From Insights to Action: How EWS Can Transform Sepsis and Patient Care

In the ever-evolving world of healthcare and patient safety, the journey from awareness to action is crucial. Today, it simply isn't enough to recognise potential risks, threats, or issues — what truly matters is how effectively we respond to them. One area where this is particularly critical is in patient care, where early detection of deteriorating health conditions can be a matter of life or death.

The equivalent of the Emirates stadium full of people die of sepsis each year in the UK. Over 1.7 million people in the United States develop sepsis every year, with a mortality rate of 15-30%. However, what's more unfortunate is that 1 in 8 sepsis deaths are preventable with early detection, timeliness, and competency of clinical response.

This is where the concept of Early Warning Scores (EWS) comes into play, offering a transformative approach to sepsis and patient care practices.

Understanding Early Warning Scores

Early warning score (EWS) is a systemic tool that healthcare teams, specifically frontline workers, can use to recognise the early signs of clinical deterioration and initiate intervention and management.

Typically, this involves assessing seven physiological parameters—respiratory rate, oxygen saturation, supplemental oxygen temperature, systolic blood pressure, heart rate, and level of consciousness — and assigning a score to each vital sign. The aggregated score is used to identify whether the patient is at risk of deterioration or not. It also empowers healthcare teams to take decisive actions such as initiating closer monitoring, adjusting medication, or activating a rapid response.

Fig: Example of a National Early Warning Scoring System

The Transformative Potential of Early Warning Scores

Integrating Early Warning Scores into Sepsis and Patient Care is crucial in transitioning from reactive to proactive healthcare delivery. While enhancing patient outcomes and improving the overall efficiency and effectiveness of the healthcare system at large, it also contributes to:

1. Timely identification and intervention: As discussed earlier, the most significant advantage of the EWS system is the ability to detect subtle changes in a patient's condition, which might otherwise be overlooked, in the early stages. This allows healthcare providers to promptly intervene and prevent further patient deterioration, which is arguably one of the most critical steps in the early management of sepsis.

2. Standardisation of care: Implementing a standard EWS system, such as NEWS (National Early Warning Score), assures standardisation of care practices across various healthcare settings. This, in turn, allows providers to ensure consistency in assessing patient status and initiating appropriate interventions, which mitigate variability and reduce the likelihood of errors.

3. Data-driven decision-making: Key to elevating patient care, EWS systems provide objective criteria that healthcare providers can use to assess patients' conditions in real-time and inform their decisions. This approach enhances clinical judgement by promoting evidence-based practice, ultimately improving patient outcomes.

4. Quality improvement initiatives: Data, trends, and outcomes obtained from the EWS system can be used by healthcare organisations to identify areas for improvement in patient care processes, such as better staff training, the implementation of digital quality management systems, and refining protocols. Implementing these initiatives can go a long way in preventing and managing adverse outcomes like sepsis.

EWS Governance Audits and Their Role In Sepsis Care

Early Warning Score (EWS) Governance Audits are assessments conducted to evaluate the effectiveness and adherence to protocols regarding the implementation and use of EWS in healthcare settings. They primarily focus on:

• Whether EWS protocols include specific criteria for identifying patients at risk of sepsis

• Whether healthcare staff are trained to recognise the signs of a deteriorating patient promptly

• The effectiveness of protocols for escalating care and initiating appropriate interventions

• Documenting vital signs, interpreting EWS scores accurately, and following predefined pathways for sepsis assessment and treatment

• Whether there are clear processes in place for communicating EWS scores, escalating concerns, and activating rapid response or sepsis teams when necessary

MEG's Deteriorating Patient Bundle

To help organisations with their quality assurance process for patient deterioration, we've compiled a collection of assessments and audit tools, including various Early Warning Score forms such as standard, paediatric, maternity, and emergency medicine, each tailored to specific patient populations. The bundle also includes associated escalation pathways following the ISBAR model.

These are governance audits that organisations can use to ensure that their processes are working as designed and that staff are following the necessary protocol to prevent patient deterioration and the likelihood of events such as sepsis.

