7 Day Services Survey: March 2017 Questions

Structure:

The data collection tool has been refined in response to the feedback received from acute trusts in England. This iteration of the survey collects data in several ways to improve data quality, and to allow for more useful local analysis and improvement work:

  1. Trust level responses: questions requiring responses at a trust level e.g. Does consultant job planning in the trust make provision for a consultant-led ward round on every ward every day of the week?
  2. Patient level responses: questions requiring responses at a patient level. E.g. time of admission, specialty, time of 1st consultant assessment.

Details of Your Case Note Review Sample Size - Trust Data

Q No / Question / Response options
1 / Number of emergency admissions in your Trust for your selected consecutive 7-day period. / Free entry of number
2 / Number of emergency admissions in your Trust for your selected consecutive 7-day period to be excluded from survey
Exclusions from the survey include:
•Patients admitted to short stay ambulatory care
•Patients who are admitted as an emergency but who stay in hospital for fewer than 14 hours from arrival
•Patients on an inpatient pathway on which care for the entire patient group is, by design, routinely delivered by non- consultants e.g Midwife led care on a maternity unit. / Free entry of number, must be smaller than the response to question 1

Sample Size Calculator(available on the 7DSAT)

Q No / Question / Response options
3 / Your selected consecutive 7-day period for the case note review / Date Entry: [Start Date] to [End Date]

Provision for Consultant Review

  1. Does consultant job planning in the trust make provision for a consultant-led ward round on every ward every day of the week?

Specialty / What is the nature of provision for 7-day consultant led ward rounds for this specialty? / (Only open this question if no inpatient beds)
Are there formal arrangements to obtain advice from specialties for which your own trust makes no acute provision / Additional Information (Optional)
Acute Internal Medicine /
  • Formal provision 7 days a week
  • Informal or adhoc arrangements 7 days a week
  • Provision on fewer than 7 days a week
  • No inpatient beds available for this specialty
/
  • Formal arrangement
  • Informal arrangement
  • No arrangement
/ Free Text
Cardiology / As above / As above / As above
Cardio-thoracic Surgery / As above / As above / As above
Diabetes and Endocrinology / As above / As above / As above
Gastroenterology / As above / As above / As above
General Surgery / As above / As above / As above
Geriatric Medicine / As above / As above / As above
Haematology / As above / As above / As above
Infectious Diseases / As above / As above / As above
Intensive Care / As above / As above / As above
Neurology / As above / As above / As above
Neurosurgery / As above / As above / As above
Obstetrics and Gynaecology / As above / As above / As above
Oncology / As above / As above / As above
Ophthalmology / As above / As above / As above
Paediatric Intensive Care / As above / As above / As above
Paediatric Medicine / As above / As above / As above
Paediatric Surgery / As above / As above / As above
Palliative Care / As above / As above / As above
Renal Medicine (Nephrology) / As above / As above / As above
Respiratory Medicine (Thoracic Medicine) / As above / As above / As above
Rheumatology / As above / As above / As above
Stroke Medicine / As above / As above / As above
Trauma and Orthopaedic Surgery / As above / As above / As above
Urology / As above / As above / As above
Vascular Surgery / As above / As above / As above
Other (Free text entry) / As above / As above / As above

Diagnostics /Interventions

Clinical Standard 5: Consultant Directed Diagnostics

  1. Are the following diagnostic tests and reporting always or usually available on site or off site by formal network arrangements for patients admitted as an emergency with critical and urgent clinical needs, in the appropriate timescales*?

Data for clinical standard 5 will be collected as a self-assessment question on the availability of consultant directed diagnostics either on-site or via a formal arrangement or protocol.

Please note that this question should be completed by a trust operational lead who is fully aware of the provision and availability of these interventions in the trust.Acute trusts should use their clinical governance processes and discussions with their commissioners to judge which diagnostic tests their patients require access to seven days a week, and whether these are delivered on site or via a formal networked arrangement.

