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State ment relating to the quality of care provided
The CQC w ill complete a further unannounced inspection of the emergency department after 1 June 2021 to monitor our progress against the action plan and w e look forw ard to the opportunity to show them the improvements w e have made.
Priorities for quality im provements 2021- 2022
Our eight Quality Account priorities for the next year are identified in line w ith the quality elements of the trust five Ps strategy: w hich covers our patients, our people, our performance and our places. Our patie nts: 1. We aim to reduce the trust mortality rate (improve the Hospital Standardised Mortality
Rate - HSMR), continuing w ith the w ork already started on learning from every death.
This w ill improve quality of care for all patients
2. Improve our performance for timeliness of treating patients requiring emergency and urgent care. This w ill improve the quality of care and experience for our patients
Our pe ople
3. We w ill improve the health and w ellbeing of our people, offering a w ide range of support so that every member of staff can recover from the effects of w orking during the pandemic, can stay w ell and feel they can meet the demands of their roles.
Measures of success w ill be improved staff health and w ellbeing results in the Staff
Survey from 5.5 to 5.7 and low er sickness absence rate by 1%, from 4.43% to 3.43%
4. We w ill complete an annual report to review the doctors and dentists rota gaps for staff in training roles. This w ill help w ith planning of rotas going forw ard
Our pe rformance
Quality improvement projects to transform services are aiming to modernise how we deliver care and improve timeliness of treatment and patient experience. These projects include: 5. Outpatie nt im provement programme: We w illimprove the use of technology and redesign of our services to enable consultations to be completed to meet the needs of our patients and our services. In some instances this w ill mean few er attendances to the hospital. Measures of success w ill include improved patient experience, reduced numbers of face-to-face consultations and freeing up clinician time to deliver acute inpatient services
6. The atre transformation:We are aiming to ensure available operating resources (including staff) are used effectively and efficiently. Measures of success w ill include reduced additional operating sessions and reduced w ork being outsourced to other providers. There w ill be evidence of reduced w aiting times for necessary operations, improving patient experience.
7. Me dicines optimisation: We are aiming to ensure that patients are involved in the decision-making about their medications and that they receive the correct medications
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at the correct time. Measures of success w ill include improved patient safety, reduced w aste caused by unnecessary prescribing of medications and improved patient outcomes.
Our place s
8. We w ill work in partnership to improve our hospitals and health infrastructure for our patients.
Our pounds
There are no objectives regarding our pounds identified w ithin the Quality Account.
M onitoring progress on our 2020-2021 quality im provements
These priorities w ill be monitored using our existing governance structures; this w ill include being monitored through our Quality and Safety Committee.
State ments relating to quality of care provided
PAHT is a 414 bedded hospital w ith a full range of general acute services, including; a 24/7 accident and emergency department (A&E), plus an intensive care unit (ICU), a maternity unit (MU) and a level II neonatal intensive care unit (NICU). During 2020-21, w eopened a new building on the main site that holds the adult assessment unit and same day emergency care unit; both w ill provide an environment and new services that w ill improve patient experience for those patients requiring urgent care. We serve a core population of around 350,000 and are the natural hospital of choice for people living in East Hertfordshire and West Essex. In addition to the communities of Harlow and Epping, w e serve the populations of Bishop Stortford and Saffron Walden in the north, Loughton and Waltham Abbey in the south, Great Dunmow in the east, and Hoddesdon and Broxbourne in the w est. The extended catchment areas incorporate a population of up to 500,000. We ow nthe main hospital site in Harlow , and operate outpatient and diagnostic services out of the Herts and Essex, Bishops Stortford and St Margaret’s Hospitals. The operation of these facilities forms part of the longer term strategy of bringing patient services closer to w here people live and making services, w here appropriate, that are more accessible and easily available to patients. We operate over forty different services to meet the needs of our patients (see the service portfolio in table 2)
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Table 2: Dire ctory of our services
Acute medicine including ambulatory care and same day emergency care Dietetics Interventional radiology
Anticoagulant and haematology clinics Early Pregnancy Unit
Maternal and Foetal Assessment Unit (MAFU) Audiology Ear nose and throat Maternity comprising: Antenatal clinic Antenatal w ard Birthing unit Breastfeeding support Labour w ard Petal counselling service Postnatal w ard Ultrasound scanning Patient at home service
Perioperative care medicine
Pharmacy
Breast screening Emergency department
Maxillofacial surgery Physiotherapy and occupational therapy Breast surgery Endocrinology Medical oncology Radiology
Cardiology and cardiac catheterisation unit End of life care Mortuary and bereavement services Research and development
Chemotherapy Endoscopy services Neonatal critical care including special care baby unit Respiratory medicine
Clinical haematology Frailty service Neurology Rheumatology Clinical oncology Gastroenterology New born hearing screening Speech and language therapy Colorectal services General medicine Obstetrics Surgery clinics and inpatient care
Colposcopy and hysteroscopy services Community midw ifery team General surgery Ophthalmology Tissue viability
Genito-urinary Medicine Oral surgery Tongue tie service
Community neonatal team Gynaecology including Paediatric: Ambulatory care, Transfusion services
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Ambulatory care Termination of pregnancy services diabetic medicine, Emergency department
Day surgery High dependency unit
Dermatology Infection prevention and control Diabetic medicine Intensive care unit for adults Palliative care Trauma and orthopaedics Pathology Urology
Patient appliances Vascular services
The review of services and all associated data is undertaken through the trust governance structure. This includes monthly meetings review ing information covering patient experience and engagement, patient safety, learning from deaths, vulnerable patients and the infection prevention and control committee and tw o monthly clinical effectiveness and compliance groups. All of these groups report monthly into the Quality and Safety Committee, a subcommittee of trust Board.
