Transcript here - National Confidential Enquiry into Patient Outcome and Death

WELCOME
Improving the quality of medical and surgical care
NCEPOD
Neil Smith
Improving the quality of medical and surgical care
Remit
To review medical and surgical practice and to
make recommendations to improve the quality of
the delivery of care.
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Improving the quality of medical and surgical care
Remit
By undertaking confidential surveys covering many
different aspects of medical care and making
recommendations for clinicians and management
to implement.
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Improving the quality of medical and surgical care
History
• Report of a Confidential Enquiry into Perioperative
Deaths -published Dec 1987
• Became the National Confidential Enquiry into
Patient Outcome and Death in 2003
• Contract managed by NICE then the NPSA and now
HQIP under the Clinical Outcome Review Programme
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Improving the quality of medical and surgical care
NCEPOD Supporting bodies
• Faculty of Public Health Medicine
of RCP
• College of Emergency Medicine
• Association of Anaesthetists
• Association of Surgeons
• Royal College of Anaesthetists
• Royal College of Radiologists
• Royal College of
Ophthalmologists
• Royal College of Surgeons
• Lay Representatives
• Faculty of Dental Surgery of RCS
• Royal College of Pathologists
• Royal College of Obstetricians &
Gynaecologists
• Royal College of Physicians
• Royal College of General
Practitioners
• Royal College of Nursing
• Royal College of Child Health and
Paediatrics
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Improving the quality of medical and surgical care
NCEPOD Observers
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Coroners’ Society
RCS Ed
RCP Ed
HQIP
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Improving the quality of medical and surgical care
Independent Advisory Group
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AoMRC
Funders
Lay
Nursing
Colleges
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Structure
• 11
Non-clinical staff
• 7
Clinical Co-ordinators
• 550+
Local Reporters
• 100+
Ambassadors
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Improving the quality of medical and surgical care
The role of the Local Reporter
• History and evolution of the role
• What the role involves
• Handing on the baton
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Improving the quality of medical and surgical care
The role of the Ambassador
• History of the role
• What the role involves
• Support provided
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Improving the quality of medical and surgical care
Why it works
• Peer review
• Independence
• Put into a report what people already suspect…
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Improving the quality of medical and surgical care
Coverage
• England, Wales, Northern Ireland
• Offshore Islands
• Independent sector
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Improving the quality of medical and surgical care
Participation
• NHS trust participation is encouraged by
– NHS Quality Accounts
– Care Quality Commission
– NCAPOP
• Doctors participation is encouraged by
– GMC - Good Medical Practice/Good Surgical Practice
– CPD
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Improving the quality of medical and surgical care
Reports
• Reports published cover a wide range of topics e.g.
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Deaths within 30 days of surgery
Coronial autopsies
Trauma care
Coronary artery bypass grafts
Cancer care
Acute kidney injury
Parenteral nutrition
Surgery in the elderly
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Improving the quality of medical and surgical care
Improving the quality of medical and surgical care
Improving the quality of medical and surgical care
Trauma: Who cares?
Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care
Impact – early NCEPOD reports
• Improved provision of surgical, anaesthetic and
critical care facilities
• Emergency (CEPOD) theatres
• More involvement of senior staff
• Better supervision of trainees
• Reduction in inappropriate out of hours surgery
• More specialisation particularly for children
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Improving the quality of medical and surgical care
Who Operates When II (2003)
• Repeat of 1997 study Who
Operates When
• To measure progress and
show change
• Focus on staffing, practice
and theatre facilities
Improving the quality of medical and surgical care
WOW to WOW II
WOW I 1997
WOW II 2003
• 20% operations OOH by SHO
• 6% operations OOH by SHO
• 47% anaesthetics OOH by SHO
• 25% anaesthetics OOH by SHO
• 51% hospitals had “CEPOD”
theatres
• 63% hospitals had “CEPOD”
theatres**
• 25% of non-elective cases
performed in CEPOD theatre
• 70% of non-elective cases
performed in CEPOD theatre
** Further improvement to 87% identified in 2009 report
(Caring to the end)
Improving the quality of medical and surgical care
Impact – focussed studies
Trauma: Who cares?
Emergency Admissions:
A journey in the right direction?