Diagnostic test / Response options
Is diagnostic testing and reporting always or usually available on weekdays? / Response options
Is diagnostic testing and reporting always or usually available at weekends?
CT /
  • Yes test is available on site by formal arrangements or protocols
  • Yes test is available off site via formal arrangement
  • Yes test is available via mix of on site and off site by formal arrangement
  • No the test is only available on or off site via informal or ad hoc arrangement
  • No the test is not available
  • Not applicable- this test is not needed by patients in this trust
/
  • Yes test is available on site by formal arrangements or protocols
  • Yes test is available off site via formal arrangement
  • Yes test is available via mix of on site and off site by formal arrangement
  • No the test is only available on or off site via informal or ad hoc arrangement
  • No the test is not available
  • Not applicable- this test is not needed by patients in this trust

Microbiology
Echocardiograph+
Upper GI endoscopy++
MRI+++
Ultrasound++++
Free text comments

Only respond yes if you are confident that patients with the conditions listed for each test would be very likely to get the test and it will be reported in time if they arrived at your trust during the period in question.

Definitions

*Critical Clinical Need:Patients whose condition would be life-threatening if they did not have rapid access to diagnostic tests, leading to the implementation of a management plan within a few hours.

*Urgent Clinical Need: Patients whose condition is not critical, but if care was postponed for more than 12 hours it may impact adversely on their clinical outcomes.

Echocardiograph+ might beindicated for new presentation with suspectedacute heart failure, valvular dysfunction, pericardial effusion etc

Upper GI endoscopy++might be indicated for acute upper GI bleeding.

MRI+++ might be indicated for patients with suspected acute spinal cord compression and some types of stroke.

Ultrasound ++++ might be indicated for assessing acute abdominal pain such as when suspect acute cholecystitis, and for urgent need in maternity and early pregnancy.

Formal network arrangement: Formal arrangements with another trust or organisation to carry out the test or the reporting of the test exist when there are established protocols formally agreed between the relevant organisations,including

  • a robust and transparent process for timely clinical assessment and patient transfer between sites ,
  • a published rota populated with consultant names and contact details and,
  • documented protocols which are available as part of the assurance process.
  • such processes should be regularly audited to ensure that transferred patients receive timely, high quality care.

A networked approach may involve patient transfer, image transfer or diagnostician in-reach in differing circumstances.

Informal and ad-hoc arrangement: Arrangements where patients are transferred for the intervention or reports are requested by asking a favour of a colleague, through a system of phoning around to seek availability or another arrangement which is not defined, documented and agreed by all parties.

  1. Availability of urgent inpatient CT slots

Question / Total number of urgent inpatient CT slots (available for all sites in the trust) on a Wednesday / Total number of urgent inpatient CT slots (available for all sites in the trust) on a Sunday
How many urgent in-patient slots for CT does your trust offer on a Wednesday and a Sunday

Clinical Standard 6: Consultant Directed Interventions

  1. Do inpatients have 24-hour access to consultant directed interventions 7 days a week, either on site or via formal network arrangements?*

Data for clinical standard 6 will be collected as a self-assessment question on the availability of interventions either on-site or via a formal arrangement or protocol.

Please note that this question should be completed by a trust operational lead who is fully aware of the provision and availability of these interventions in the trust.The principle is that patients should receive urgent interventions within a timeframe that does not reduce the quality of their care (safety, experience and efficacy).

Acute trusts should use their clinical governance processes and discussions with their commissioners to judge which of the agreed list of clinical interventions their patients may require access to seven days a week and whether these are delivered on site or via a networked arrangement.

