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Performance
Our performance
During the past year the trust has seen significant improvements in clinical performance such as cancer waiting times and infection control. The trust has also become host to the south west London major trauma centre and hyper acute stroke unit, with both services achieving excellent results in national audits and seeing improved patient outcomes.
Last year at St George’s Hospital…
| 2011/12 | |
|---|---|
| Babies born | 5,118 |
| Day cases | 28,702 |
| Inpatient admissions | 69,765 |
| Outpatient attendances | 558,518 |
| A&E attendances | 163,155 |
| Community appointments | 647,198 |
Dr Foster Hospital Guide 2012
St George's Healthcare has been named as one of an elite group of only 16 trusts in the country to have 'lower than expected' mortality rates for the Summary Hospital-level Mortality Indicator (SHMI), which measures the ratio of observed deaths to expected deaths. St George's was also named as one of the leading trusts in the country for SHMI in 2011, the first time Dr Foster reported on these mortality rates.
As well has also being named amongst the leading performers for SHMI, the trust has also been named among trusts with a 'better than expected' outcome for Hospital Standardised Mortality Ratio (HSMR) and emergency HSMR.
Other areas in which St George's Healthcare is named amongst the leading performers in the country include:
- Having lower than expected 28 day emergency readmission rates;
- Having a higher than expected ratio of MRI scans carried out on the day of admission, demonstrating that we are providing timely diagnostics throughout the night and at weekends to some of south west London’s most seriously ill patients;
- Elderly inpatients having a shorter length of stay than most other hospitals, showing that we are effectively treating patients and getting them home quicker where they can be treated in the comfort of their own homes by our community nursing and therapy teams;
- Having one of the quickest ‘first to follow up’ ratios in the country, which shows that we see, treat and discharge our outpatients using fewer appointments and return trips than other hospitals. This is good for patients and demonstrates effective use of our resources;
- Carrying out more procedures at the weekend than most other hospitals, showing that we are offering our patients more procedures at times that suit them.
Find out more about the Dr Foster Hospital Guide 2012
CQC ratings
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. It regulates care provided by the NHS, local authorities, private companies and voluntary organisations that provide regulated activities under the Health and Social Care Act 2008.
The CQC registers, and therefore licenses, all NHS trusts. It monitors trusts to make sure they continue to meet very high standards of quality and safety. If services drop below the CQC's essential standards it can impose fines, issue public warnings, or launch investigations. In extreme cases it has the power to close services down.
The information below shows the results of recent checks to each of our four main healthcare sites by the CQC, showing that they all meet the standards that the government says patients have the right to expect.
St George's Hospital
Queen Mary's Hospital
St John's Therapy Centre
HMP Wandsworth
18 weeks
96 per cent of outpatients and 82 per cent of admitted patients were treated within 18 weeks of referral. The national standard is for 95 per cent of outpatients and 90 per cent of admitted patients to receive treatment within 18 weeks.
The trust has experienced difficulties reporting against the 18 week referral to treatment target since the introduction of new clinical information systems at the end of March 2010. We have developed an action plan to improve this with support from NHS South West London and the Department of Health’s intensive support team.
A&E
During 2010/11 attendances at St George’s Hospital A&E have increased to an average of 360 a day. 97 per cent of cases were admitted, transferred or discharged within four hours against a national target of 95 per cent.
In 2011/12 A&E performance will be measured against eight new national clinical quality indicators designed to improve the quality of care in A&Es across the country. The trust has drawn up an action plan to further improve the quality of data recording to help with measurements against these indicators and to improve performance in areas that will challenge us. The new indicators are:
- Ambulatory Emergency Care
- Unplanned re-attendance rate
- Total time in the A&E dept
- Left without being seen rate
- Service experience
- Time to initial assessment
- Time to treatment
- Consultant sign off
The A&E clinical indicators and A&E service experience are available to download in PDF format. Published monthly they show how St George's Hospital A&E department performs against national benchmarks.
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A&E service experience | |
Cancer
This year we achieved all of our cancer waiting time targets with 96 per cent of suspected cancer patients having an appointment with a consultant within two weeks of referral by their GP. We have also increased the number of cancer patients beginning treatment within 31 days of diagnosis to 98 per cent.