It also comes with a Quality Improvement Plan (QIP) tool to identify and address any issues or gaps in the assurance process. To see the tool in action, reach out to our team.

The CQC’s New Assessment Framework: Everything Providers Need to Know

The Care Quality Commission (CQC) in England plays a significant role in assessing and regulating health and social care services to guarantee adherence to fundamental quality standards and ensure safe, effective, and compassionate care.

In 2021, the CQC announced updates to its inspection framework and assessment methodology, changing how social care services are evaluated.

While these changes have yet to be fully implemented, it’s important to understand what's coming. This blog post provides an overview of what we know so far —what's changing, what's staying the same, and how you and your team can prepare for the new assessment framework.

Why is the CQC changing its assessment framework?

The CQC's ultimate aim with the new assessment framework is to enable a simpler and smarter regulatory approach that meets the needs of a changing health and social care sector. This entails a streamlined process geared towards prioritising the needs of individuals accessing care services and their families, timely and holistic assessment of care providers, and a robust learning and safety culture to improve the quality of care where it's most needed.

What's staying the same?

The 5 Key Questions

These are the same questions that the CQC asks of all care services they inspect and are at the heart of their regulatory process:

1. Are they safe?

Are all individuals protected from abuse and avoidable harm?

2. Are they effective?

Does your care, treatment, and support achieve good outcomes? Does it help maintain quality of life and is based on the best available evidence?

3. Are they caring?

Do staff involve and treat individuals with compassion, kindness, dignity, and respect?

4. Are they responsive to people's needs?

Are the services organised so that they meet the needs of all individuals?

5. Are they well-led?

Do the organisation's leadership, management, and governance ensure that it provides high-quality care based on every individual's needs? Does the organisation encourage learning and innovation and promote an open and fair culture?

While these five key questions remain the same, how the CQC assesses health and social care services in accordance with them will be changing.

The 4-point rating scale

The CQC will continue to give an overall rating for care services as one of the following:

• Outstanding

• Good

• Requires Improvement

• Inadequate

However, how this rating is calculated will be changing.

What's changing?

CQC's Single Assessment Framework

Until now, the CQC has had three separate assessment frameworks—one for hospitals, one for adult social care, and one for primary medical services. The Single Assessment Framework streamlines and simplifies the assessment process by combining all three frameworks. The new model will consist of only one set of expectations that clearly define 'quality' care and 'good' service.

How the 5 key questions are used in inspections: KLOEs to Quality Statements

Historically, each of the five key questions was dissected into a further set of questions called the "Key Lines of Enquiry" (KLOEs), which served as the focal points during CQC inspections.

With the introduction of the single assessment framework, the KLOEs are being replaced by quality statements framed as "we statements," demonstrating the provider's commitment to being safe, effective, responsive, caring, and well-led. Unlike the extensive 330+ prompts associated with KLOEs, there are only 34 quality statements, simplifying the assessment process for both regulators and providers. They set clear expectations for providers based on people’s experiences and the standards of care they expect.

Evidence Categories

Until now, care services were monitored primarily through in-person inspections, scheduled based on the previous rating and the CQC’s risk assessment.

Moving forward, the CQC will employ a dual approach to monitor services, combining in-person inspections with ongoing assessments and evidence gathering. To determine a service's adherence to each quality statement, the CQC will now evaluate evidence from six distinct categories:

1. People's experience of health and care services

2. Feedback from staff and leaders

3. Feedback from partners

4. Observation

5. Processes

6. Outcomes

Each category outlines the types of evidence used to assess both the quality of care provided and the service's performance against each quality statement. This restructuring aims to enhance the transparency and consistency of the CQC's evaluations.

