National Infection and Sepsis Audit – Acute NHS settings

The National Infection and Sepsis Audit – Acute NHS settings (NISA-Acute) will be for NHS-funded acute hospital care in England and Wales (inclusion of other Devolved Nations/Crown dependencies is yet to be determined and will be detailed within the tender documentation).

The initial contract is anticipated to be for a period of 3 years, at a maximum total budget of up to £ 1,146,300.00 excl VAT and £1,375,560.00 with VAT. Bids exceeding this limit will be rejected. Due to the unknowns in advance of holding the premarket engagement session, it is currently expected that the extension value will be a 2 year pro rata of the core 3 year funding, estimated at £743,300.00 excluding VAT.

Further to this funding, the final specification will contain a list of aspirational measures which will be expected to be modified into the contract should the need and funding become available. The aspirational intent value is unknown at the point of drafting this notice, This aspirational intent has the potential to be invoked fully, partially, or not at all, and the Authority cannot guarantee that the successful provider will be required to do any of the aspirational measures that will be listed in the final specification.

The values stated may be subject to change and the final values will be given when the tender goes live.

The role of a national clinical audit is to stimulate healthcare improvement and reduce unwarranted variation through the provision of high-quality information on the organisation, delivery and outcomes of healthcare, together with tools and support to enable healthcare providers and other audiences to make best use of this information. Performance and outcomes metrics are benchmarked against national guidance and standards e.g. quality standards from the National Institute for Health and Care Excellence (NICE), and those from other established professional and patient sources.

For all HQIP-commissioned national clinical audits, the default expectation is that existing, routinely collected digital data will be used wherever available, and bespoke collection of data is avoided unless there is no other means of sourcing the data capable of meeting the needs of the project. Potential sources of existing digital data can include national data collections (for example, Hospital Episode Statistics and the Patient Episode Database for Wales), and Electronic Patient Records (EPR) data (whether from the system providers or via local data extraction and upload). Data is most useful locally for healthcare improvement when its provision to clinical teams is timely, the data is refreshed regularly and appropriate tools, support and guidance accompany the data outputs. The intent is for all of these features of the audit to be implemented and improved during the period of this contract.

This audit programme is expected to:

a)Develop a robust, high-quality audit designed around key quality indicators likely to best support local and national quality improvement;

b)Achieve, articulate and maintain close alignment with relevant NICE national guidance and quality standards throughout the audit, as appropriate;

c)Enable improvements through the provision of timely, high-quality data that compares providers of healthcare, and comprises an integrated mixture of named trust, health board, commissioner, MDT, possibly consultant or clinical team level and other levels of reporting;

d) Engage parents, carers and families in a meaningful way, achieving a strong patient voice which informs and contributes to the design, functioning, outputs and direction of the audit;

e)Consider the value and feasibility of additional data linkage, at an individual patient level, to other relevant national datasets either from the outset or in the future, and plan for these linkages from the inception of the contract;

f)Ensure robust methodological and statistical input at all stages of the audit;

g)Identify from the outset the full range of audiences for the results and other audit outputs, and plan and tailor them accordingly;

h)Provide audit results in a timely, accessible and meaningful manner to support quality improvements, minimising the reporting delay and providing continual access to each unit for their own data;

i)Utilise strong and effective project and programme management to deliver audit outputs on time and within budget; and

j)Develop and maintain strong engagement with local clinicians, networks, commissioners, patients and their families and carers and charity and community support groups in order to drive improvements in services.

HQIP and the funders have begun early conversations considering key features of the NISA-Acute audit. The initial intention is an audit that focuses on:

1. early stages of the hospital emergency department and inpatient infection/sepsis care pathway
2. inclusion of all patients (both children and adults)
3. inclusion of both those newly admitted to hospital with infection/sepsis and those already in hospital for other reasons (hospital-onset infections)

Other in-hospital components of the infection/sepsis care pathway could also be included in the specification, potentially as future ‘modules’ invoked under aspirational intent.

In terms of the potential scale of the audit:

there are around 1 million emergency admissions with infection as the primary diagnosis;

in NHS acute hospitals, around a third of inpatients are taking antibiotics at any given time.

Given the potential size of the cohort, it is likely that potential suppliers will need to consider possible approaches to maximise the utility of the audit dataset on a limited budget - such combining use of of routine administrative data plus representative sampling of the care of relevant patients.

This description is based on preliminary discussions and is subject to change.

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