Review of each services’performance (in table 2) w ithin the trust is monitored through the Performance and Finance Committee, w ith external review undertaken by both Essex and Hertfordshire commissioners at the monthly Service Performance and Quality Review Group.
Table 3: State ments of assurance from the Board
Pre scribed information
1. The number of different types of relevant health services provided or subcontracted by the provider during the reporting period, as determined in accordance w ith the categorisation of services:
(a) Specified under the contracts, agreements or arrangements under w hich those services are provided or
(b) In the case of an NHS body providing services other than under a contract, agreement or arrangements, adopted by the provider. During 20/21, The Princess Alexandra Hospital NHS Trust (PAHT) has provided a range of health services listed in the directory of services, table 2. Services are provided by the trust to Clinical Commissioning Groups (CCGs) and are usually commissioned under standard form NHS contracts. How ever, in order to support the COVID-19 response during 20/21 operating plans and normal contractual arrangements w ere suspended. Instead, a national ‘adapted financial regime’ w as in place. This reverted activity based contracts to be block contracts i.e. fixed levels of income. Block
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Form of s tatement
contracts w ere supplemented by ‘top up’ and COVID-19 payments. These payments w ere agreed w ith the Integrated Care System (ICS). The above arrangements w ill remain in place until the first half year of 21/22.
Subcontracted activity: During the year, the trust subcontracted a small number of services to private or other NHS providers. Services are generally subcontracted w herethere is a short-term capacity constraint and the response to COVID-19 has required additional resources. Examples of subcontracted services w ere urology (day case and OPD), endoscopy surveillance, and gastroenterology and specialist clinical tests. The trust is the lead provider for musculoskeletal (MSK) services. The trust has subcontracted arrangements in place from our local mental health provider (EPUT) and Stellar Ltd, a local GP service. Subcontract arrangements are in place.
Pre scribed information
1.1 The number of relevant health services identified under entry one in relation to w hich the provider has review ed all data available to it on the quality of care provided during the reporting period. 1.2 The percentage that the income generated by the relevant health services review ed by the provider, as identified under entry 1.1 represents of the total income for the provider for the reporting period under all contracts, agreements and arrangements held by the provider for the provision of, or subcontracting of, relevant health services.
Form of s tatement
We have review ed all the data available on the quality of care provided by the services listed in table 2.
In 2020-21, £267.8m (85%) of the total income of £315.1m w as received for patient care activities for services listed in table 2. In reality some income classified as other operating income as part of the adapted financial regime e.g. ‘top up’ (£27.5) funding related to the provision of patient care. Including
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2 The number of national clinical audits (a) and national confidential enquiries (b) w hich collected data during the reporting period and w hich covered the relevant health services that the provider provides or subcontracts. 2.1 The number, as a percentage, of national clinical audits and national confidential enquiries, identified under entry tw o, that the provider participated in during the reporting period.
2.2 A list of the national clinical audits and national confidential enquiries identified under entry tw o that the provider w as eligible to participate in.
2.3 A list of the national clinical audits and national confidential enquiries, identified under entry 2.1, that the provider participated in. 2.4 A list of each national clinical audit and national confidential enquiry that the provider participated in, and w hich data collection w as completed during the reporting period, alongside the number of cases submitted to each audit, as a percentage of the number required by the terms of the audit or enquiry.
