Our HSMR (hospital standardised mortality ratio)  is the best it has been for years.

After a tremendous amount of work it stands at 100 which is a reflection of all hard work around improving the care of the acutely-ill patient.

For explanation, 100 is the figure given when a Trust's number of deaths is in line with expectations which are based on a patient's age, condition and diagnosis on admission.  The actual deaths are recorded and if these are higher than expected,  then the HSMR is a number above 100. If under 100 a Trust has had less deaths than expected. Previously we have recorded numbers higher than 100.

Several innovations have led to us seeing the reduction down to 100.

The introduction of Nervecentre which has meant that we are detecting patients who are becoming ill more quickly and getting the right care to them more quickly.  This was enabled by the introduction of the HOOP team. (see collage).   Matron Cath Briggs, said: " I am immensely proud of our HOOP team and feel quite privileged to have been able to provide leadership to this team in its infancy." 

HOOP was set up to better organise care  in evenings, nights and weekends, including public holidays.  HOOP  streams and prioritises all ‘tasks’ created in the out-of-hours  period, enabling a clinical co-ordinator to work with a team of medical and clinical support staff to deliver the Right care, to the Right Patient, at the Right Time. HOOP requires this co-ordination to function. There is an audit trail of all tasks generated. The Hoop team consist of senior band 6 nurses ( clinical coordinators) with strong clinical skills they are currently going through a period of development to become independent non-medical prescribers and have enhanced clinical assessment skills. There is also a team of band 3 Clinical support Workers who work alongside the who have enhanced skills and carry out cannulation, venepuncture and ECGs 

1,916 sets of patient records have been reviewed to find out if there is anything we can learn. This has shown where there were gaps in good care which have included timely escalation and senior medical review, fluid balance recording, recording of NEWS (national early warning score), issues around doses of medication and inconsistency in completing care bundles.

We have improved the care for patients with Acute Kidney Injury, acute stroke, sepsis, acute gastrointestinal bleeds, cancer and older people all as part of the programme through changes to pathways, better use of information and training of staff.

We have worked with colleagues in Primary care, GPs, social care and commissioning to make these changes and also made financial investments.

Mostly though it has been the hard work and dedication of our clinical staff and those who support them that have helped us get to this place for the first time ever.