Scoring System

While retaining the 4-point rating scale, the CQC is introducing a scoring system to improve the clarity and consistency of their assessments concerning:

• the quality of care within a service

• the efficacy of a local authority in delivering its duties under the Care Act

• the performance of an integrated care system

Each quality statement will be assessed based on the evidence gathered from each key evidence category. Depending on the findings, a score will be assigned to each evidence category as follows:

4 = Evidence shows an exceptional standard

3 = Evidence shows a good standard

2 = Evidence shows some shortfalls

1 = Evidence shows significant shortfalls

The scores from evidence categories are combined to determine the score for the corresponding quality statement. These quality statement scores are then combined to calculate a total score for the relevant key question. This cumulative score generates a rating for each of the five key questions, and the collective scores for all key questions determine an overall rating based on the 4-point scale: outstanding, good, requires improvement, or inadequate.

This scoring methodology provides providers with clear insights into which specific quality statements require attention to boost their total score for a key question and, consequently, improve their overall rating.

As the CQC transitions away from conducting assessments at a single point in time, future evaluations will likely occur periodically across different areas of the framework. This approach allows for updating scores for various evidence categories at different intervals.

What can providers do to prepare?

• Stay up-to-date with the CQC

Keeping abreast of the latest developments as the new framework unfolds will enable providers to navigate the transition smoothly. Here are some valuable resources to assist you:

• CQC's provider guidance on their new assessment approach

• Videos and webinars on the new regulations

• CQC's digital engagement platform to share feedback

• CQC's email newsletter for all updates

• Review and understand the new framework

As an organisation, take some time to thoroughly review the CQC's new Single Assessment Framework. Understand what's changing, what's staying the same, the scoring criteria, and the new key evidence categories. This will help you align your practices with the updated expectations.

• Conduct Internal Assessments

Perform internal assessments of your services based on the new framework's quality statements and evidence categories. Talk to internal stakeholders, gather feedback, and identify areas where you excel and areas where you can improve. This proactive approach can help you identify and correct shortcomings long before the official CQC assessment.

• Improve Data Collection and Documentation

Strengthen your data collection and documentation processes to ensure accurate and comprehensive evidence collection. Consider implementing a digital auditing system to replace cumbersome paper-based processes. These systems streamline processes, ensuring you efficiently capture all the necessary information and evidence for your regulatory and accreditation requirements.

How can MEG help?

MEG, with its comprehensive digital auditing and management capabilities, can help care providers prepare for and navigate the new CQC Single Assessment Framework through:

1. Customisable Audits

MEG allows for the creation of custom audits tailored to the specific requirements of the CQC framework. Providers can design audit forms based on the quality statements and evidence categories, ensuring that they gather relevant data during internal assessments.

2. Real-time Monitoring and Reporting

MEG monitors compliance status in real time and generates comprehensive reports on care quality. This allows providers to quickly identify areas of strength and those that need improvement, aligning with the CQC's emphasis on ongoing assessment and improvement.

3. Comprehensive Document Management

MEG offers a centralised platform for managing and storing policies, procedures, protocols, quality statements, and evidence categories in alignment with the new CQC guidelines. This ensures that care providers can readily access all the necessary documentation whenever needed.

Book a call with our team to know more!

Interview with Jafet Arrieta, VP at IHI

Transforming Healthcare in Latin America: An Exclusive Interview with Jafet Arrieta

In the realm of healthcare, where equity, quality, and humanisation are imperatives, Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI), offers an inspiring insight into the challenges and opportunities in Latin America. With a passionate and systematic approach, Jafet leads initiatives to enhance the health of populations and transform healthcare systems in the region. In an exclusive interview, she highlighted several key points summarising her approach and vision for the future of healthcare in Latin America.

CHECK THE FULL VIDEO INTERVIEW HERE

In this interview, Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI), shares her unique perspective on the challenges and key strategies for improving quality, humanizing care, and ensuring equity in healthcare institutions in Latin America. From identifying areas for improvement in patient experience to addressing common errors in medical risk management, Jafet provides a comprehensive insight into leveraging technology, enhancing care quality, and preventing medical errors in the region. Join us to explore how principles of healthcare humanisation intertwine with patient safety and medical risk management, and discover how these practices are positively transforming the healthcare landscape in Latin America.