2.5 The number of national clinical audit reports published during the reporting period that w ere review ed by the provider during the reporting period.
2.6 A description of the action the provider intends to take to improve the quality of
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this reimbursement, 94% of income related to patient care. The most significant element of nonpatient income (£7.6m) related to provision of education and training.
PAHT has during 2020-21 participated in 37 national clinical audits and five national confidential enquiries covering relevant health services that are provided.
During that period, w e have participated in 73% national clinical audits and 100% of those national confidential enquiries that w ere relevant and w hichPAHT w as eligible to participate in.
The national clinical audits and national confidential enquiries that the trust w as eligible to participate in during 2020-21 are detailed in tables 11 and 12. The national clinical audits and national confidential enquiries that w e have participated in during 202021 are detailed in tables 11 and 12.
The national clinical audits and national confidential enquiries that w e have participated in, and for w hich data collection w as completed during 2020-21, are listed alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. The reports of no national clinical audits w ere review ed by the provider in 2020-21. See statement detailed against point 2.6 During 2020-21 the local review of national clinical audits reports w as
healthcare follow ing the review of reports identified under entry 2.5. impacted by COVID-19 and w ork is now taking place to address this. Reports published during the 20/21 reporting period and their recommendations are being review ed to identify actions required to improve the quality of healthcare
Pre scribed information Form of s tatement
2.7 The number of local clinical audit (a) reports that w ere review ed by the provider during the reporting period. 2.8 A description of the action the provider intends to take to improve the quality of healthcare follow ing the review of reports identified under entry 2.7. 3. The number of patients receiving relevant health services provided or subcontracted by the provider during the reporting period that w ere recruited during that period to participate in research approved by a research ethics committee w ithin the National Research Ethics Service. 4 Whether or not a proportion of the provider’s income during the reporting period w as conditional on achieving quality improvement and innovation goals under the Commissioning for Quality and Innovation (CQUIN) payment framew ork agreed betw een the provider and any person or body they have entered into a contract, agreement or arrangement w ith for the provision of relevant health services. The reports of 20 local clinical audits w ere review ed by the trust in 202021. Please see the section on infection prevention and control w here actions are detailed.
The number of patients receiving relevant health services provided or subcontracted by PAHT in 2020-21 that w ere recruited into research studies during the period and approved by a research ethics committee w as 1,331. As part of the response to COVID19 and the adoption of an ‘adapted financial regime’, the basis of the trust’s income w as derived from block contract arrangements supplemented by ‘top up’ arrangements.
During the first half of the financial year the ‘top up’ arrangements ensured providers met a breakeven position and w ere reimbursed for costs.
This is unlike previous years w here some aspects of the trust’s income w erepredicated on delivery of quality related factors e.g. CQUIN and maternity incentive, these w ere removed.
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4.1 If a proportion of the provider’s income during the reporting period w as not conditional on achieving quality improvement and innovation goals through the CQUIN payment framew ork, the reason for this. 4.2 If a proportion of the provider’s income during the reporting period w as conditional on achieving quality improvement and innovation goals through the CQUIN payment framew ork, w here further details of the agreed goals for the reporting period and the follow ing 12-month period can be obtained.
Pre scribed information
5. Whether or not the provider is required to register w ith the CQC under Section 10 of the Health and Social Care Act 2008. Not applicable for 2020/21.
Not applicable for 2020/21.
Form of s tatement
PAHT is required to register w ith the Care Quality Commission. The current registration status is “registered w ithout condition”.
5.1 If the provider is required to register w ith the CQC: w hether at end of the reporting period the provider is: (i) registered w ith the CQC w ith no conditions attached to registration (ii) registered w ith the CQC w ith conditions attached to registration If the provider’s registration w ith the CQC is subject to conditions, w hat those conditions are and w hether the CQC has taken enforcement action against the provider during the reporting period. The current registration status is “registered w ithout condition”.
The Care Quality Commission issued a Section 29a w arning notice against the trust during 2020-21. A robust action plan has been completed and all actions are being tracked to ensure they are completed w ithin timeframes.
6 Removed from the legislation by amendments made in 2011
7. Whether or not the provider has taken part in any special review s or investigations by the CQC under Section 48 of the Health and Social Care Act 2008 during the reporting period. PAHT has not participated in any special review s or investigations by the CQC during the reporting period.
