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Two members of our surgical team in an operating theatre

Commissioning for Quality and Innovation (CQUIN) is a quality improvement initiative run by NHS England to encourage and reward excellence through the use of a payment structure. This works by linking a proportion of the Trust’s income (currently 2.5%) to achieving certain local quality outcomes and improvement goals. The CQUIN framework intends to reward best practice and encourage a culture of continuous quality improvement in all providers whether acute hospital or community services.

Delivery of the CQUIN programme has continued to benefit from a structured programme management approach. There are a number of agreed national, local and specialist goals.

A summary of the 2015/16 programme that is made up of 13 goals is below:


National Goals:

  1. Acute Kidney Injury - to improve the quality of information that is sent to GPs for patients who have been treated for acute kidney injury whilst in hospital
  2. Sepsis - to ensure all appropriate patients are screened for sepsis in A&E and treated rapidly with intravenous antibiotics (within 1 hour of presentation) for those patients who have suspected severe sepsis, Red Flag sepsis or septic shock
  3. Dementia and Delirium – to support the identification of patients with dementia and delirium, prompt appropriate referral, follow up and effective communication with GPs on discharge and to ensure that staff are trained to provide high quality care to patients with dementia and support their carers.
  4. Urgent and Emergency Care – contains a number of discrete schemes designed to reduce avoidable emergency admissions and improve flow through the hospital.


Local goals:

  1. Direct Access for GPs to Assessment Areas – develop a plan to support the increase in numbers of patients admitted to hospital via their GP directly to an assessment unit
  2. Medication Optimisation – to undertake medication reviews on high risk patients to review polypharmacy and ensure that patients are only continued on medication appropriately with all benefits/risks considered
  3. Cancer Patient Experience - improve cancer patient experience in 4 key areas; Clinical nurse specialist, Support for patients with cancer, Cancer research, Hospital care as a day patient/outpatient
  4. Identification and Advice for Alcohol Misuse – to reduce alcohol related admissions to hospital by improving identification and treatment of alcohol use disorders in three key areas; A&E, Antenatal clinics and Gastroenterology outpatients
  5. GAP/Grow Programme - support the implementation of this programme as part of a safety improvement programme to reduce stillbirths by ensuring that all women will have an individualised foetal growth chart and a risk assessment in line with RCOG guidance number 31


Specialised Services goals:

  1. Delayed discharges from ICU to ward based care – support the improvement of bed management in wards to reduce delays to less than 24 hours after decision made.
  2. Neonatal Unit Admissions - to ensure that every baby admitted to the neonatal unit (NICU and SCBU) at term (≥37 weeks gestation) have a thorough clinical review to improve learning from avoidable term admissions
  3. Oncotype DX test - to incentivise the uptake of the Oncotype DX test to ensure a more consistent uptake of NICE DG10 recommendations for hospitals and help patients make a more informed choice about undertaking chemotherapy
  4. Completion of a Quality Dashboard for Dental Services