A report of the National Confidential Enquiry
into Patient Outcome and Death (2007)
A report of the National Confidential Enquiry into Patient Outcome and Death (2007)
Improving the quality of medical and surgical care
Acutely ill patients
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1500 patients
Lack of consultant involvement
Lack of recognition of illness
Poor monitoring
Poor supervision
Lack of knowledge
Failure to seek help / working
outside competence
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Impact – focussed studies
Improving the quality of medical and surgical care
Trauma
• Trauma: Who cares?
– 48% of patients received less than good
care in the view of the advisors
– Consultant involvement low
– Delays in treatment
– Avoidable deaths
– Patients received better care in centres that
reported a high volume of cases
Improving the quality of medical and surgical care
Trauma
• Trauma: Who cares?
– Widely accepted report by
the professions
– Timely in view of Ara
Darzi’s reform of services
– Appointment of a new
National Director for
Trauma care
Improving the quality of medical and surgical care
This is a national health
service and what we need is
a national trauma system.
..our mortality rates are
among the worst in the
developed world
.. This important study by
NCEPOD restates the need
for regional trauma
systems.
..The Government must now
act on these
recommendations and
urgently implement a
national trauma system.
AKI – key findings
• There was poor assessment of risk factors for AKI
• The advisors judged there to be an unacceptable delay in
recognising post-admission AKI in 43% (42/98) of patients.
• A fifth (22/107) of post-admission AKI was both predictable
and avoidable in the view of the advisors.
• Recognition of acute illness, hypovolaemia and sepsis was
poor.
• Only 67/551 (12%) patients received RRT
Improving the quality of medical and surgical care
AKI - Recommendations
• All patients admitted as an emergency, should have their
electrolytes checked routinely on admission and
appropriately thereafter. This will help prevent the insidious
and unrecognised onset of AKI
• Predictable and avoidable AKI should never occur. For those
in-patients who develop AKI there should be both a robust
assessment of contributory risk factors and an awareness of
the possible complications that may arise.
Improving the quality of medical and surgical care
AKI - Recommendations
• NCEPOD recommends that the guidance for recognising the
acutely ill patient (NICE CG 50) is disseminated and
implemented.
• All acute admitting hospitals should have access to a renal
ultrasound scanning service 24 hours a day including the
weekends and the ability to provide emergency relief of
renal obstruction.
• All acute admitting hospitals should have access to either
onsite nephrologists or a dedicated nephrology service
within reasonable distance of the admitting hospital.
Improving the quality of medical and surgical care
AKI – NICE Guidance
Acute kidney injury
Prevention, detection and management of
acute kidney injury up to the point of renal
replacement therapy
NICE Clinical Guideline 169 (issued August 2013)
Improving the quality of medical and surgical care
AKI – NICE Guidance
Other deficiencies in the care of patients who
died of acute kidney injury included failures in
acute kidney injury prevention, recognition,
therapy and timely access to specialist services.
This report led to the Department of Health's
request for NICE to develop its first guideline on
acute kidney injury in adults and also,
importantly, in children and young people.
Improving the quality of medical and surgical care
Local impact
• Stake holder survey
• NCEPOD talks
• Poster competitions
• Checklists/audit tools
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Improving the quality of medical and surgical care
Running a study
Kathryn Kelly
Improving the quality of medical and surgical care
Topic selection
• Call for topics made to all our stakeholders
• 1st review made by NCEPOD Co-ordinators
• 2nd review made by NCEPOD Steering Group
• Consensus exercise performed
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Improving the quality of medical and surgical care
Questionnaire development
• Expert group
– Identify study themes
– Determine what questions need to be asked
– Clinical q. or advisor assessment form
• Questionnaires developed
• Pilot*
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Improving the quality of medical and surgical care
Running the study
Eva Nwosu
Improving the quality of medical and surgical care
Running the main study
• Main study
– Cases are identified to us*
– Clinical questionnaires sent to the LR or clinician*
– Extracts of the case notes requested*
– Organisational questionnaire by site*
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Improving the quality of medical and surgical care
Return of questionnaires and
case notes
Dolores Jarman
Improving the quality of medical and surgical care
Questionnaires /case-note return
• Qs sent with FREEPOST envelope
– Recorded delivery: £1.10 using envelope
• Qs and case-notes logged on study database
– NCEPOD number
– Automated email to LR
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Improving the quality of medical and surgical care
Questionnaire and case-note return
• Confidentiality
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Case notes /Qs stored in locked cupboards
Electronic data protected
Anonymisation of patient data
Clinical coordinators, Advisors don’t have access
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Improving the quality of medical and surgical care
Case Review Meetings, Analysis
and Report Launch
Hannah Shotton
Improving the quality of medical and surgical care
Who are NCEPOD Case Reviewers?