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7.1 If the provider has participated in a special review or investigation by CQC: (a) the subject matter of any review or investigation (b) the conclusions or requirements reported by the CQC follow ing any review or investigation (c) the action the provider intends to take to address the conclusions or requirements reported by the CQC and (d) any progress the provider has made in taking the action identified under paragraph (e ) prior to the end of the reporting period.
Pre scribed information
8. Whether or not during the reporting period the provider submitted records to the secondary uses service for inclusion in the hospital episode statistics,w hich are included in the latest version of those statistics published prior to publication of the relevant document by the provider.
8.1 If the provider submitted records to the secondary uses service for inclusion in the hospital episode statistics w hich are included in the latest published data:
(a) the percentage of records relating to admitted patient care w hich include the patient’s: (i) valid NHS number (ii) General Medical Practice Code
(b) the percentage of records relating to outpatient care w hich included the patient’s: (i) valid NHS number (ii) General Medical Practice Code
(c) the percentage of records relating to accident and emergency care w hich included the patient’s:
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Form of s tatement
PAHT submitted records during 2020-21 to the secondary user service for inclusion in the hospital episode statistics, w hich are included in the latest published data.
PAHT w as not subject to the Payment by Results clinical coding audit during 2020-21 by the audit commission. How ever, an internal clinical coding information governance (IG) audit w as undertaken by an external NHS Digital qualified clinical coding auditor. The percentage of records in the published data w hich included the patient’s valid NHS number w as: 99.7% for admitted patient care 99.7% for outpatient care and 98.6% for accident and emergency care. This included the patient’s valid General Medical Practice Code w as: 99.8% for admitted patient care; 99.9% for outpatient care; and 99.4% for accident and emergency care.
Pre scribed information Form of s tatement
9 The provider’s Information Governance
Assessment Report overall score for the reporting period as per the Data Security
Protection Toolkit (DSPT) grading criteria. 10 Whether or not the provider w as subject to the payment by results clinical coding audit at any time during the reporting period by the audit commission. PAHT Information Governance Assessment Report via the DSPT has an overall scorefor 2020-2021 as Standard Met. PAHT w as not subject to the payment by results clinical coding audit during 2020-21 by the audit commission.
10.1 If the provider w as subject to the payment by results clinical coding audit by the audit commission at any time during the reporting period, the error rates, as percentages, for clinical diagnosis coding and clinical treatment coding reported by the Audit
Commission in any audit published in relation to the provider for the reporting period prior to publication of the relevant document by the provider. 11 The action taken by the provider to improve data quality. How ever, an internal clinical coding information governance audit w as undertaken by an NHS Digital qualified clinical coding auditor. Not applicable for 2020/21.
PAHT w ill be taking the follow ing actions to improve data quality: a) a full suite of data quality reports produced daily/w eekly and circulated to operational teams for resolution of key issues b) data quality issues are monitored and addressed through the trust data quality group c) data quality updates are provided to the Performance and Finance Committee, information governance steering group and elective care operational group d) respond in full to externally reported data quality issues from NHS Digital and our commissioners
The NHS Digital Data Quality Maturity Index score is 92.7% for
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12. (a) The value and banding of the summary hospital-level mortality indicator (‘SHMI’) for the trust for the reporting period; and
13. 14. 15. 16. 17.
(b) The percentage of patient deaths w ith palliative care coded at either diagnosis or specialty level for the trust for the reporting period. a) SHIMI banding 105.37 ‘as expected’ range for period Jan 20 Dec 20 (the latest data available) b) Palliative care coding w as 3.10% at either diagnosis or speciality level This is an improvement on previous years, this continues to be slightly behind the national and peer group rates.
Mental health trusts Ambulance trusts Ambulance trusts Ambulance trusts Mental health trusts 18. The trust’s patient reported outcome measures scores for: (i) groin hernia surgery (ii) varicose vein surgery (iii) hip replacement surgery and (iv) knee replacement surgery during the reporting period. January 2021; the national average is 82% e) Conducts full user training and refresher training to support the capture and recording of good quality data, operational processes are review ed and aligned to system functionality. Furthermore, system user training guides are regularly review ed and updated f) Complies w ith the data quality standards w ithin the data security and protection toolkit g) Specialist clinical coding w orkshops to develop coders’ know ledge
N/A
EQ5D Inde x
Hip replacement: 98.40% Knee replacement: 91.30%
EQ-VAS
Hip replacement: 83.10% Knee replacement: 74.50%
National EQ5D Inde x
Hip replacement: 95.50% Knee replacement: 92.00%
EQ-VAS
Hip replacement: 78.80% Knee replacement: 71.70%
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19. The percentage of patients aged: (i) 0 to 14 and (ii) (ii) 15 or over Readmitted to a hospital that forms part of the trust w ithin 28 days of being discharged from a hospital that forms part of the trust during the reporting period. It has been acknow ledged that an error w as made in the drafting of the regulations and that the split of patients for this indicator should be (i) % of 0 to 15 years readmitted w as 6.7% (ii) 16 years and over readmission rate w as 10.3% The regulations refer to 28-day readmissions rather than 30.