Complaints
The trust increased in the amount of complaints responded to within 25 days significantly, jumping from 51 per cent in 2009/10 to 81 per cent this year despite an increase in the number of formal complaints in to 1,177 from 905.
The trust’s Patient Advice and Liaison Service (PALS) team work to address any problems or concerns that patients may have about services, and listen to their views and comments. They also provide access to interpreters, signers and other services, and help staff when they need support. The PALS team also provides customer care training to staff across the organisation. In 2010/11 the PALS team was contacted 6,421 times, compared to 5,954 times in the previous year.
Infection control
Last year we saw the lowest infection rates we have ever recorded for MRSA and Clostridium difficile (C.diff) at St George’s Hospital, Tooting, and the Wolfson Neurorehabilitation Centre, Wimbledon.
Acquiring only nine MRSA infections and 83 C.diff infections during 2010/11, the trust remained within its mandatory performance limits for both MRSA and C.diff, of nine and 168 respectively. This achievement included a period of over 200 days where none of the hospital’s patients acquired MRSA blood stream infection.
The trust’s management of infection has been developing over recent years and infection rates have improved consistently since 2006. In 2010/11 St George’s Healthcare recorded the lowest C.diff rate and the second lowest MRSA rate among teaching hospitals in London.
Major trauma
In April 2010 St George’s Hospital became the major trauma centre for south west London. Since then we have passed four performance review visits from the London Trauma Office and have developed and implemented protocols that have significantly improved patient care, including spinal and head injuries.
In 2010/11 we treated 310 cases of major trauma, while trauma cases have risen from 35 per month to 85 per month. Paediatric trauma has increased from eight cases in the whole of 2009/10 to eight cases per month in 2010/11.
Mixed sex accommodation
Over the last year we have worked hard to eliminate mixed sex accommodation across St George’s Healthcare and have made significant improvements, as reflected in the Care Quality Commission National Inpatient Survey.
Since March 2010 we have been compliant with the NHS Operating Framework guidance ‘to eliminate mixed sex accommodation except where it is in the overall best interests of the patient, or reflects their patient choice.’ However, new guidance released in February 2011 stating that clinical decision units (CDUs) should be included in the reporting has provided the trust with significant challenges. The trust immediately implemented an interim solution to make sure that the CDU at St George’s Hospital meets the new guidance while we work on a sustainable long-term plan.
National audits
In 2010/11 St George’s Healthcare took part in 35 national clinical audits and four national confidential enquiries. The results of all of the national audits have been presented either to the relevant services or to the trust board and action plans have been developed to improve quality in identified areas. A number of local audits have also been presented to the trust’s board.
You can find out more about the national audits that trust has participated in and how we put the reports into action read the St George’s Healthcare quality account.
National inpatient survey
Following disappointing results in the 2009 Care Quality Commission national inpatient survey, the trust developed an action plan to make patients feel more comfortable during their stay in hospital.
The hourly rounding initiative sees nurses attend every patient hourly and ask five questions relating to their comfort and whether there is anything that the patient needs help with. This initiative continues through the night, with silent rounds conducted when patients are sleeping.
The trust also introduced a Don’t take your troubles home campaign, encouraging patients to share their worries and concerns with a senior sister or matron so they could be resolved as quickly as possible.
Other schemes included weekly quality rounds, improvements in patient information and the development of the trust’s food and nutrition strategy.
The results of the 2010 national inpatient survey showed that the action plan has helped St George’s Healthcare to make significant improvements in a number of areas, with the trust ranked in the top 20 per cent of trusts in the country in nine categories, compared to just three categories in 2009. Although still scoring in the bottom 20 per cent in 11 categories, this is also a marked improvement on 2009 when the trust scored in the bottom 20 per cent in 36 categories. St George’s Healthcare was ranked in the middle tier of trusts in the remaining 49 categories, compared to 25 the previous year.
Find out more about the trust’s national inpatient survey results on the Care Quality Commission website
Stroke
Stroke services at St George’s Healthcare have been rated the best in the country in results from the National Sentinel Audit for Stroke, organised by the Royal College of Physicians. The audit assesses quality of care by looking at the process of care in place for patients and how the service is organised. Over 200 trusts in England, Wales and Northern Ireland were assessed across eight categories and the stroke service at St George’s achieved the highest overall score.
