Harrison Judith R
Royal Surrey County Hospital NHS Foundation Trust.
BMJ Qual Improv Rep. 2017 May 17;6(1). doi: 10.1136/bmjquality.u212202.w4875. eCollection 2017.
Dementia is a common condition, and people with dementia occupy around 25% of hospital beds. Commissioning for Quality and Innovation (CQUIN) is an NHS payment framework that links part of English healthcare providers' income to quality improvement. The dementia CQUIN goals are designed to encourage the recognition of dementia in hospital. The Royal Surrey County Hospital, Guildford, introduced new procedures to meet the dementia CQUIN targets. Adherence to the changes was a problem. This project aimed to improve hospital's implementation strategy. At baseline, completion rates for dementia CQUIN assessments were just 27%. Interventions were informed by semi-structured interviews with junior doctors and dementia leads in neighbouring trusts. Progress was measured by regular audits and interventions were made over several months. Changes suggested by junior doctors and nurses proved very effective, and involving the multidisciplinary team produced the most significant improvement. Gradual progress was made until we achieved and maintained 90% completion for dementia assessments. In conclusion, we made changes to working practices to achieve the CQUIN targets and promoted quality care for older adults. Our experience highlighted the importance of involving multidisciplinary frontline staff in the design of service changes.
痴呆症是一种常见病症，患有痴呆症的人占用了约25%的医院床位。质量与创新委托计划（CQUIN）是英国国家医疗服务体系（NHS）的一个支付框架，该框架将英格兰医疗服务提供者的部分收入与质量提升挂钩。痴呆症CQUIN目标旨在鼓励在医院中识别痴呆症。位于吉尔福德的皇家萨里郡医院引入了新程序以实现痴呆症CQUIN目标。然而，对这些变化的依从性是个问题。该项目旨在改进医院的实施策略。在基线时，痴呆症CQUIN评估的完成率仅为27%。通过对初级医生和邻近信托机构的痴呆症负责人进行半结构化访谈来确定干预措施。通过定期审计来衡量进展情况，并在几个月内进行干预。初级医生和护士提出的改变被证明非常有效，让多学科团队参与带来了最显著的改善。我们逐步取得进展，直至痴呆症评估的完成率达到并维持在90%。总之，我们对工作实践进行了改变以实现CQUIN目标，并促进了对老年人的优质护理。我们的经验凸显了让多学科一线工作人员参与服务变革设计的重要性。
