Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?

BACKGROUND: In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust. METHODOLOGY: Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum. RESULTS: Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74-£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74-£31,670.10. CONCLUSION: Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.

Outbreak of pertussis among healthcare workers in a hospital maternity unit.

In December 2015, an outbreak of pertussis was detected among staff working in the Maternity Unit of a district general hospital in Hampshire. This occurred in the background of increased pertussis activity in the community. The outbreak occurred over the Christmas holiday period causing staff shortages at a time when the departments were already overstretched. The high prevalence of upper respiratory tract infections at the time were difficult to distinguish from pertussis. This paper describes the outbreak, infection control measures implemented and the learning points.