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Category Archive: Adult Cardiac Surgery

Clinical Services Quality Measures: Consultation Launches Today

The overall objective of the NICOR cardiac audits is to provide information to enable those who receive, deliver and commission healthcare to measure and improve services.

Clinical Services Quality Measures are one of the ways we will provide this information in a timely manner and will allow ‘at-a-glance’ comparisons of similar services across the country. The work has been commissioned by NHS England, and the cardiac measures will initially focus on the treatment of patient with hearts attacks.

We are currently in the development phase and have identified a long list of measures. These measures will be used to measure a quality service and aim to answer the following questions:

Patients: Clinicians: Answered by:
 Was I given the best care?  Did I do the right things?  CSQM measures based on good practice criteria or standards.
 Has my health improved?  Am I helping to improve survival and reduce morbidity?  CSQM based on life mortality and morbidity rates.

We would like your help to ensure we have the right domains and indicators to answer these questions.

What are the measures?

The CSQM spreadsheet* provides a full list of measures that cover both STEMI and NSTEMI patients.

*If you have any problems accessing the spreadsheet file, please access this link

These are separated into two worksheets to reflect the different patient pathways for Heart attack patients:

1) Primary Percutaneous Coronary Intervention (pPCI) Centres (centres that treat over 20 patients per year)

2) Non primary PCI centres or centres performing less than 20 cases per year.

If you would like to provide feedback on both the pPCI and nonPCI centres you will need to complete both surveys:

  1. primary PCI CSQM survey
  2. non primary PCI CSQM survey.

We would very much appreciate whatever you are able to do, while recognising that you are busy and have many demands on your time. Your input is very valuable.

The consultation closes on July 31st 2016.

  • Further information  about the CSQM programme can be found on the NHS England website.
  • A summary and FAQs for the Cardiac Clinical Services Quality Measures is available here.

NACSA-COP-2015

The refresh of the National Adult Cardiac Surgery Audit including data for operations undertaken between 1st April 2011 and 31st March 2014 is published today (15/09/2015) at http://www.scts.org/modules/surgeons/default.aspx and my NHS https://www.nhs.uk/Service-Search/performance/Consultants. The data is in response to the NHS England transparency agenda and gives activity and risk adjusted mortality rates for all hospitals and surgeons in England and Wales, and hospital level data for Scotland and Northern Ireland. It should be noted that the results reflect activity and mortality rates in the period under scrutiny and may not reflect more contemporaneous results.

The methods for data validation and statistical analysis are complex and have been subjected to extensive external scrutiny.

The 2010-2013 analysis was reviewed by a team led by Professor Nick Black –http://www.ucl.ac.uk/nicor/audits/adultcardiac/documents/reports/nicor-response-nick-black.

The 2011-2014 analysis was reviewed both by a team led by Professor Nick Black and by Professor David Spiegelhalter – Further information on this is available.

The full methods for the NACSA audit (the Strobe Statement) is available on request.

NICOR’s statistical response to Nick Black’s report into the review of data validation and statistical processes for consultant outcomes publication 2014

As part of NHS England’s consultant outcomes publication (COP), Professor Nick Black was asked to review the National Adult Cardiac Surgery Audit (NACSA) and provide assurance the data were fit for purpose and publication.

NICOR would like to thank Nick Black and his panel for their report (which is Appendix I in the document provided below). The panel acknowledged the complexity of this process, made recommendations for potential improvements, and highlighted the chain of responsibility.

They concluded in spite of the complexities identified the data are sufficiently complete and accurate to allow a comparison of individual consultants. They recommended further development of the processes involved and also the risk adjustment model, but concluded the adopted method is fit-for-purpose. The panel raised some important points.

NICOR would wish to highlight a number of issues related to his report.

NICOR response to Prof Nick Black

2014 Consultant Outcomes Publication

MY NHS – NHS Choices has today published the consultant outcomes data for both the National Audit of Percutaneous Coronary Intervention (NAPCI) and the National Adult Cardiac Surgery Audit (NACSA).

NACSA – This data covers the reporting period 2010 – 2013. The data again shows very low overall mortality rates following adult cardiac surgery in the UK. The data is from 36 hospitals and 307 consultants who submitted data to the NICOR database during the reporting period.

NAPCI – The National Audit of Percutaneous Coronary Intervention (PCI) assesses percutaneous coronary intervention in the United Kingdom, and for the second year reports the volume of cases performed by operators and by PCI centres. It also describes their case mix and outcomes.

More information on the analyses can be found on the Society for Cardiothoracic Surgery and the British Cardiovascular Intervention Society websites.