Recognising Challenges and Embracing Opportunities

She emphasises the importance of understanding the scope of the problem to properly prioritise resources and make a real impact on populations. She also underscores the need to adopt a systemic perspective and address the five fundamental goals:

• Improving population health

• Patient experience

• Healthcare staff well-being

• Resource efficiency

• Equity in access to and quality of care

“It is important to be able to truly assess not only what the problem is, but also what impact these problems are having on the population, and on the communities we seek to serve.”

“And in that sense, I would tell you that besides seeing many challenges, I see opportunities. I see opportunities to work, to address those challenges.”

MaximiSing Technology to Enhance Care Quality

When it comes to harnessing technology to improve care quality, Jafet staunchly advocates for a systemic approach. She highlights how technology can enhance medical care by closing access gaps and increasing patient safety, especially during the pandemic. It is crucial to adopt it as part of a comprehensive strategy that includes active patient and family engagement.

Another significant example highlighted in the interview is that of the Hospital Israelita Albert Einstein, which has implemented telehealth to reach remote communities in the Amazon, improving access and health indicators at the population level.

Technology also facilitates communication among medical staff, patients, and their families, creating efficiencies and enabling real-time data tracking to identify important events and understand their causes.

"...there is a lot of room to maximise technology, and it is important to understand that technology is a means to an end and not an end in itself. So, there, I think it is very important for technology to be adopted in the context of a much broader, much more comprehensive strategy to improve quality, patient safety, and to humanize care..."

Addressing Areas for Improvement in Patient Experience

Jafet points out the need to adopt a holistic approach to identify and address areas for improvement in patient experience. She emphasizes the importance of working from risk management towards risk prevention, integrating elements such as planning, quality improvement, and quality control. She also underscores the fundamental role of effective communication between healthcare staff, patients, and their families, and highlights how simple strategies can have a significant impact on reducing pain and fear in children with cancer.

“The third aspect proposed by Juran's trilogy, which is quality control seeks to generate mechanisms so that once the systems, the processes are set in motion, they reach the desired performance level and can be sustained over time, allowing us to control quality."

-Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI)

A Story of Transformation in Pediatric Healthcare

Jafet shares an inspiring story of transformation in pediatric care, highlighting a collaborative project with St. Jude Children's Research Hospital. Through the "Global Comfort Promise" project, Jafet and her team work with hospitals worldwide to reduce pain associated with medical procedures in children with cancer. She highlights how the systemic approach and improvement science can generate transformative results, not only in patient experience but also in the culture and satisfaction of healthcare staff.

In summary, the interview with Jafet Arrieta offers an inspiring and practical insight into addressing healthcare challenges in Latin America. With a focus on equity, quality, and humanization, she demonstrates how technology, effective communication, and improvement science can transform healthcare systems and improve people's lives in the region.

Interview with Dr. Sergio Meneses, Researcher at INSP Mexico

Challenges and Perspectives in Latin America's Public Health: A Conversation with Dr. Sergio Meneses Navarro

In the field of public health, Latin America faces a series of complex and urgent challenges. To gain a deeper insight into these challenges and explore possible solutions, we interviewed Dr. Sergio Meneses Navarro, National Researcher of Science and Technology Commissioned to the National Institute of Public Health in Mexico. With a distinguished career as a physician and anthropologist, Dr. Meneses Navarro shared some valuable perspectives on topics ranging from structural inequality to the transformative role of technology in healthcare.

CHECK THE FULL VIDEO INTERVIEW HERE

Social Inequalities and Equitable Healthcare

Regarding social inequalities in healthcare, Dr. Meneses Navarro highlighted the profound stratification that characterises Latin American societies. In his own words:

"These structures of inequality, these ideologies that stratify our society and determine forms of mistreatment, are present in all areas of life. To some extent, this also explains why we are so tolerant because we have normalised, for example, violence in our countries in places like Colombia, Venezuela, Mexico, Central America, where we have serious problems of inequality but also various forms of violence."