• Active working clinicians
• Review other clinicians work
• Assess cases
• Common themes
• Recommendations
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Improving the quality of medical and surgical care
Case Reviewers
• Multidisciplinary Group
• Specialties
• Hospitals
• Recruitment *
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Improving the quality of medical and surgical care
Case Reviewer meetings
• 8-10 advisors
• 5 cases – CNs & Q
• Assessment Form
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Improving the quality of medical and surgical care
Case Reviewer meetings
• Overall quality of care assessed on a 5 point scale
• Cause for Concern
– Group discussion
– Chief Executive & Lead Co-ordinator
– Letter to Medical Director
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Improving the quality of medical and surgical care
Analysis
• Not statistical (scientific) research
• Qualitative analysis of Case Reviewer opinion of
quality of care- AF
• Supplemented by data from OQ & CQ
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Improving the quality of medical and surgical care
Analysis
• Data scanned into preset database
and validated/cleaned
• Strategy of analysis
• Data analysed using descriptive statistics in MS Excel
• Results reviewed by Case Reviewers, Steering Group and Study
Advisory Group
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Improving the quality of medical and surgical care
Report writing
• Report written by Clinical coordinators and NCEPOD staff
• 2 Drafts: Reviewed by Steering group, Study Advisory group
& Case Reviewers
• Ensure recommendations are up-to-date
• Final draft of report sent to designers
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Improving the quality of medical and surgical care
Report Launch/dissemination
• PDF of the full report and a summary document are produced
• Disseminated to stake-holders*
• Report Launched at day event with
representative speakers from relevant
associations
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Improving the quality of medical and surgical care
Data Security
Robert Alleway
Improving the quality of medical and surgical care
Confidentiality
• It applies to the patient data
• It applies to the doctor and the hospital
• Section 251
• DPA 1998
• Ethics
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Improving the quality of medical and surgical care
What we would like to avoid at NCEPOD
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Improving the quality of medical and surgical care
What we do…
• Information Security policy document (ISO/IEC 27001:2005)
• Information Security Procedures
• Assign Information Asset Owners
• Information Security Forum
• Improved data security by encryption, passwords, and
confidential disposal of paper
• NHS mailbox for receiving data and emails from Local Reporters
• Polythene envelopes and considered using DX boxes
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Improving the quality of medical and surgical care
Current Studies
Improving the quality of medical and surgical care
Gastrointestinal Bleeds
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• Gastrointestinal Haemorrhage (GIH) is a common
cause of hospital admission and death.
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incidence 100/100,000 adults annually
overall in-hospital mortality is 10%
• GIH is managed by both medical and surgical teams
and requires a multidisciplinary approach.
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management differs between upper and lower GIH
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• To identify the remediable factors in the quality of care
provided to patients who are diagnosed with an upper
or lower GIH
– Initial assessment and treatment plan
– Availability and timeliness of interventions (e.g. endoscopy, IR
and surgery)
– Use of guidelines, protocols and policies
– Organisational aspects of care including network arrangements
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• Method: Population/Inclusions
• All patients aged 16 or over who were admitted between the 1st January
2013 and the 30th April inclusive
• Diagnosed as having a gastrointestinal haemorrhage (GIH) at any time
during their inpatient stay.
