Improving quality and safety in healthcare: assessing and responding to patient risks

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Case studies on appropriate use of clinical risk assessment tools, developing new evidence-based alerting systems and developing personalised risk management plans for people who use services, to manage risks positively.

Central Manchester University Hospitals NHS Foundation Trust

Case study: Improving management of deteriorating acutely ill patients PDF, 189.1 KB

Outlines Central Manchester University Hospitals NHS Foundation Trust's approach to improving management of deteriorating acutely ill patients.

Improving compliance with an Early Warning Score protocol PDF, 194.3 KB

Outlines the use of bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol.

Escalation flowchart PDF, 159.1 KB

A flowchart for the escalation of deteriorating patients.

Western Sussex NHS Foundation Trust

Case study: Using electronic bedside observation to target support to deteriorating patients and facilitate research and development of new triaging and scoring systems PDF, 230.6 KB

Outlines how the trust uses information technology and staff training to improve identification of deteriorating patients and those at risk of acute kidney injury, to reduce time to treatment.

University Hospitals Bristol NHS Foundation Trust

Case study: Empowering a clinical champion to ensure effective use of the World Health Organization surgical safety checklist PDF, 227.7 KB

Supporting a clinical champion to take the lead in adapting the World Health Organization (WHO) surgical safety checklist and introducing quantitative and qualitative audit to ensure it is used effectively.

WHO checklist PDF, 403.2 KB

The WHO checklist, adapted for use in University Hospitals Bristol NHS Foundation Trust.

As a learning organisation, we would be grateful for feedback, as well as suggestions of local good practice that could complement our case studies. Please email any feedback and examples through to nhsi.medicaldirectorate@nhs.net using the subject line 'safety case studies'. 

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