Prescribed information
20. The trust’s responsiveness to the personal needs of its patients during the reporting period.
Form of statement
PALS responded to 10.4% more cases in 2020-21. The patient advice and liaison service is our first contact and point of care resolution service and in total responded to 3467 cases (against 2827 in the previous year, a 22% increase).
21. The percentage of staff employed by, or under contract to, the trust during the reporting period w ho w ould recommend the trust as a provider of care to their family or friends. 21.1 Friends and Family Test – patient. The data made available by the National Health Service Trust or NHS Foundation Trust by NHS Digital for all acute providers of adult NHS funded care, covering services for inpatients and patients discharged from accident and emergency (types 1 and 2) The Staff Friends and Family test did not run during 2020-21.
The staff friends and family test w as not conducted during 2020/21.
Please note: there is a not a statutory requirement to include this indicator in the Quality Accounts reporting, but provider organisations should consider doing so. 23. The percentage of patients w ho w ere admitted to hospital and w ho w ere risk assessed for venous thromboembolis m during the reporting period. Data for period April 2020-December 2020 show s PAHT: 98.28% National: 95.47% Data for Q4 is not available as the trust moved to a new server and the programme w as being rew ritten.
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Pre scribed information Form of s tatement
24. The rate per 100,000 bed days of cases of
C.difficile infection reported w ithin the trust amongst patients aged 2 or over during the reporting period. There w ere 43 hospital onset cases of Clostridium Difficile reported to the national surveillance database for April 2020-March 2021.
Rate per 100,000 bed days as 30.76 (based on our ow n Trust data. This information has not been published for 20-21 by PHE)
25. The number and, w here available, rate of patient safety incidents reported w ithin the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. April 2020 to March 2021: The total number of incidents w as 10226 w ith 6902 for patients. Severe harm incidents: 23 (0.33%) Death incidents: 93 (1.34%) of w hich 83 w ere hospital onset COVID-19 infection cases.
26 Statement on seven day hospital services as a trust w e are w orking tow ards implementation of seven day services. The National Reporting and Learning System (NRLS) show s during the reporting period, the trust’s severe and death incidents is below 1%, w hichis in line w ith the national average.
Due to the pandemic and the nationally recognised issue of hospital onset COVID-19 infection, there has been an increase in reported death incidents from below 1% to below 1.7%.
During 2020/21, the regular selfassessment reports that the trust completed and submitted to NHSI w ere not required.
Update from NHSI states: The 7-day service programme and service improvement support ceased w hen NHS E/I came together. There is no longer a national programme or meetings.
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Pre scribed information Form of s tatement
27.1 The number of its patients w ho have died during the reporting period, including a quarterly breakdow n of the annual figure. From 1 April 2020 to 31 March 2021, 1,341 of The Princess Alexandra Hospital NHS Trust patients died. This comprised the follow ing number of deaths each quarter: Quarter 1: 375 Quarter 2: 216 Quarter 3: 338 Quarter 4: 412
27.2 The number of deaths included in item 27.1 w hich the provider has subjected to a case record review or an investigation to determine w hat problems (if any) there w ere in the care provided to the patient, including a quarterly breakdow n of the annual figure. By March 2021, 497 case record review s and 18 serious incident (SI) investigations w ere raised in relation to 1,341 deaths (item 27.1). The number of deaths in each quarter for w hich a case record review or a serious investigation w as carried out w as:
Quarter 1: 236 case record review s 18 SI investigations Quarter 2: 109 case record review s 3 SI investigations Quarter 3: 104 case record review s 31 SI investigations Quarter 4: 48 case record review s 31 SI investigations
During Q1, 16 serious incidents w ere nosocomial COVID-19 related deaths that w ere investigated as part of an aggregated serious incident report. All of these deaths had an SJR completed; none w eredeemed to be an avoidable death (due to the patient comorbidities and frailty), how ever there w as other learning taken.
