1 / 84

Scottish Stroke Audit

Scottish Stroke Audit. 3rd National Meeting 7th Dec 04. Welcome. NHS QIS funded audit - Oct 02 - 05 Original plan - 6 to 10 hospitals Impact of CHD & Stroke strategy NHS QIS standards and visits. Program. Comparisons between hospitals Control charts

tea
Télécharger la présentation

Scottish Stroke Audit

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Scottish Stroke Audit 3rd National Meeting 7th Dec 04

  2. Welcome • NHS QIS funded audit - Oct 02 - 05 • Original plan - 6 to 10 hospitals • Impact of CHD & Stroke strategy • NHS QIS standards and visits

  3. Program • Comparisons between hospitals • Control charts • Demonstration of real time data capture system • Audit of swallow screening • Update on “MCNs on the Web”

  4. How can these data help improve patient care? • Identify variation in “performance” and to raise questions about cause of variation • Identify methods which increase performance? • Highlight services requiring more investment or re design

  5. Reasons for variation in “Performance” • Method of collection data • Definitions, case ascertainment and audit period • Method of analysing data • Which numerator and denominator? • Chance • Actual performance of service

  6. Some statistical terms • Proportions (%) • 95% confidence intervals • Means and medians • Inter quartile range

  7. Proportions • Numerator / Denominator = Proportion • 100 patients admitted • 60 enter stroke unit • Proportion is 60/100 = 0.6 or 60% • We have had problems with denominators • NHS QIS ask % admitted SU within 1 day • Is denominator 60 or 100?

  8. Denominators • If admit 100 stroke patients • 60 enter the stroke unit • therefore 60% managed in a stroke unit • if half get into stroke unit within a day • % admitted to SU <1day = 50% or 30% • NHS QIS want 30% figure

  9. 95% confidence intervals • Measure the proportion entering your stroke unit once • Calculate the 95% Confidence intervals • Measure the proportion a further 100 times and one would expect 95 estimates to lie within the 95% confidence intervals.

  10. Effect of sample size

  11. A normal distribution No. of patients Mean = 10 Median = 10 Length of stay in Days

  12. Length of stay Mean = 10 Median = 10 No of people. Length of stay (days) Mean = total no. of days / total no. of people Median = LOS where half the people have longer ones and half shorter ones

  13. A skewed distributione.g. length of stay in acute stroke unit No. Mean = 7.3 Median = 6 Days

  14. A very skewed distributione.g. delay to CT scan No. Mean = 4.9 Median = 3 Days

  15. Quartiles (quarters) No. Mean = 10 Median = 10 Days Interquartile range (IQR) (half the patients are included)

  16. Comparisons between hospitals A few hospitals which are currently collecting data are not included because too few data are available.

  17. Inpatients

  18. Data collection periods vary • Longer period will provide more patients and more precise estimates • Longer period will include older data • Recent short period will not include patients still in hospital - therefore may give biased estimates

  19. Variable data collection times

  20. No. of admissions available for analysis – Group 1 Ninewells estimates will have wide Confidence intervals so differences are more likely to be due to chance

  21. No. of admissions per year Group 1 At Ninewells may be missing cases - not identified or simply not yet discharged

  22. No. of admissions available for analysis – Group 2

  23. No. of admissions per year – Group 2

  24. No. of admissions per year – Group 3

  25. No. of admissions per year -Group 4 The estimate in your hand out for St Johns is incorrect

  26. No. of admissions per year – Group 5

  27. Length of Stay in HospitalMean MedianGroup 1 Patients with longer LOS in Ninewells not yet discharged Why is LOS shorter in ARI than Edinburgh??

  28. Length of Stay in HospitalMean MedianGroup 2 Length of Stay in HospitalMean MedianGroup 2

  29. Length of Stay in HospitalMean MedianGroup 3 Length of Stay in HospitalMean MedianGroup 3 Two fold difference Monklands & Falkirk - why?

  30. Length of Stay in HospitalMean MedianGroup 4 Length of Stay in HospitalMean MedianGroup 4

  31. Length of Stay in HospitalMean MedianGroup 5 Length of Stay in HospitalMean MedianGroup 5 Imprecise estimates because small numbers Shetland a different model of service?

  32. Proportions admitted to Stroke Unit – Group 1 77 beds 42 beds 18 beds Note the 95% CI vary with amount of data collected

  33. 43 beds 35 beds 30 beds 16 beds 10 beds Proportions admitted to Stroke Unit – Group 2 Ayr & Crosshouse are doing well! - ? chance because only 3 month 7.6-8.3 pts/SU bed/yr cf 14 pts/SU bed/yr in Inverclyde

  34. Proportions admitted to Stroke Unit – Group 3 24 bed 24 beds 25 beds 30 beds 15 male

  35. Proportions admitted to Stroke Unit – Group 4 15 beds 14 beds 21 beds 17 beds 8 beds 0 beds

  36. Proportions admitted to Stroke Unit – Group 5 6 beds Variable

  37. Mean Delay in accessing SU – Group 1

  38. Mean Delay in accessing SU – Group 2

  39. Mean Delay in accessing SU – Group 3

  40. Mean Delay in accessing SU – Group 4 X

  41. Mean Delay in accessing SU – Group 5 X

  42. Proportion of admission in Stroke Unit – Group 1 Reflects delay in admission % entering SU and exit from SU before discharge X

  43. Proportion of admission in Stroke Unit – Group 2

  44. Proportion of admission in Stroke Unit – Group 3

  45. Proportion of admission in Stroke Unit – Group 4 X

  46. Proportions of admission in Stroke Unit – Group 5 X X

  47. Proportions scanned – Group 1 ARI seem to be having problems getting scans

  48. Proportions scanned – Group 2 Delays in Ayr and Crosshouse

  49. Proportions scanned – Group 3

  50. Proportions scanned – Group 4 Raigmore and Victoria Hospital Kirkaldy having problems

More Related