Transcript Stroke Care Audit - an update September 2004

Making sense of stroke audit data
Robin Henderson
National Stroke Audit Coordinator
Royal Infirmary of Edinburgh
What do we as Stroke Audit
Coordinators?
• We are involved in PM = ?
PERFORMANCE MONITORING
How do we do it?
•
We obtain PIs=?
PERFORMANCE INDICATORS
1.
Measurements
2. Counts
What can be done with them?
• We can assess performance against national
standards - Clinical Standards for Stroke Services:
Care of the Patient in the Acute Setting March 2004
• We can see if performance of a unit improves over
time
• We can compare performance of units
• Publish in National Report on Stroke Services in
Scottish Hospitals
What PIs do we use?
• The ones we’re asked to use, generally
• Local variation possible
Do we miss any cases?
SMR01 List
SSCAS List
………….
………….
………….
#Henrietta Ford
*Joe Bloggs
………….
………….
#Henrietta Ford
………….
………….
•Tom Jones
………….
………….
SSCAS
No stroke
SMRO1
Stroke
No Stroke
n/a
*
Stroke
●
#
Hospital X
SSCAS
No stroke
SMRO1
Comment: -
Stroke
No Stroke
n/a
0
Stroke
0
634
Hospital Y
SSCAS
No stroke
SMRO1
Comment: -
Stroke
No Stroke
n/a
27
Stroke
0
873
Hospital Z
SSCAS
No stroke
SMRO1
Comment: -
Stroke
No Stroke
n/a
0
Stroke
19
721
The reality - RIE
SSCAS
No stroke
SMRO1
No Stroke
Stroke
Stroke
n/a
177
517
653
SMR01 identified 1170 strokes
Robin entered 830 strokes into SSCAS – a 71% capture rate
if SMRO1 is “true”!
FACTOR 1
Joe Bloggs
Diagnosis: - Analgesia induced tension headache
Incidental finding – right internal capsule infarct
(established stroke) on SMR01 list only
Tom Jones
Diagnosis: - Atypical migraine
… decided not to give secondary stroke prevention
…
Recorded as stroke initially so if not careful could
end up on SSCAS only
FACTOR 2
Data collection at RIE is suspended when I’m on
leave!
This brings my capture rate up to 80% if SMRO1
is “true”.
FACTOR 3
Notes requested sometimes never appear!
Julie Bladen
Facilitator (Chronic Disease Registers)
Diabetes, CHD And Stroke MCN's, NHS
Lothian
Audit of case ascertainment and coding
for SSCAS data and SMR01 data
published in the Stroke Care Audit. She is
working on this through the Stroke MCN
and with Professor Martin Dennis.
How do we report PIs?
FOR MEASUREMENTS
We report: Mean
Median
Minimum
Maximum
LET’S DO A PRACTICAL EXERCISE!!!
Length of Stay in ASU (days)
1 10 15
1
16
4 27 11
1
9
6
1 17 20 17 13
16
1
4 31 11
Minimum = 0
Maximum =86
9 14 14
3
1
7
6
6
8 13
2 22 39 43
1 10 13 15
7
2
6
0
9 13 86
8 32
1
6
0
01111111122344666667788999
1
0011333344556677 Please carry on
2
3
4
5
6
7
8
0
01111111122344666667788999
1
0011333344556677
2
027
3
129
4
3
How many patients?
5
6
Median Stay = 9 days
7
8
6
The stay of 86 is thought
of as a leaf 6 on the stem
8.
0
01111111122344666667788999
1
0011333344556677
2
027
3
129
4
3
5
6
7
8
6
Draw rectangles round the
leaves, rotate and erase the
leaves and we have a
histogram of the data.
H i s to gr a m o f S ta y
25
Fr e q ue nc y
20
15
10
5
0
0

10
20
30
40
Average (Mean) Stay = 12.56
50
St a y
60
70
80
90
100
How do we report PIs?
COUNTS
We report: Observed Percentage
95% confidence interval for “True” percentage
LET’S DO A PRACTICAL EXERCISE!!!
SEE spreadsheet SSCASCIEx.xls for Data and CI Table
5 0 % c o n fid e n c e in te rv a ls
P e rc e n ta g e s c a n n e d w ith in 2 d a y s
100
80
60
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
M o n th
The true proportion is 80% - here we have 21/40 = 52%
capture. 52% is close to 50%, the confidence level used.
9 5 % c o n fid e n c e in te rv a ls
P e rc e n ta g e s c a n n e d w ith in 2 d a y s
100
80
60
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
M o n th
The true proportion is 80% - here we have 37/40 =92% capture.
52% is close to 95%, the confidence level used as in SSCAS.
At the Flaig McDowall hospital only common cause variation is
evident in the monthly percentages.
Thank You Very Much!
Telephone 0131 242 6934
e-mail [email protected]