the 12 bulletin
Audit report It is two years since I wrote the last combined audit report for the Bulletin and with separate more recent updates on the advances in thoracic audit, and with all units now represented on the SCTS congenital committee, this report will concentrate on adult cardiac surgery. David Jenkins, Chair of audit committee, SCTS executive
I
am sure all are aware that the publication of the latest 2014-17 audit data cycle, due in May, has been delayed by NICOR (National Institute for Cardiovascular Outcomes Research). The data submissions and analysis were completed on time at NICOR and the results communicated to the senior members of the SCTS executive. I am pleased to report that the provisional analysis indicates there were no alarm outliers at unit or individual level and all will be shown as ‘as expected’ in the public domain when the publication is released. There were 13 surgeon and 3 unit alert outliers, evenly distributed between positive and negative and the joint NICOR/ SCTS letters have already been sent informing those members affected. We have again kept the recalibration of logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) I stable over the last few years and the formula is available to your audit departments so that you can replicate the NICOR analysis for your own data locally. In addition, the corrections for dispersion have not changed. The last revision of the dataset has allowed us to collect the
variables needed to calculate EuroSCORE II, but no decision has been made about changing the risk stratification at present. The reason for the delayed publication was due to a potential analysis error in another NICOR audit. This prompted an external review by the UCL statistical department, and until this has been completed, HQIP (Healthcare Quality Improvement Partnership) agreed that publication of all the audits should be delayed. Although frustrating, I think for the future of the adult cardiac surgery, and
There have been considerable changes at NICOR over the last two years. The organisation is now hosted by Barts and has moved site. Last year it successfully bid to continue to run the six cardiac audits and HQIP re-commissioned NICOR for a further three year period. The plan is to integrate the audits further and develop joint reports. The audit component is now renamed NCAP, national cardiac audit programme. Andrew Goodwin remains as the NICOR lead for the adult cardiac surgery audit. NICOR and SCTS have worked together to develop additional outcome measures related to morbidity and process and these will be published at unit level in the future. Examples of additional outcome measures include deep sternal wound infection, stroke, renal failure and return to theatre because of bleeding. This has highlighted that the completeness of the database fields for some variables could be improved and your help at local level is appreciated. Those of us working in England will have contributed to the GIRFT report that was lead by Dave Richens and published a few months ago (http://gettingitrightfirsttime.co.uk).
“I am pleased to report that after a 2 year delay we are nearing completion of the analysis of a major project to review 15 years of cardiac surgery data. This will be developed into a new ‘Blue book’ demonstrating the changes in practice and outcomes over the last 15 years.” congenital, audits (both run by NICOR), this will be an important step. It is likely that the results will be published in a similar format to previous publications, but in future we need to consider formats that are more easily understandable by patients. SCTS welcomes more external statistical scrutiny, and we have been promised that this will now become routine with all six NICOR audits receiving the same support.
