the NIHR Clinical Research Facility for experimental medicine. A total of 5500 participants were recruited into research studies during 2012/13 at this facility. Research focuses on understanding mechanisms of disease (mainly in diabetes and cardiovascular patients) and introducing improvements to patient care. The high quality of the research at the Trust is demonstrated by the level of external grant funding, which in 2012/13 exceeded £5 million. Additionally, in the last three years, 400 publications have resulted from our involvement in research, evidencing our commitment to transparency and desire to improve patient outcomes and experience across the NHS. CASE STUDY Emergency laparotomy – a race against time Every year, around 160 patients are admitted to the RD&E requiring emergency laparotomy. This group of patients are often very sick and suffer a high rate of morbidity and mortality. An audit carried out last year, by anaesthetists Louise Cossey, Bruce McCormick and James Pittman, showed that the RD&E’s mortality rate for these patients was around14% – slightly better than the national average, but enough to motivate the team to seek improvement. As a result of that initial study, the Trust will now take part in a multi-centre pilot of a new care pathway, launched on 3rd December 2012. The pathway follows guidance on best practice issued by the Royal College of Surgeons and the National Confidential Enquiry into Peri-Operative Deaths (CEPOD). It was designed by the Royal Surrey County Hospital NHS Foundation Trust, which has one of the lowest mortality rates in the country for these patients. “We know that with emergency laparotomy patients, we’re in a race against time to make a diagnosis and commence life-saving treatment as soon as possible,” said Dr McCormick. “The key is to identify these patients and intervene with antibiotics and, where indicated, perform emergency surgery within six hours of diagnosis, so that they have the best chance of recovery. We hope that by close attention to all aspects of each patient’s care we can achieve ’incremental gains’ that will result in improved survival of these patients.” The new pathway adopts a truly multi-disciplinary approach, involving staff from the Emergency Department, Surgery, Anaesthetics, ICU and Radiology. Key to implementation of the new pathway is the role of the Trust’s four Physicians’ Assistants in Anaesthesia, who provide an on-call support service. The pilot is running for six months before being evaluated for its impact on length of hospital stay and mortality rates. If, as hoped, the results show a drop in mortality then the pathway will be adapted for ongoing use.
2. Statement of Assurance from the Board Royal Devon and Exeter NHS Foundation Trust Quality Report 2012/13 37 Goals Agreed with Commissioners Use of CQUIN payment framework A proportion of the Royal Devon & Exeter’s income in 2012/13 was conditional on achieving quality improvement and innovation goals agreed between the Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation (CQUIN) payment framework. Further details of the agreed goals for 2012/13 (detailed below) and for the 12 month period is available electronically at www.rdehospital.nhs.uk. The 2012/13 NHS Operating Framework continued the potential for Trusts to earn additional income, conditional upon achieving quality improvement and innovation goals. The Trust agreed a suite of schemes for which the Trust could earn an additional £6.7 million of income in 2012/13. In 2012/13 the Trust received payment to the value of £6.4 million. In 2011/12 the Trust received payment to the value of £3.8 million. National guidance increased the proportion of contract income that could be earned through CQUIN schemes from 1.5% in 2011/12 to 2.5% in 2012/13.
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