For all media enquiries, please contact Harry Dayantis:

E-mail: h.dayantis@ucl.ac.uk

Tel: 020 3108 3844

For further background on the COP programme, please visit Health Quality Improvement Partnership website.

NACSA response to NHSE

The NHS Medical Director, Sir Bruce Keogh, requested written assurance from The Healthcare Quality Improvement Partnership (HQIP) that the validation and analytical processes used to deliver the adult cardiac surgery audit managed by NICOR are fit for purpose and had been applied appropriately. NICOR responded by describing the processes applied for data validation and risk adjustment and demonstrating their appropriateness within the context of a national clinical audit reporting at consultant level.

This report is summarised in the document attached with this article.

NACSA response to NHSE

NICOR statement regarding National Adult Cardiac Surgery Audit data validation

NICOR’s mission is to provide accurate data on cardiovascular outcomes for the public, healthcare providers and the medical profession. NICOR manages the National Adult Cardiac Surgery Audit, which has been reporting risk adjusted* outcomes since 2005. The most recent hospital and consultant procedure numbers, risk-adjusted in-hospital mortality and risk factor incidence were published for NHS hospitals and individual consultants in April 2014.

Since this publication, it has become clear that there may be some data irregularities, which raises concerns about the data validation processes for the Audit. NICOR leads a rigorous validation process for data submitted to the audit for the risk-adjusted outcomes reporting, consisting of three rounds of data analysis being sent to hospitals for local validation. At each of these three stages hospitals are required to acknowledge receipt of the analysis, and amend data to rectify any data completeness or accuracy issues.

Accurate data for indicating hospital and surgeon performance is a complex process between NICOR and local hospitals. While NICOR provides data quality assessment and data validation reports, the process is dependent on surgeons and their local teams using these reports effectively to verify data and undertake local data validation.  NICOR is currently reviewing how they can work with surgeons and hospitals to facilitate this process further in the future.

As concerns have been raised about data quality NICOR will now repeat the data validation process, supporting units to re-check all data and submit revisions if inaccuracies are identified. Once this process is complete the analysis will be re-done and published on the SCTS website.

NICOR continues to be committed in all its registries to provide appropriately analysed, accurate outcome data in a timely manner which is understandable by the public, health care providers and the medical profession.

A statement from the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) on the National Adult Cardiac Surgery Audit and Mr Ian Wilson has been published on its website.

*’Risk adjustment’ is a sophisticated statistical process that takes into account the riskiness of a medical intervention when calculating clinical outcomes, like mortality. Risk adjustment is based on the presence of certain patient risk factors, like high blood pressure and diabetes. Whether risk factors are present in each patient is reported by hospitals along with other national clinical audit data.

Audit data shows fall in adult heart surgery death rates

The number of UK adult heart patients dying in hospital has fallen by more than 20% in the last ten years, according to the latest National Adult Cardiac Surgery Audit (NACSA) data published today.

The audit found that mortality rates fell to 2.98% nationally in the ten years to 2012/13 – despite the fact that heart surgeons increasingly take on more difficult cases.

Innovative reporting gives interactive access to the NACSA data. Reporting tools are designed to help doctors improve the quality of heart surgery, reassure patients that standards of care are being monitored and improved, as well as helping them make informed choices about their treatment.

This includes publishing results for individual hospitals and consultant surgeons, which has been done for UK adult heart surgery since 2005. This was emulated by nine other medical specialties in 2013 as part of the NHS England Consultant Outcomes Publication programme, which is expanding to include 13 clinical areas in 2014.

The suite of online resources is based on data that covers all NHS heart surgery in the UK up to 31 March 2013, and has been thoroughly checked for accuracy by each hospital.

Consultant Outcomes Publication

www.scts.org/patients shows the number and type of heart operations each consultant and hospital is carrying out, as well as the associated mortality rate. Results are searchable by an interactive map, name or, for consultant, GMC code. For 2014 this incorporates recommendations from the Healthcare Quality Improvement Partnership (HQIP) COP Style Guide for National Clinical Audits.

SCTS iData app

This web based and Apple iOS app is designed to support patient and clinical decision making. It allows NACSA to be queried by placing filters on five years’ worth of data, generating a tailor-made report on up-to-date operations. It can be downloaded to Apple devices by searching ‘SCTS iData’ or accessed on www.idata.scts.org.

Blue Book Online

www.bluebook.scts.org shows interactive analysis of up-to-date procedure numbers and data completeness for UK heart surgery hospitals, along with national trends over time for mortality and operative risk.

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