Transcript Where we are now

South Central Regional
Collaborative Data
13th November 2014
Wokefield park
Regional Collaborative
Regional Collaborative
Actual deceased donorsSouth Central team
DCD
DBD
110
47
100
39
90
80
23
20
28
20
29
70
Number
25
60
16
62
60
60
58
57
54
13
50
48
48
44
40
40
10
30
29
20
10
0
05/06
06/07
07/08
08/09
09/10
10/11
11/12
12/13
13/14
14/15
14/15
Apr-Sep proj ected
Year
1 April 2005 to 30 September 2014, data as at 14 October 2014
Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation
Regional Collaborative
Actual deceased donors
DBD
DCD
60
50
51
46
40
41
40
38
Number
36
33
30
29
26
20
25
25
29
26
25
21
22
21
20
19
17
10
10
16
10
3
0
Eastern
London
Midlands
North
West
Northern
Northern
Ireland
Scotland
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
South
Central
South
East
South
Wales
South
West
Yorkshire
Plan
•
•
•
•
DCD
DBD
Our possible DBD not tested
DBD case presentations (Roger)
Regional Collaborative
DONATION AFTER
CIRCULATORY DEATH
Regional Collaborative
Why less DCD?
•
•
•
•
•
•
Chance
Not being referred? Referral % still increasing
Fewer people dying in ICU
Less withdrawal of treatment (LCP effect)
Surgeons becoming more risk averse
Informal triage filtering out patients who
previously might have become donors
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Regional Collaborative
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South Central DCD referral
rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD referral rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD SN-OD involved
1 April 2014 to 30 September 2014, data as at 14 October 2014
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DCD consent rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD conversion rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Trends in national DCD rates
100
80
%
60
54
53
47
49
40
42
61
55
56
50
51
67
62
57
53
54
49
70
72
73
76
73
63
70
60
55
49
53
48
51
46
Apr 13 Sep 13
Oct 13 Mar 14
Apr 14 Sep 14
50
20
0
Apr 10 Sep 10
Oct 10 Mar 11
Apr 11 Sep 11
Oct 11 Mar 12
Referral rate
SN-OD involved rate
Apr 12 Sep 12
Period
Approach rate
Consent/authorisation rate
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Oct 12 Mar 13
Trends in South Central DCD
rates
100
88
80
74
67
66
60
%
40
60
63
50
46 50
39
42
41
30
75
74
47
43
45
53
55
55
61
57
54
46
75
71
64
54
47
42
41
40
20
0
Apr 10 Sep 10
Oct 10 Mar 11
Apr 11 Sep 11
Oct 11 Mar 12
Referral rate
SN-OD involved rate
Apr 12 Sep 12
Apr 13 Sep 13
Period
Approach rate
Consent/authorisation rate
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Oct 12 Mar 13
Oct 13 Mar 14
Apr 14 Sep 14
DCD consent/authorisation
rate by ethnic group
ODS team
Eastern
London
Midlands
North West
Northern
Northern Ireland
Scotland
South Central
South East
South Wales
South West
Yorkshire
Total
White patients
Family
Consent/ authorisation
approached
rate*
95
58
62
50
125
50
96
56
61
64
33
48
62
55
56
43
71
62
57
44
64
56
79
54
861
54
BAME patients
Family
Consent/ authorisation
approached
rate*
7
22
45
12
25
4
2
4
6
3
2
2
2
66
35
* Consent/authorisation rates are not shown where the number of families approached is less than 10
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD Summary
• Fewer people dying on ICU
• Fewer families approached
• More age 70 to 79 declined by
transplant surgeons
• Consent rate dropped to 40%
• South Central SNOD involvement
slipping?
Regional Collaborative
DONATION AFTER BRAIN
DEATH
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Trends in national DBD rates
100
92
86
83
80
73
69
64
71
66
76
70
63
65
94
92
73
72
91
93
93
92
79
94
93
75
69
66
67
Apr 12 Sep 12
Oct 12 Mar 13
Apr 13 Sep 13
76
78
96
92
82
95
70
67
Oct 13 Mar 14
Apr 14 Sep 14
80
64
%
60
90
40
20
0
Apr 10 Sep 10
Oct 10 Mar 11
Apr 11 Sep 11
Oct 11 Mar 12
Testing rate
Approach rate
Consent/authorisation rate
Period
Referral rate
SN-OD involved rate
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Trends in South Central DBD
rates
100
96
84
79
81
68
62
80
72
60
%
52
40
87
83
76
89
97
89
91
80
75
67
67
Oct 11 Mar 12
Apr 12 Sep 12
89
89
89
90
79
73
70
66
94
85
76
76
94
Oct 13 Mar 14
Apr 14 Sep 14
86
71
66
61
55
39
20
0
Apr 10 Sep 10
Oct 10 Mar 11
Apr 11 Sep 11
Testing rate
Approach rate
Consent/authorisation rate
Apr 13 Sep 13
Period
Referral rate
SN-OD involved rate
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Oct 12 Mar 13
DBD- Neurological death
testing rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
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DBD- South Central
Neurological death testing rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD- South Central
Neurological death testing rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD referral rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD approach rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD SN-OD involved
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD consent rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD conversion rate
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD consent/authorisation
rate by ethnic group
ODS team
Eastern
London
Midlands
North West
Northern
Northern Ireland
Scotland
South Central
South East
South Wales
South West
Yorkshire
Total
White patients
Family
Consent/ authorisation
approached
rate*
50
72
54
72
67
70
70
61
41
66
31
77
55
69
36
78
55
75
16
56
30
90
32
78
537
72
BAME patients
Family
Consent/ authorisation
approached
rate*
7
45
33
10
50
7
1
1
4
7
2
1
85
36
* Consent/authorisation rates are not shown where the number of families approached is less than 10
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Coroner permission requested
Permission given
100
90.82%
77.92%
85.71%
79.55%
71.43%
None
77.27%
Partial
85.45%
Full
64.15%
90.32%
88.71%
74.47%
90
80
70
%
60
50
40
28.30%
30
16.07%
20
16.88%
14.77%
10.20%
10
14.89%
22.73%
12.50%
10.91%
7.14%
0
5.68%
5.19%
Eastern
London
7.55%
Midlands
North
West
Northern Northern
Ireland
South
Central
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
South
East
6.45%
South
Wales
8.06%
10.64%
South
West
Yorkshire
DBD summary
• 5% increase in DBD nationally but not in
South Central
• Brain stem death testing rates remain
red on dashboard at 66%. Blip or trend?
• Other areas of pathway remain ok
Regional Collaborative
South Central Brain Stem
Death Testing
•
•
•
•
•
Jan to Oct 2014
21 cases BSD? Not tested
4/21 not referred
3/21 never planned to test
We think 7 could/should have been
tested
Regional Collaborative
Reasons
• Delay in testing due to sedation
• Patient not for donation (malignancy,
advanced directive, refusal after 1st set)
• Miscellaneous (individual consultant
behaviour)
Regional Collaborative
Dr Roger Lightfoot
BRAIN STEM DEATH?
PRESENTATIONS
Regional Collaborative
Questions, discussion
1. Compared to other regions our BSD
testing is lower. Problem or statistical
blip?
2. Is brain stem death testing whenever
possible still our aim? If not why not?
Regional Collaborative