Volume 4 Issue 4 October 2010 Welcome to Knowledge Matters Hello everyone and welcome to another exciting edition of Knowledge Matters! I want to draw your attention to a few important developments over the past couple of months. Firstly, September saw the publication of the first post-operative scores from the PROMs programme. This publication builds upon the published pre-operative data and for the first time provides us with information on the improvements that patients have themselves experienced post surgery. In the next issue of Knowledge Matters we will provide you with an overview of the results for South East Coast. If you can’t wait until then, you might want to have a look at the following link at the HES on-line website: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295 October saw the publication of the long awaited consultation document ‘An Information Revolution’. This is one of a series of documents published subsequent to the White Paper and describes how the Government intends to transform they way in which information is accessed, collected, analysed and used so that people are at the heart of health and social care services. One of the things that I was really encouraged to read is the strong emphasis on the importance of good data quality—this of course underpins the delivery of safe, effective and efficient health services. This consultation is open until 14th January 2011 and I would encourage you to read the strategy and provide feedback. All relevant documents can be accessed from the following website http://www.dh.gov.uk/en/Consultations/Liveconsultations/ DH_120080 Finally, I want to make you aware of work which has now been initiated by the Department of Health to undertake a fundamental review of data returns. This review aims to discontinue returns of limited value and follows a commitment made in the White Paper earlier this year. The NHS Information Centre has set up a series of workshops focussing on a variety of data sets relevant to different clinical (and other) areas—these workshops provide the NHS with an opportunity to provide feedback on the utility of different data sets. A full list of workshop dates appears on page 19—again, I would encourage you to get involved with the review to ensure that the data burden on the NHS is reduced, but that the data sets which are valuable and important in measuring the quality and efficiency of services are maintained. Happy reading!
Inside This Issue : The Inpatient Variation in Expenditure Tool (IVET)
2
Introduction to SINAP
8
A3: Ask an Analyst
14
SPOKE heads north……...
3
The Activity Trend Explorer Tool
9
A comprehensive stroke service for East Kent
16
Department of Health South East update
4
Payment by Results
10
Analysis Ancient and Modern
18
The Safety Thermometer
6
Skills builder—forecasting
12
News
19
http://nww.sec.nhs.uk/QualiityObservatory Quality.Observatory@southeastcoast.nhs.uk
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The Inpatient Variation in Expenditure Tool (IVET) By Bryn Shorney, Economic Adviser, Department of Health Do you know how much your PCT spends compared to others on inpatient admissions for the highest spend diseases and procedures? If not, the Inpatient Variation Expenditure Tool (IVET) can help. IVET is an Excel based tool that presents benchmarking information on PCT expenditure on inpatient admissions adjusting for the age, sex and additional need of the population. Figure 1 shows an example screenshot from IVET. This shows expenditure on Cancer inpatient admissions per 1000 weighted population for each PCT with the selected PCT highlighted in green. The user can select a benchmark level (e.g. national average, 25th percentile) to view potential savings from moving to this level. Figure 1: Inpatient expenditure rate weighted for age, sex and need for all PCTs – 2008/9
IVET currently contains information on four diseases (Cancer, CVD, Respiratory and Musculoskeletal) and ten high spend procedures. The chart shown in Figure 1 is available for each of these diseases and procedures. Figure 2 shows another benchmarking view. This shows the potential savings from moving to the selected benchmark level for all Musculoskeletal admissions and the three high spend procedures within this category, knee replacement, hip replacement (cemented) and complex elderly procedures.
