Below are some suggested actions to take, once processes from the other six GNBSI toolkit areas are in place.

Action: review admissions and care pathways

Consider working with commissioners on unplanned admissions, and consider a review of pathways of care.

Action: review data and feedback

Review the Getting It Right First Time (GIRFT) data and feedback from relevant providers, to determine if any benchmarking improvements along patient pathways are required.

• Oxford University Hospitals NHS Foundation Trust – GNBSI HPB analysis – Initial work from Oxford University Hospitals NHS Foundation Trust on hepato-biliary sources. Further information will be posted when more data is available, with more suggested interventions for the hepato-biliary group.

Action: consider infection sources and review practice

Consider hepato-biliary sources of infection and surgical site infection (SSI) reduction. Compare SSI rates following hepato-biliary interventions. Review practice against best practice; consider using a specific subgroup to review this risk factor.

• SSI guidelines – NICE guidelines on prevention and treatment of SSIs.

Action: benchmarking

Consider benchmarking against systems that have sustained an improvement.

Action: review Klebsiella/Pseudomonas data

Review Klebsiella and Pseudomonas data, and benchmark against appropriate systems.

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