• The diagnosis does not have to be the patients primary diagnosis
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• The spreadsheet collected data on a number of fields many of
which are key to the study
• Retrospective via ICD10 coding (e.g. K92.2)
• Focus on severe bleeders
– Cross reference with blood transfusion data
– Patients receiving 4 or more units of blood included in peer review
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• Sample of ~ 900 patients (with a maximum of 5 patients per
hospital)
• Clinician questionnaire
• Photocopied case note extracts requested for each patient
included in the study sample
• Organisational questionnaire – Information regarding
facilities, equipment, policies and guidelines relevant to the
management of patients with a GI Bleed
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Improving the quality of medical and surgical care
Gastrointestinal Bleeds
• Exclusions
• Coded incorrectly for GI Bleed
• Did not have a transfusion of over 4 units
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Improving the quality of medical and surgical care
Current Status
• Data collection for clinician questionnaires and case notes is
closed
• Still accepting organisational questionnaires
• Initial findings have been presented to SAG, Reviewers and SG
• Report currently being drafted, launch in June 2015
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Improving the quality of medical and surgical care
Sepsis
Hannah Shotton
Improving the quality of medical and surgical care
Sepsis: Introduction
• Sepsis is an overwhelming systemic response to infection
• Untreated can lead to severe sepsis (+dysfunction of one or
more organs) and septic shock
• Can arise in patients in the community or in deteriorating
patients in hospital
• It is associated with a high mortality and morbidity
• Variety of care bundles but not used universally and always
well implemented
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Improving the quality of medical and surgical care
SEPSIS: Aim
“To identify and explore avoidable and
remediable factors in the process of care for
patients with sepsis”
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Improving the quality of medical and surgical care
SEPSIS: Objectives
• To examine organisational structures, processes, protocols
and care pathways for sepsis recognition and management in
hospitals from admission through to discharge or death
• To identify avoidable and remediable factors in the
management of the care for a sample of adult patients with
sepsis, throughout the patient pathway from presentation to
primary care (if applicable) throughout secondary care to
discharge or death
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Improving the quality of medical and surgical care
Sepsis: Key areas
• Recognition of sepsis
• Evaluation of systems in place to facilitate
recognition/ escalation/ treatment
• Management of infection
• MDT approach
• Communication
• End of life care
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Improving the quality of medical and surgical care
Sepsis: Study population
• Adult patients (≥16 years old) diagnosed with sepsis
that are seen by the critical care outreach team (or
equivalent) or that are admitted directly to critical
care during the study period:
6th - 20th May 2014
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Improving the quality of medical and surgical care
Sepsis: Exclusions
• Immunosuppressed neutropaenic patients on
chemotherapy or immunosuppressant drugs for transplant
programmes.
• Pregnant women up to 6 weeks post-partum (covered by
MBRRACE-UK sepsis study)
• Patients on end of life care pathway at time of diagnosis or
consultant-led decision made not to escalate (prior to
entry into the study)
• Patients that develop sepsis after 48 hours on ICU/HDU
• Children <16 years
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Improving the quality of medical and surgical care
Sepsis: Case ID/ data collection
• Study contacts identify patients with sepsis
admitted to ICU/HDU and seen by CCOT during
study period
– Spreadsheet: details of consultant, date identified for the
study
• Cases selected- 5/hospital
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Improving the quality of medical and surgical care
Sepsis: Data collection
• Clinician questionnaire – completed by named
consultant
- Collect data on acute care from admission (or 2 weeks before
ID) up to 30 days after identified by the study ~60% so far
• Case note extracts
– Admission to discharge/30 days after entry into the study.
~60% so far
• Organisational questionnaire
– Collect data on organisation of care
– To be sent to all hospitals that deal with adult patients with
sepsis ~55% so far
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Improving the quality of medical and surgical care
Advisor case review
• Multidisciplinary group of Advisors review case notes
and questionnaires and rate the quality of care
– 130 cases seen
• GP details identified for patients that saw GP in
relation to the hospital episode
– Request for GP notes
– GP Advisors review cases February 2015
• Questionnaire to Ambulance Trusts
• Publication Autumn 2015
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Improving the quality of medical and surgical care
Study timeline
Nov-15
Oct-15
Sep-15
Aug-15
Jul-15
Jun-15
May-15
Apr-15
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Form the EG
Write the protocol
Design the questionnaires
Write the strategy of analysis
Write the database
Advertise the study
Advertise for Advisors
Test data collection methods
Meet with EG
Final protocol to SG + IAG
Start data collection
Run Advisor meetings
Data analysis
Presentation to EG and
Advisors
Presentation to SG
CORP IAG
Write the report
First draft to reviewers
Second draft to reviewers
Report design and print
Embargo copies sent
Publish the report
Disseminate findings
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Improving the quality of medical and surgical care
Acute Pancreatitis
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Improving the quality of medical and surgical care
Background
 The incidence of acute pancreatitis ranges from 150 to 420
cases per million population in the UK
 Gallstones and alcohol account for the majority (50% and 25
% respectively)
 In order to determine the aetiology and monitor progress,
further investigations and imaging are necessary – there is
often disagreement between clinicians about whether /when
these should occur
Improving the quality of medical and surgical care
Background
 Severe pancreatitis should be managed in a HDU/ITU setting,
but their condition and co-morbidities will determine access
 Mortality rate is 14-25% increasing to 47% with complications,
half the deaths occurring within 2 weeks of onset
 Patients with AP 2o to gallstones should have definitive
treatment within 2 weeks to prevent acute recurrences and
increased risk of mortality, but this does not always happen
due to availability of resources
Improving the quality of medical and surgical care
Background
Supporting evidence
 BSG guidelines (2003) provide recommendations for diagnosis
and management of pancreatitis, however adherence is not
always possible and they are often challenged
− Scoring systems for severity stratification to determine
level of care
− Recommended time frames for radiological/surgical
interventions
− Use of antibiotics
Improving the quality of medical and surgical care
Aim
Aim/ Objectives
 To explore remediable factors in the process of providing care to
patients admitted with acute pancreatitis.