IVET can be accessed from the ‘Key Tools’ section of the Health Investment Network website; http://www.networks.nhs.uk/nhs-networks/health-investment-network/key-tools The site includes links to the other key Programme Budgeting and Health Investment tools, user guides, analysis and a range of other useful resources. More diseases and procedures will be added to IVET in the next couple of months. Register as a member of the site to receive regular updates. Information on Patient Reported Outcome Measures for Knee, Hip, Groin Hernia and Varicose Vein procedures will also be made available. If you have any queries please do get in touch! Bryn.Shorney@dh.gsi.gov.uk
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Sussex Risk Prediction Tool Heads North……. By Colin Styles, Information Architect, Sussex Health Informatics Service Around eighteen months ago, Knowledge Matters reported on a risk prediction tool developed by Sussex HIS to predict patients at risk of chronic admission. Titled SPOKE (Sussex Predictor Of Key Events), the tool works by analysing the healthcare history of each resident in Sussex to predict likelihood of future admission. This information is accessed on a regular basis by community Matrons to develop and prioritise their active patients for caseload management, in order to reduce/avoid admission. The predictive power of the tool has been independently verified by East Sussex Public Health Department. Currently the model is based on hospital and community healthcare activity, although it has potential to include other datasets such as clinical systems and primary care visits/prescriptions. Following a successful pilot, we launched the tool to Community Matrons via a series of Roadshow events in early Spring. There has been very positive feedback from matrons , plus suggestions for extra functionality in the next release, including the ability to see a change in patients’ risk scores over time. Sussex HIS are also now looking to deploy the tool further afield – Brighton PCT are about to run a pilot giving a cluster of GPs access to the tool, also both Kent HIS and Surrey PCT are considering implementation of the tool locally.
I think that SPOKE is brilliant … it is so good I think the other community matrons should have access to their surgery data ASAP’
The SPOKE tool has proved very useful in identifying patients from our surgeries who have a history of acute hospital admissions.
There has also been discussion of the tool at a national level and, following a formal quotation of service North East Essex PCT, based in Colchester, have approved a pilot using an adoption of SPOKE to support their virtual ward development. We will host the tool as a managed service, and the pilot is looking to include primary care as well as hospital data. The model is based around a similar data mining approach to third-party tools such as the combined model. A key difference with SPOKE is that:
•
the model is built on local data, so it reflects the local population
•
the model is relational, which means that we can include additional datasets as these become available locally (eg Primary Care data)
•
the tool has been developed and managed within the NHS
This means that we can tailor both the inputs and outputs of the predictive model based on the local data available and the business requirements of the organisation. Also the algorithm is portable to other NHS organisations. Please do contact me if you would like to learn more! colinstyles@nhs.net
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Update from the Department of Health South East By Robert Kyffin, Senior Public Health Intelligence Officer, Department of Health South East While we await the Public Health White Paper, which is due to be published in December and will set out the form and function of the new national Public Health Service, it’s ‘business as usual’ for the Department of Health South East (DHSE) public health information team. The DHSE regional health and adult social care programmes are supporting the NHS and Local Authorities to ensure that good practice in areas such as tobacco control and dementia care is embedded in local transition plans, and the implementation of the aims and objectives of the South East Health & Well-Being Strategy is continuing apace. The DHSE information team is continuing to produce a number of analytical and information resources including: • the Health Inequalities Gap Measurement Tool • the South East England Indicator Tool (SEEIT) • a three-weekly health and social care information update. Health Inequalities Gap Measurement Tool Tackling health inequalities remains a challenge for the NHS and Local Authorities in England. The gap tool was first produced to provide users in the South East with detailed information on the nature and extent of health inequalities across the region, but has now been expanded to include all areas in England. It shows inequality gaps in mortality rates within and between areas by grouping local populations according to relative levels of deprivation. Results are available for all PCTs and Local Authorities, as well as for SHAs, Government Office Regions and England as a whole. Users can select a wide range of comparisons. For example, mortality rates for the most deprived parts of an area can be displayed alongside the rates for the least deprived parts, illustrating the inequality gap between them.