During Q3 and Q4, 31 Serious Incidents in each reporting period w erenosocomial COVID-19 related deaths and w ereinvestigated under one aggregated report.
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Pre scribed information Form of s tatement
27.3 An estimate of the number of deaths during the reporting period included in item 27.2 for w hich a case record review or investigation has been carried out w hich the provider judges as a result of the review or investigation w ere more likely than not to have been due to problems in the care provided to the patient (including a quarterly breakdow n), w ith an explanation of the methods used to assess this. 7 cases [0.52%] of the patient deaths during the reporting period are judged more likely than not to have been due to problems in the care provided to the patients. In relation to each quarter, this consisted of: Quarter 1: 1 - [0.07%] 1 investigation remains in progress Quarter 2: 1 - [0.07%] 2 investigations are still in progress Quarter 3: 1 - 1 [0.07%] Quarter 4: 4 - [0.29%]
Cases referred for a structured judgment review (case record review ) have data captured on an electronic system called Clarity. All of these cases are rated w ith an avoidability rating of: Score 1: Definitely avoidable Score 2: Strong evidence of avoidability Score 3: probably avoidable (more then 50:50) Score 4: Possibly avoidable, (less than 50:50) Score 5: Slight evidence of avoidability Score 6: No evidence of avoidability
The seven cases have had an avoidability score of tw o on SJR. All cases that receive a score of one or tw o are referred for: - a review by the trust’s learning from deaths panel - are logged on Datix as an incident and investigated - w ill be review ed by the trust’s
Incident Management Group - The investigation w ill identify any learning, an action w ill be
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Pre scribed information
27.4 A summary of w hat the provider has learnt from case record review s and investigations conducted in relation to the deaths identified in item 27.3.
27.5 A description of the actions w hich the provider has taken in the reporting period, and proposes to take follow ing the reporting period, in consequence of w hat the provider has learnt during the reporting period (see item 27.4).
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completed and monitored by the relevant healthcare group - Are reported to the clinical commissioning group (CCG)
Form of s tatement
The majority of learning identified has been in relation to nosocomial COVID19 from both the first and the second w aveof the pandemic, this includes: - The trust has implemented the 10 key actions for infection control published by NHS England (NHSE) - A robust testing pathw ay is core to ensuring that patients are on the correct pathw ay and that staff w ho are COVID-19 positive are identified - The flow of information in relation to patients being transferred from one COVID-19 pathw ay to another betw eenclinical team members and the site management team needs to be strengthened - High standards of infection prevention and control including the w earingof personal protective equipment (PPE) must follow the standards detailed in the trust guidance - The number of bed moves has reduced since the firstw ave - Lateral flow testingis now in place in the emergency department (ED) w hichis helping stream emergency admissions into red and amber pathw ays earlier in their admission - Lateral flow testingbiw eekly is in place for all frontline staff - A simplified testing pathw ay has been introduced from 25/1/21 - Perspex screen installation is in progress to bed spaces w here beds cannot be tw ometres apart
Pre scribed information
- Most visiting w as virtualas special case exemptions w ereinplace - PPE competency and audits of compliance are being undertaken to ensure staff know ledgeand compliance - There is a continued focus on reducing the number of bed and w ardmoves
Form of s tatement
27.6 An assessment of the impact of the actions described in item 27.5, w hich were taken by the provider during the reporting period. - Reduced length of stay in ED for patients w aitingto be admitted to w ards dueto lateral flow testingin
ED - started 31/11/2020. - Reduction in asymptomatic staff shedding due to lateral flow testing for staff bi-w eekly - Perspex screen installation to maximise the tw ometre social distancing guidance, thus reducing cross-contamination - Virtual visiting minimised cross-contamination w ithinthe hospital setting - PPE compliance audits demonstrated improvement in use of PPE. PPE champions w ere implemented. - Bed move reduction w as apparent in w avetw o,minimising cross-contamination
27.7 The number of case record review s or investigations finished in this reporting period w hich related to deaths during the previous reporting period but w ere not included in item 27.2 in the relevant document for that previous reporting period (2019/20). Four case review s and investigations w ere concluded for incidents taking place in 2019/20.
27.8 An estimate of the number of deaths included in item 27.7 w hich the provider judges as a result of the review or investigation w ere more likely than not to have been due to problems in the care provided to the patient, w ith an explanation of the methods used to assess this. Tw odeaths harm cases w ere confirmed follow inginvestigation and w eremore likely than not due to the problems in the care provided.
