Respiratory Collaborative 12th November 2015

COPD Dashboard Update Jo Congleton

KSS AHSN Respiratory Clinical Lead

2014-15 Influenza Outbreak

• Winter characterised by early influenza activity, with

A(H3N2) virus the dominant circulating sub-type.

• By week 4 2015 peak influenza activity levels had

exceeded those seen in the past three seasons.

• Led to large numbers of care home outbreaks, often

in highly vaccinated populations, hospitalisations and

significant excess all-cause mortality in the over 65

year-old population.

Eurosurveillance, Volume 20, Issue 5, 05 February 2015Rapid communicationsLOW

EFFECTIVENESS OF SEASONAL INFLUENZA VACCINE IN PREVENTING

LABORATORY-CONFIRMED INFLUENZA IN PRIMARY CARE IN THE UNITED

KINGDOM: 2014/15 MID–SEASON RESULTSR G Pebody

• Found overall VE in preventing influenza in

primary care was 3.4%

• −2.3% specifically against A(H3N2)

• Also found clear evidence of antigenic and

genetic mismatch between circulating

A(H3N2) viruses and the 2014/15 northern

hemisphere vaccine strain.

PHE Report

• Effectiveness of the adult flu vaccine

influenza A : 29.3%

• Effectiveness of the adult flu vaccine

against influenza B was 46.3%

0

5

10

15

20

25

30

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10

/11

Q1

10

/11

Q2

10

/11

Q3

10/1

1 Q

4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14

/15

Q4

15

/16

Q1

Admissions per 1000 COPD population*

Total Kent and Medway

0

5

10

15

20

25

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10

/11

Q1

10

/11

Q2

10

/11

Q3

10/1

1 Q

4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14

/15

Q4

15

/16

Q1

Admissions per 1000 COPD population*

Total Surrey

0

5

10

15

20

25

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10/1

1 Q

1

10

/11

Q2

10

/11

Q3

10

/11

Q4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14/1

5 Q

4

15

/16

Q1

Admissions per 1000 COPD population*

Total Sussex

The Seasonal Surge

Total Kent and Medway Total Surrey Total Sussex

Total Sussex quarterly actual

Rolling 12 month average

Total Kent Surrey Sussex

0

5

10

15

20

25

30

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10

/11

Q1

10

/11

Q2

10

/11

Q3

10

/11

Q4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14

/15

Q4

15

/16

Q1

Admissions per 1000 COPD population*

Total Kent and Medway

0

5

10

15

20

25

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10

/11

Q1

10

/11

Q2

10

/11

Q3

10

/11

Q4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14

/15

Q4

15

/16

Q1

Admissions per 1000 COPD population*

Total Surrey

0

5

10

15

20

25

08

/09

Q1

08

/09

Q2

08

/09

Q3

08

/09

Q4

09

/10

Q1

09

/10

Q2

09

/10

Q3

09

/10

Q4

10

/11

Q1

10

/11

Q2

10

/11

Q3

10

/11

Q4

11

/12

Q1

11

/12

Q2

11

/12

Q3

11

/12

Q4

12

/13

Q1

12

/13

Q2

12

/13

Q3

12

/13

Q4

13

/14

Q1

13

/14

Q2

13

/14

Q3

13

/14

Q4

14

/15

Q1

14

/15

Q2

14

/15

Q3

14

/15

Q4

15

/16

Q1

Admissions per 1000 COPD population*

Total Sussex

KSS COPD Bed Days

0

10000

20000

30000

40000

50000

60000

Kent Surry Sussex Total

Bed

Days

2010/11

2011/12

2012/13

2013/14

2014/15

Admissions

How could we cope with the

seasonal surge?

• Employ more staff in Q4

• Stop doing some activities in Q4

• Offer flexible hours contract

• Do everything possible to reduce effect: • IBIS care plans

• Influenza vaccination

• PEPR

• Self Management plans

• COPD Discharge Bundle

Care Bundles

• Developed by the Institute for

Healthcare Improvement to help

healthcare providers more reliably

deliver quality patient care

• Elements are accepted best practice

and have been demonstrated to make a

difference to patient outcomes

The 30-day readmission rates before and after the initiation of the chronic obstructive

pulmonary disease discharge care bundle.

Hopkinson N S et al. Thorax 2012;67:90-92

Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.

COPD Discharge Bundle Elements

Referral to smoking cessation service if a current smoker

An assessment of suitability for and enrolment into a pulmonary rehabilitation programme

Provision of written information and rescue packs for future exacerbations

Ensure that patient can demonstrate good inhaler technique whilst on the wards

Ensure that they have appropriate follow up once discharged from hospital

JP