- Criteria used to determine severity of acute pancreatitis
- The appropriateness of investigation request pattern and ITU
support requests
- The compliance with existing guidelines
- Use of radiological imaging and its timing
- Timeliness of transfers
Improving the quality of medical and surgical care
Acute Pancreatitis
Method/patient sample
 Retrospective case note review of a sample of patients during
a defined time period
 Identify patients through ICD10 codes for acute pancreatitis:
K85.0, K85.1, K85.2, K85.3, K85.8, K85.9
(HES (2012): 24373 admissions for acute pancreatitis, 22400 of which were
emergency admissions)
 Identify markers of ‘severity’
 HDU/ITU admissions
 Previous inpatient episodes
Improving the quality of medical and surgical care
Study Advisory Group
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Ms Joanne Bishop
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Mr Tim Brown
Dr Mark Callaway
Dr David Cressey
Mr Chris Halloran
Ms Jill Henderson
Dr Mike Mitchell
Mr Murali Partha
Dr Stephen Pereira
Ms Mary Phillips
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Dr Pat Twomey
Ms Marion Thompson
Hepato-Pancreatico-Biliary Nurse Specialist,
Leicester
Pancreatico-biliary Surgeon, Swansea
Radiologist, Bristol
Intensivist, Newcastle
Surgeon, Liverpool
Pancreatitis Nurse Specialist, Newcastle
Gastroenterologist, Belfast
Surgeon (joint proposer of study), Ipswich
Gastroenterologist, London
Hepato-Pancreatico-Biliary Specialist Dietitian,
Guildford
Chemical Pathologist, Bury St Edmunds
Lay rep
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Improving the quality of medical and surgical care
Current Status
• Met with the Study Advisory Group
• Developing initial drafts of questionnaires
• Finalising protocol
• LR starter packs to be sent out next week
• Recruiting Cases reviewers
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Improving the quality of medical and surgical care
Study timeline
Write the protocol
Design the questionnaires
Advertise the study
Advertise for case reviewers
Create the database
Test data collection methods
Meet SAG
Final protocol to SG, IAG, ROCR & HRA
Start data collection
Run Advisor meetings
Data analysis
Presentation to SAG and case reviewers.
Presentation to SG
CORP IAG
Write the report
First draft to reviewers
Second draft to reviewers
Report design and print
Embargo copies sent
Publish the report
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Improving the quality of medical and surgical care
Jun-16
May-16
Apr-16
Mar-16
Feb-16
Jan-16
Dec-15
Nov-15
Oct-15
Sep-15
Aug-15
Jul-15
Jun-15
May-15
Apr-15
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Form Study Advisory Group (SAG)
Provision for Mental Health in
Acute Care
Hannah Shotton
Improving the quality of medical and surgical care
Mental Health in Acute Care: Introduction
•Poor mental health is the largest cause of disability in the UK
and closely connected with poor physical health
•Patients with a mental health disorder have more medical
illness, longer hospital stays, poorer outcome and shorter life
expectancy
•Concern that healthcare professionals may have stigmatising
attitudes/prejudice towards patients with mental health
disorders and they may receive a poorer quality of care
•Series of recent reports highlighting issues and outlining
standards of care and recommendations of how to achieve them
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Improving the quality of medical and surgical care
Mental Health in Acute Care: Aim
• Study Advisory Group meeting 12th February
2015
• Pilot study April/May 2015
• Data collection will begin May 2015
• Publication November 2016
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Improving the quality of medical and surgical care
Mental Health in Acute Care:
Nov-16
Oct-16
Sep-16
Aug-16
Jul-16
Jun-16
May-16
Apr-16
Mar-16
Feb-16
Jan-16
Dec-15
Nov-15
Oct-15
Sep-15
Aug-15
Jul-15
Jun-15
May-15
Apr-15
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
1st EG meeting
Write the protocol
Design the questionnaires
Advertise the study
Advertise for Advisors
Create the database
Test data collection methods
2nd EG meeting
Final protocol to SG, IAG, ROCR &
HRA
Start data collection
Run Advisor meetings
Data analysis
Presentation to EG and Adv.