Responses by weekday and weekend
Critical Care /
  • Yes – on Site
  • Yes – off Site (via formal arrangement)
  • Yes – off Site (NOT via formal arrangement)
  • Mix of on and off site (all by formal arrangement)
  • No
  • N/A This intervention is not needed by patients in this trust
/
  • Yes – on Site
  • Yes – off Site (via formal arrangement)
  • Yes – off Site (NOT via formal arrangement)
  • Mix of on and off site (all by formal arrangement)
  • No
  • N/A This intervention is not needed by patients in this trust

Primary Percutaneous Coronary Intervention
Cardiac Pacing
Thrombolysis for Stroke
Emergency General Surgery
Interventional Endoscopy
Interventional Radiology
Renal Replacement
Urgent Radiotherapy
Free text for all N/A responses

*Formal network arrangement:

Formal arrangements with another trust or organisation to carry out the intervention exist when there are established protocols formally agreed between the relevant organisations including

  • a robust and transparent process for timely clinical assessment and patient transfer between sites,
  • a published rota populated with consultant names and,
  • contact details and documented protocols which are available as part of the assurance process.
  • Such processes should be regularly audited to ensure that transferred patients receive timely, high quality care.

Informal and ad-hoc arrangement: Arrangements where patients are transferred for the intervention, or reports are requested by asking a favour of a colleague, through a system of phoning around to seek availability or another arrangement which is not defined, documented and agreed by all parties.

Patient Data

Clinical Standard 2 – Time from Admission to First Consultant Review

Definition of consultant for CS 2 is ‘A doctor who has completed all their specialist training and been placed on the General Medical Council’s specialist register’

Q No / Question / Response options
1 / Please select the hospital site the patient was originally admitted to / Drop down list of your trust hospital sites
2 / Patient ID for local use / Auto populated
3 / Admitted specialty / sub specialty / List of specialties as drop down list, see appendix A
Includes an option free text ‘other specialty’
4 / Date and time of arrival at hospital as an emergency / Date and time entry
Date not documented
Time not documented
5 / Dateand time of admission at hospital as an emergency / Date time entry (mandatory field)
6 / Date of discharge (includes date of death, discharge date and transfer out of hospital) / Date entry
No discharge date
7 / Date and time of the 1st consultant review?
(it may be clinically appropriate for the patient to be reviewed by the specialist consultant once decision to admit has been made but prior to admission. In these cases record time of this firstconsultant review even if its prior to admission) / Date and time entry
Date not documented
Time not documented
Patient not reviewed
8 / If 1st review was not within 14 hours of admission at hospital, what is the reason?
Survey tool will flag when > 14 hours elapsed between admission and 1st consultant review. / Drop down list
  • The patient was excluded from the need for the first review to be by a consultant as all of the exclusion criteria are met*
  • The patient was reviewed by a consultant but after 14 hours from admission had elapsed
  • Consultant review not documented
  • Other reason free text
*Patients can be excluded from the need for their first review to be by the consultant if
-there is a clear written local protocol for the pathway the patient is on which has been agreed within the trust clinical governance system and supported by the commissioners AND
-the protocol describes actions to be taken in the event of clinical concern, including robust and rapid escalation to a consultant where appropriate: eg a maternity patient who develops the need for an emergency Caesarean section, or a patient with a superficial abscess who appears to be developing sepsis AND
-the patient's care is still recorded as being under a named consultant for the purpose of clinical governance (excluding patients specifically on midwife-led care pathways).
9 / What was the date and time discussions about initial review, which may include the diagnosis, management plan and prognosis, were had with the patient (and where appropriate families/ carers?) / Date and time entry
Date not documented
Time not documented
No documented discussion with the patient/family
10 / If the patient (and where appropriate families / carers) were not involved in discussions about the initial review within 48 hours of admission, what was the reason? / •The patient was unable to be made aware due to their clinical condition
•The patient died within 48 hours
•Family/ carers could not be contacted or there are no family/ carers to be informed
  • None of the above

Clinical Standard 8 – Ongoing Review

The questions in this section use question routing based on your response as to whether the patient required twice daily review or once daily review. These questions are to be answered for each day that the patient is subject to reviews (up to a maximum of 5 days). The questions that display for each choice are shown in the table below:

Questions for Once Daily review:

Q No / Question / Response options
1 / Day Two: Date (1 day after admission) / Date entry (auto populated)
2 / Day Two: Specialty / List as appendix A
3 / Day Two:
Did the patient require twice daily review? /
  • Patient required twice daily review
  • Patient required once daily review
  • Patient required no review
  • Review requirement not documented

4 / Day two: Did the patientreceive a consultant review on this day (between 00:01-24.00)? /
  • Yes -patient received a consultant review (record date and time)
  • Yes -Consultant review was delegated and done by delegate (record date and time)
  • No -patient was not reviewed by the consultant
  • No- consultant review was delegated but not done
  • No – consultant review was not delegated or done
  • No- patient was discharged
  • Review not documented

5 / Day two: what was the date and time of the completed daily review? / Date and time to be entered
Time not documented
6 / Day two: Who undertook the daily review? /
  • The consultant
  • Senior trainee (ST3+)
  • Advanced nurse practitioner/ nurse specialist
  • Other doctor
  • Other Nurse
  • Other health care professional

During the period the patient was reviewed were they informed of review outcomes or any changes to care plan?
Asked once over consultant review period / Date and time of review
  • Yes
  • The patient was unable to be made aware due to their clinical condition. The carers/ family were informed
  • Neither the patient nor their family was informed
  • None of the above
  • Review not documented

Questions for Twice Daily Review:

Q No / Question / Response options
1 / Day Two: Date / Date entry
2 / Day Two: Speciality / Drop down list as Appendix A.
3 / Day Two:
Did the patient require twice daily consultant review? /
  • Patient required twice daily review
  • Patient required once daily review
  • Patient required no review
  • Review requirement not documented

4 / Day two: Did the patient receive twice daily consultant review on this day (between 00:01-24:00)? /
  • Yes - patient received both reviews by the consultant (date and time)
  • Yes -consultant reviews were delegated to and both done by delegate (date and time)
  • Yes - patient received 1 review from the cons and 1 from the delegated team member
  • No- patient required twice daily review but was only reviewed once on this day
  • No- patient required twice daily reviews but was not reviewed on this day
  • No - patient was discharged
  • Review was not documented

5 / Day two: What was the date and time of the 1st completed twice daily review? / Date entry and time entry
Time not documented
6 / Day two: Who undertook the 1st review? /
  • The consultant
  • Senior Trainee (ST3+)
  • Advanced nurse practitioner / nurse specialist
  • Other doctor
  • Other nurse
  • Other health care professional

7 / Day two: Date and time of 2nd completed twice daily review / Date and time of second review
Time not documented
8 / Day two: Who undertook the 2nd review? /
  • The consultant
  • Senior Trainee (ST3+)
  • Advanced nurse practitioner / nurse specialist
  • Other doctor
  • Other nurse
  • Other health care professional

During the period the patient was reviewed were they informed of review outcomes or anychanges to care plan
Asked once over consultant review period / Date and time of review
  • Yes
  • The patient was unable to be made aware due to their clinical condition. The carers/ family were informed
  • Neither the patient nor their family was informed
  • None of the above
  • Review not documented

Check Data

Details of Your Case Note Review – Trust Data

The questions detailed in the table below relate to the survey as a whole and provide data on items such as the case note review period chosen, number of patients included in the sample and consultant ward rounds.

1 / Number of case notes your trust has reviewed / Autopopulated
Free text comment box for if actual sample size differs from auto populated number
2 / Was this a prospective or retrospective case note review? / Prospective, Retrospective
3 / Does your trust use an electronic patient record to capture patient information? / If yes, was the EPR used to complete the 7DS survey?
oYes completely
oYes partially
oNo
4 / What is the role of the person(s) undertaking the case note review? / Change to the drop down list: Audit team, clinicians, audit team with clinical input, Other combination

Appendix A