"All of this is not unrelated to the healthcare system. Within the healthcare system itself, which is embedded in our societies, it is not a separate world; there, too, morphologies and treatments towards others are expressed, and this is a challenge when considering guaranteeing respectful or good treatment for each person we attend to."

Sergio highlighted how inequalities in the healthcare system are evident in the segmentation of the population based on employment status, resulting in unequal access and quality of healthcare. Addressing inequality and violence within healthcare has become imperative in recent years, particularly in Latin America, including Mexico, where deep-seated inequality rooted in discriminatory ideologies like racism and sexism persists. This normalisation of violence extends into healthcare, presenting a challenge to providing dignified treatment for all. Recognising and confronting these structural inequalities within healthcare is essential as part of broader efforts to promote social equity and justice in Latin America.

Technology and Reduction of Inequalities

One of the most fascinating areas of focus is the role that technology can play in reducing inequalities. Dr Meneses Navarro emphasised the potential of using technology to improve the coverage and quality of healthcare but stressed the importance of programming these technologies to avoid the reproduction of discriminatory ideologies. According to his words:

"The technology in medicines, the technology in equipment…for example, that also is having an incredible boom, artificial intelligence, well, it is also a field that can allow us to increase coverage, also improve the quality of care…if we are going to have these kinds of technologies, we are going to program them so that they do not reproduce these ideologies and these practices in which I think we can find a consensus that they are undesirable and that we want to eradicate them from our society. Then we want to eliminate these ideologies that are harmful and that cause damage, that causes violence, and that ultimately also generate mistreatment and generate death, and even in the healthcare system death due to poor, poor forms of care, poor practices."

Quality Management and Accreditation in Health

When discussing quality management and accreditation in health, Sergio Meneses highlighted a crucial point: the need to consider the structures of inequality in these processes.

"The effects of structural inequality have been omitted, forgotten…Our accreditation system must include indicators and specific actions aimed at addressing these forms of mistreatment, and these forms of violence. For example, concrete actions to prevent and eradicate forms of violence against women, specific not only in sexual and reproductive health services or obstetric services but also in the care of chronic diseases. Also, for any reason, include specific actions to eliminate any form of racism, classism, or discrimination based on gender identity or religious reasons, and indeed they occur, or for any other reason including your employment status."

-Dr. Sergio Meneses, INSP Mexico

He emphasised the importance of including specific indicators and actions aimed at addressing the forms of mistreatment and violence present in the healthcare system.

Conclusions and Final Reflections

Throughout the interview, it became clear that addressing inequalities in Latin America's public health requires a comprehensive approach that recognises the complex interactions between social, economic, and technological factors. Dr. Meneses Navarro's words resonated with an urgency and deep commitment to more equitable and just healthcare for all.

In summary, the interview with Dr. Sergio Meneses Navarro provided a revealing insight into the challenges and opportunities in the field of public health in Latin America. His informed perspectives and commitment to equity in healthcare offer a valuable starting point for future research and actions in this crucial area that can be linked to a quality management and safety system for all patients.

Harnessing the Patient Voice for Better Care: MEG’s Patient Experience Module

This blog post is the final one in the series "Elevating Patient Experience in 2024" — a comprehensive guide where we discuss the various elements of patient experience, the role of tools like feedback and complaint forms, strategies organisations can implement to create a holistic and positive care experience, MEG's Patient Experience Module, and more. Read the previous blogs here:

1. Patient-Centered Care: Strategies and Tools for Effective Patient Feedback

2. Strategies for Success: A Comprehensive Guide to Improving Patient Experience in Healthcare

3. Emerging Tech Trends Reshaping the Future of Patient Experience

This piece is a deep dive into MEG's Patient Experience Module. We'll discuss some of the key features and functionalities of the software, what makes it unique, and how healthcare organisations can leverage it to transform how they interact with and care for their patients.