Presentation to SG
CORP IAG
Write the report
First draft to reviewers
Second draft to reviewers
Report design and print
Embargo copies sent
Publish the report
Improving the quality of medical and surgical care
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NCEPOD Checklists
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Improving the quality of medical and surgical care
Purpose
To allow Trusts/hospitals to benchmark
themselves against NCEPOD report
recommendations
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Improving the quality of medical and surgical care
Format
• Simple table format (example in packs)
• Recommendation
• Is it met? Y/N/Partially/ Planned
• Comments (Examples of good practice or deficiencies
identified)
• Action required
• Time scale
• Person responsible
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Improving the quality of medical and surgical care
Audit Tool
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Improving the quality of medical and surgical care
Purpose
• To provide health care professionals with a tool to
carry out local audits based on the findings of each
of the NCEPOD reports
• Aimed to be as simple to use as possible
• Examples of use
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Junior doctors who needed to do an audit
Reporting back to Trust boards
Evidence of CPD activity
Compliance with NHSLA CNST standard 2.9
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Format
• Audit pack
• Introduction and method
• Overall quality of care
• Key findings and recommendations
• Data collection tool
• Data comparison tool
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Improving the quality of medical and surgical care
Data collection tool
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Improving the quality of medical and surgical care
Data comparison tool
NCEPOD AKI data comparison tool
Hospital Number _____________________
Recommendations
Data collection tool
Response
Q7c – Were U + Es measured as part of the initial assessment?
Yes
No
Q11 – Which risk factors were not adequately assessed/documented
(biochemistry)?
Yes
No
Q19a/b – Was investigation of the patient’s AKI adequate (biochemistry)
Yes
Initial clerking of all emergency patients should
include a risk assessment for AKI.
Q10b – Adequate risk assessment of AKI?
Yes
No
Risk factors for AKI should be clearly
documented in the patients’ notes.
Q11 – Which risk factors were not adequately assessed/documented?
All acute admissions should receive adequate
senior reviews with a consultant review within
12 hours of admission.
Q28a - Did the patient receive adequate senior reviews
Yes
No
Q28b – Time to first consultant review
≤12 hrs
>12 hrs
Appropriate modalities should be employed to
fully assess the patient’s AKI.
Q19a Was investigation of the patient's AKI adequate?
Yes
No
All patients with AKI should have a suitable
management plan established and documented.
Q21a Was the documented management plan adequate for this patient?
Yes
No
All emergency admissions, regardless of
specialty, should have their electrolytes checked
routinely on admission and appropriately
thereafter.
Action
required
No
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Audit tools
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Audit tools
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Audit tools
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Improving the quality of medical and surgical care
Audit tool
• On website
• Rolled out for each new study and being back
dated for previous studies
• Feedback appreciated
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Improving the quality of medical and surgical care
The Surgical Outcome Risk Tool (SORT)
Improving the quality of medical and surgical care
The Surgical Outcome Risk Tool (SORT)
• NCEPOD “Knowing the Risk” study (2011)
• Identification of high risk patients
• Risk prediction tool developed and validated to calculate
death within 30 days of inpatient surgery
• British Journal of Surgery: 12 November 2014
Improving the quality of medical and surgical care
The Surgical Outcome Risk Tool (SORT)
• Rapid and simple data entry of 6 variables, including patient
characteristics (age and cancer) to calculate % mortality risk
• Solely preoperative variables
• In the analyses, SORT also found to have greater accuracy
than 2 other preop tools
Improving the quality of medical and surgical care
The Surgical Outcome Risk Tool (SORT)
Improving the quality of medical and surgical care
The Surgical Outcome Risk Tool (SORT)
At the time of publication, this work represents the largest
analysis of risk prediction tools in a UK cohort of patients
undergoing inpatient surgery in multiple surgical
specialties
App available in 2015
www.bjs.co.uk
www.sortsurgery.com
Improving the quality of medical and surgical care
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Improving the quality of medical and surgical care