2016 QI Fellows and their QI Projects:

Dr Claire EvansDr Eleanor RaynerDr Shinoy Kurup

Problem:
The NLS guidelines state that the new born neonate’s temperature should be actively maintained between 36.5°C and 37.5°C. This is due to a strong association between neonatal hypothermia and morbidity and mortality.

With the data currently available to us, it appears that approximately 23% of preterm neonates born at the Royal Devon & Exeter NHS Foundation Trust have an admission temperature lower than 36.5°C.

Plan:
• We will input a new system where the temperature is taken at certain stages during the post birth period and reliably recorded
• Using this data we will implement a change in temperature management depending on the stage at which the neonates are getting cold (e.g. hats, polythene bags, transformer mattress, battery for radiant heater, transferring using incubator, set temperature of delivery room/operating theatre)

Primary Outcome Aim:
To improve the admission temperatures of babies admitted to the neonatal unit from delivery.

Problem:
Outpatient induction of labour is current practice within several hospitals across the U.K, being offered for patients undergoing a low risk induction. It has been identified as having many potential benefits, including increased patient satisfaction and may be associated with cost savings also.

Plan:
We plan to implement this service within Derriford Hospital, Plymouth and produce a 'package' to enable other centres currently not offering this service within the South West to implement if desired.

Primary Outcome aims:
The aim will be to increase the uptake of patients opting for this service in units already offering this process across the South West.

Problem:
• There is an increased demand on primary care service primarily due to growing and ageing population with complex health needs.
• New models of care are piloted in different parts of the country. Currently, developing a MCP (Multi-speciality Community Provider) type model in Torquay, incorporating clinical pharmacist, mental health team, paramedics and advanced nurse practitioner in the structural framework.
• Reports published in 2015 suggest 27% of GP appointments are potentially avoidable. These appointments could have been dealt by another professional in the practice, community pharmacists and health navigators.
• NHS England brought forward “Ten high impact actions to release capacity” which identifies ways to release capacity for general practices.
• Evidence is emerging in the form of case studies, audits and satisfaction questionnaires about high impact actions to release capacity

Plan:
Our practice has implemented Health Navigation, an ODT (On the Day Team) service and looking ahead hope to incorporate e-consult on the basis of published case studies and experiences from different practices in the country.

Primary Outcome aims:
Increase appointment capacity (routing/ non-urgent) approximately to 10% (day) in 12 months and decrease the number of unavailable appointments by 3% (week) in 12 months