The client
Healthcare – A large acute trust
Challenge
Quality assessment and improvement.
The staff in an emergency department raised concerns with the Care Quality Commission (CQC) that patients routinely remained in the ED after they had been recorded as having left.
In response to concerns raised to the CQC, the trust’s deputy medical director and interim manager of the clinical effectiveness unit conducted an audit of ED data and presented a report to the trust board. The audit did not find any evidence to support the staff concerns raised with the CQC.
Our challenge was to independently investigate data reporting practices across the ED. We were asked to establish whether there is any systematic failure to report waiting times correctly and to review and evaluate current reporting practices, clinical validation practices and the governance supporting the production of validated waiting times.
Scope
In order to satisfy itself that the concerns raised by staff were unfounded, the trust commissioned Verita to conduct an independent investigation into practice and the reporting of data at the ED.
Process
Our independent investigation involved 26 interviews, a drop- in session, data analysis and an examination of all available documentation.
Our team consisted of Kieran Seale, Jess Heinemann, Amber Sargent, Peter Killwick and Barry Morris. Expert advice was provided by Verita associate and former NHS chief executive, Andrew Woodhead.
Findings
Our team found that there was some poor practices in the department related to recording waiting times and a system of validating data that routinely amended the number of breaches of the four hour waiting time. Although these practices resulted in inaccuracies in reported waiting times there was no evidence that staff were systematically ‘gaming’ the system and there was no collective will to misreport in order to improve performance.
Recomendations
Our recommendations were centred around ensuring that new and improved processes were put in place in order to make sure that these details were recorded and logged more accurately and reliably. We also provided recommendations on processing clock stops, carrying out unannounced spot checks and improving the level of board oversight and audits.
Outcome
The report was received well by the new management team at the trust who committed to accepting recommendations and resolving poor practice and reporting in the ED.