Dementia Memory Assessment Service (MAS) Audit 2019 Aim • To share the learning and best practice from the South East (KSS) MAS Audit 2019 • To facilitate networking and enable attendees to talk to others about how they are working to reduce variation within in their services • To discuss future steps for improvement 2 | Background • 2 KSS MAS services were visited in 2018 to help process map and streamline their services. • We held a workshop on 25th April 2019, process mapping their current pathways. The London CN were able to share the learnings of their previous audits. • Purpose: learn from sharing best practice from London audits, identify variation, improve care for patients, address challenges regionally. • Result of the audit workshop, each STP/ICS held senior clinical meetings with their MH trust to help implement some of the learnings. • 23 MAS services were asked to complete an audit of 50 consecutive patients starting from the 1st January 2019. This data has been analysed at a regional level and also has been sent to London for national analysis. 3 | Methodology 2019 MAS Audit methodology • 14 organisational questions • 6 demographic questions • 50 consecutively seen patients from 1st January 2019 • 23 services participated - covering the 19 CCGs of KSS (and some patients from Surrey Heath & Farnham NE Hants) • 1150 patients in total • Females: Sussex 60%, Surrey 55%, Kent 60%. 5 | Participation List Kent (11 services) Surrey (6 services) Sussex (6 services) Ashford East Surrey Brighton and Hove Canterbury and Coastal Farnham and NE Hants Coastal West Sussex - Northern Dartford, Gravesham and Swanley Guildford Coastal West Sussex - Western Dover Mid Surrey Coastal West Sussex - Southern Maidstone NW Surrey East Sussex Medway Surrey Heath HWLH Sevenoaks Shepway Swale Thanet Tunbridge Wells 6 | Learnings from the 2019 Audit process • First KSS MAS audit. • Kent Audit sample - interpretation of the cohort needed further clarification. Variation in organisation policy e.g. 2017 patients. • Face to face visits to each service was not possible. • Timing - summer holidays led to delay in submission of analysis • Clarity of questions i.e. more options vs clarity of them • Data not readily available through IT systems (manual extraction) – time consuming • Clinical knowledge of person undertaking the audit 7 | Analytical Limitations • Size of sample restricts definitive conclusions • Population weighting not taken into account • Data cleansing was required as services had not previously participated 8 | Highlights from Organisational questions Question Kent (11 services) Surrey (6 services) Sussex (6 services) MSNAP Accreditation 10/11 5/6 4/6 Organisation All secondary care All secondary care 2/6 community services Primary/Secondary MAS provider 4/6 secondary care ECG prior to ACEI 10/11 all patients 6/6 Other 5/6 only bradycardia Ability to reFer For CSF 10/11 Yes 6/6 Yes 2/6 Yes examination Joint working with 10/11 Yes 0/6 Yes (all ‘adhoc advice’) 0/6 Yes (all ‘adhoc advice’) neurology Joint working with 10/11 Yes 0/6 Yes (all ‘adhoc advice’) 0/6 Yes (3 ‘no’, 3 ‘adhoc neuroradiology advice’) Joint working with geriatrics 10/11 Yes 0/6 Yes (all ‘adhoc advice’) 0/6 Yes (all ‘adhoc advice’) 9 | Demographics Patients under 65 years 20% • K&M 9% 18% • Surrey 4% 16% 14% • Sussex 7% 12% 10% Young onset dementia clinical 8% lead: 6% • K&M 10/11 4% • Surrey 6/6 2% • Sussex 2/6 0% J I D A C K B F G H E O L P M Q N S R T U V X K & M Surrey Sussex K & M Surrey Sussex STP/ICS Numerator: Total number of patients with a recorded age less than 65 11 | Denominator: Total number of patients Ethnicity 100% • Several services where 90% ethnicity was stated were 80% 100% white. 70% • Service V could not provide us with ethnicity 60% for their patients, and may 50% want to look at their system to ensure they can 40% record this in future. 30% • Other services also had a large number of patients 20% where ethnicity was not 10% stated. 0% I J D K C H F E G A B M Q N O L P T R U S X V K & M Surrey Sussex White Non-white British or non-white Irish or non- white other background Ethnicity not stated All patients 12 | % of patients recorded as living alone • K&M 31%, 60% • Surrey 30% 50% • Sussex 40% 40% • Service K reported that 10% of patients 30% live alone, but 20% answered ‘not clear from notes’ for 22% 10% of the cohort. 