Harnessing the Patient Voice for Better Care

For as long as one can remember, healthcare has traditionally conformed to a top-down model, where healthcare decisions were made by relying on medical expertise alone. However, today, the tides are changing. Organisations across the globe are increasingly recognising the significance of listening to the unique insights, concerns, and lived experiences of patients, and incorporating them into the healthcare framework to deliver patient-centric, safe, and effective care.

Simply put, harnessing the patient's voice for better care means empowering patients to actively participate in the decision-making process. This approach allows healthcare providers to gain a comprehensive understanding of individual needs, preferences, and challenges, cultivating a collaborative partnership rooted in transparent communication. This results in patients feeling acknowledged and valued, and are more likely to adhere to prescribed treatment plans, leading to improved clinical outcomes.

Today, technology plays a large part in amplifying the patient's voice — from electronic health records that allow them to access and understand their medical information to virtual patient advocacy groups that enable them to share their experiences and advocate for their needs. Concurrently, healthcare organisations are increasingly leveraging tools to collect and analyse patient feedback, identify areas for improvement, and enhance overall care quality.

That's where MEG's Patient Experience Module comes in. Our software is designed to transform how healthcare providers gather and interpret patient feedback and the patient voice, leading to more informed and effective care strategies. It enables a comprehensive understanding of the patient experience, care quality, and patient satisfaction through the following offerings:

1. Comprehensive feedback and analysis

MEG's Feedback platform is designed to capture the patient's experience at every touchpoint, from admission to post-treatment follow-ups. It offers:

• A multi-channel approach to collecting surveys by making them accessible via mobile devices, website, SMS, and more, so healthcare providers can gather real-time feedback and act on it efficiently.

• Fully-customised surveys with questions tailored to different patient experiences. This ensures a comprehensive understanding of patient feedback, allowing for targeted improvements.

• The option to capture insights from a diverse range of stakeholders, including staff, patients, families, and caregivers. This inclusive approach provides a holistic understanding of patient care experiences.

Fig: Sample Feedback Form

The data gathered from these surveys serves as a powerful tool for:

• Addressing Patient Concerns: Understanding patient concerns and implementing changes based on feedback to create an environment centered around safe and effective patient care.

• Data-Driven Resource Allocation: Analyse trends, allocate resources effectively, and shape future policies and improvement initiatives based on real patient insights.

• Proactive Risk Mitigation: Proactively address negative feedback, showcase positive testimonials, and use data-driven insights to mitigate potential issues and improve patient satisfaction.

• Regulatory Compliance: Ensure ongoing compliance with regulatory requirements by actively involving patients, families, caregivers, and staff in the feedback loop.

In a nutshell, our Feedback platform is designed not just as a data collection tool but as a strategic instrument to improve patient care, shape policies, and foster continuous improvement in healthcare services.

2. Efficient Complaint Management:

MEG's Complaint Management Software is a digital, user-friendly solution that offers end-to-end complaint handling in a single location. With the ability to capture and track complaints from various channels, analyse complaint data, and use insights to create and delegate corrective action plans, MEG's platform enables organisations to act on complaints promptly and drive quality culture.

The system includes built-in workflows and complaint triage, escalation and quality assurance steps, procedural guidance references, and the ability to link complaints to patient records, incident reports, and risk assessments. To support continuous learning and quality improvement, the platform includes reporting tools that evaluate data on a granular level and generate reports for governance reviews.

3. Data Integration for Informed Decision Making:

MEG's Patient Experience Module seamlessly integrates with existing electronic health records and various healthcare systems, ensuring a streamlined flow of information and a comprehensive view of patient care. Real-time data synchronisation guarantees accuracy, providing a foundation for well-informed decision-making.

Fig: Sample Dashboard

Advanced analytics tools dissect the data gathered from the feedback and complaints platforms to provide actionable insights that can drive improvements in patient care. Further, real-time dashboards enable providers to track quality improvement initiatives and monitor and measure Key performance indicators (KPIs).

Keen to see MEG’s Patient Experience Module in action? Schedule a demo now!