0% J I F H D E G B A C K M N L O P Q T V R X U S Numerator: Total number of patients who K & M Surrey Sussex were recorded as living alone K & M Surrey Sussex STP/ICS Denominator: Total number where there was a recorded response to living alone 13 | Alcohol consumption not documented • K&M 40% 100% • Surrey 19% 90% • Sussex 10% 80% • Better documentation 70% • K&M on average recorded that 40% of patients drank more than 60% 14 units a week, Sussex 7% & 50% Surrey 6% 40% • Not enough data to investigate links with ARBI 30% • We have noted feedback that 20% there should be more granular 10% options over 14 units. 0% Numerator: Total number of patients I J H D F A E G K C B L Q P O N M T V X S R U where alcohol consumption was not K & M Surrey Sussex documented K & M Surrey Sussex STP/ICS Denominator: Total number of patients 14 | Patient history documented Question Kent (11 services) Surrey (6 services) Sussex (6 services) • Better Smoking 67% 90% 94% documentation Hearing 52% 32% 36% Vision 51% 70% 81% Falls 63% 76% 93% 15 | Pathways % of referrals referred from GP • Majority of patients referred 100% by GPs 90% • Surrey 80% 70% • 4% from acute hospital 60% • Services N & M, 12% 50% from acute hospital 40% • Remainder of referrals were 30% mostly called ‘other’ 20% 10% 0% J I C E F H K A G B D L O Q P N M S X U V T R Numerator: Total number of patients who K & M Surrey Sussex were recorded as referred from the GP K & M Surrey Sussex STP/ICS Denominator: Total number where referral origin was recorded 17 | Waiting times from referral to initial assessment • K&M 5 weeks 25 • Surrey 6 weeks • Sussex 14 weeks 20 • In Sussex there is a range from 6 weeks to 22 weeks. 15 • Correlation between when 10 scan requested and waiting times 5 Those with both referral and initial assessment date where referral was before the initial 0 assessment (excluding data quality issues) J I A H C E G D K B F O M N P L Q X U V T R S K & M Surrey Sussex K & M Surrey Sussex STP/ICS 18 | % who had an initial assessment in 6 weeks from referral 100% • K&M 88% 90% • Surrey 60% 80% • Sussex 21% 70% • Service ‘J’ - 100% in 6 weeks 60% 50% • Service ‘U’ 0% 40% 30% 20% Those with both referral and initial assessment 10% date where referral was before the initial assessment (excluding data quality issues) 0% J I F K G B A D H E C Q L P M N O S R T V X U K & M Surrey Sussex 19 | K & M Surrey Sussex STP/ICS % of patients whose initial assessment was in clinic • K&M 72% 100% • Surrey 75% 90% • Sussex 82% 80% 70% • Variation across KSS from 100% to 42% 60% 50% 40% 30% 20% Numerator: Of those with a recorded 10% response how many were seen in clinic 0% Denominator: all patients excluding J I E F B C K A D H G Q O P M L N U X V R T S blanks K & M Surrey Sussex K & M Surrey Sussex STP/ICS 20 | Scanning Scanning Question Kent (11 services) Surrey (6 services) Sussex (6 services) CT/MRI reported by 11/11 6/6 4/6 neuroradiologists View scan images (e.g. 10/11 4/6 2/6 using PACS) Appointment Facilitated 10/11 0/6 4/6 by MAS service ReFer For PET scans 10/11 6/6 3/6 ReFer For DAT scans 11/11 6/6 4/6 • Some services noted that it would have been useful to be able to indicate further types of scan e.g. SPECT, DSQUID etc. • Surrey do not facilitate any appointments. Is this necessary? 22 | Mean scan wait • K&M 5 weeks 9 • Surrey 2 weeks 8 • Sussex 5 weeks 7 • ‘L’ has 1 week 6 • ? time of scan related to 5 assessment/request 4 3 2 This is calculated using the date scan was 1 requested to the date the scan was 0 performed (Excluding data quality issues - J I H F A G K E B C D Q O P M N L V X T U S R where this could not be worked out. K&M K & M Surrey Sussex 25%, Surrey 2%, Sussex 28%) K & M Surrey Sussex STP/ICS 23 | % of documented scans who had MRI/ CT/ Both 100% 90% • Variation 80% • ‘B’ has 80% MRI 70% • ‘V’ and ‘X’ have 94% 60% CT 50% • CT & MRI both required is about 6% 40% in ‘B’. 30% 20% 10% 0% I J B A D F H K E G C Q O L N P M S R T U V X This graph excludes those who have not K & M Surrey Sussex had a scan and those who have not had a overall % MRI overall % CT overall % MRI and CT of documented, not having a scan scan type documented.