The gap tool can be used to support planning and commissioning to reduce health inequalities by giving users the means to: • identify the causes of death with the largest inequality gap within areas • see the age groups with the greatest absolute and relative gaps in mortality • compare the overall mortality profile for different areas • view the ‘direction of travel’ for mortality rates and the local inequality gap. The gap tool currently covers the years 2001 to 2008, and the 2009 mortality data will be added shortly. It can be accessed on the SEPHO website at www.sepho.org.uk/gap_intro.aspx
Page 5 South East England Indicator Tool (SEEIT) SEEIT an interactive Excel tool which displays trends, projections and trajectories for a wide range of health and social care National Indicators and Vital Signs. It brings together data from a number of sources including the Data Interchange Hub, the Compendium of Population Health Indicators, the Information Centre, and the Department of Health. It can be used to visualise the direction of travel, evaluate local performance against a range of comparators, and help guide target setting. SEEIT is updated on a quarterly basis and alongside the addition of new data and indicators, the functionality of the tool has been extended substantially to include a range of area and thematic dashboards. The tool will also be updated as the new public health outcomes framework is published. The most recent version of SEEIT can be downloaded from the SEPHO website at tinyurl.com/seeitool
Health and Social Care Information Update The DHSE information team continues to produce a three-weekly information update which provides details of recent publications, policies, consultations and conference announcements across a range of health and social care themes. An archive of over 100 updates can be found on the SEPHO website (tinyurl.com/kmupdate) and you can join the mailing list by emailing anh.tran@dh.gsi.gov.uk For further information contact Robert Kyffin (robert.kyffin@dh.gsi.gov.uk or 01483 882 264)
Mental Health Service Users Survey Benchmarking Tool The Quality Observatory is pleased to announce the development of the Mental Health Service Users Survey Benchmarking Tool. This tool contains national data from the CQC user survey for community mental health services in 2005, 2006, 2007 and 2008. This tool shows the results of the survey from all providers in simple way, and allows comparison between organisations and regions. The data reflected here is for users under the age of 65; the over 65 age group was included in the 2008 survey but for fair comparison has been removed. We have just received the most recent year of data - the format of the survey has however changed so further work will need to be undertaken to enable the tool to compare between years. MENTAL HEALTH USERS SURVEY BENCHMARKER 2006-2008: KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST 100
100
To see the survey and for further information visit: http://www.cqc.org.uk/usingcareservices/healthcare/patientsurveys/mentalhealthservices.cfm
90
The 2008 community mental health survey included service users over the age of 65, but surveys carried out before 2006 did not. To enable fair comparisons with previous surveys, benchmark scores for 2008 were calculated using only respondents of working age (<65). Data on individual trusts for the whole sample is available on request: patient.survey@cqc.org.uk.
Current organisational configurations are used; where the survey contains data for more than one legacy organisation, and average score is taken. Some organisations either did not complete the survey beyond 2006 or ceased to provider relevant services; these will be shown as zero or blank values in subsequent years.
80
60
50
90
40
% achievement (high is good)
% achievement (high is good)
70
SELECT OPTIONS FOR COMPARISON
Select service provider:
KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST
Select benchmark: ENGLAND
Select domain of interest: HEALTH PROFESSIONALS
Select question of interest:
Did the CPN treat you with respect and dignity?
30
GRAPH DISPLAY OPTIONS
20
Bar chart
10
The tool contains national data and can be downloaded from the Quality Observatory website.
80
0
2006
2007 Year
Selected provider
Selected benchmark
Line chart
Show benchmark
TABULAR DISPLAY OF RESULTS 2006
2007
2008
KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST
91.42%
88.04%
94.57%
ENGLAND
91.80%
91.42%
91.86%
ENGLAND
91.80%
91.42%
91.86%
2008
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The Safety Thermometerâ&#x20AC;&#x201D;taking the temperature of care By Katherine Cheema and Adam Cook, Specialist Information Analysts On the 15th September this year trusts across the land were encouraged to fill data in on the safety thermometer. This is part of a programme to help build up a profile of patient safety which can help inform decisions around providing high quality care and improving outcomes. The initial survey was carried out across a variety of patient care settings; acute, community, and mental inpatients and the wider community setting. It was recommended that each organisation looked at four wards or settings of care, and then report back on four key safety areas: pressure ulcers, patient falls (including level of harm), catheter acquired UTIs and VTE. The safety thermometer tool was designed by the Information Centre for individual wards to fill in a snapshot of care on that date. A random sample of patients for each care setting was chosen dependant on the size of the ward, and details of issues relating to the four patient safety measures were collected. All organisations were asked to complete this and the data was sent to the Information Centre for further analysis. South East Coast were very involved in this and half of the national data came from organisations within Kent, Surrey and Sussex. At the Quality Observatory we have been developing dashboards based on this information. The first answers a number of questions that were asked in the initial paper that went out with the Safety Thermometer. It shows the four safety domains and users can select trust, ward type, patient age, and patient sex. And it also has an alternative view which displays organisations against their peers and is selectable by metric, ward type, patient age and patient sex. Hereâ&#x20AC;&#x2122;s a couple of South East Coast - Safety Thermometer Results (Survey: screen shots: All Acute Inpatients Ward Type: All, Age: All, Sex: Female
Pressure Ulcers
Falls
9%
1%
8%
Key
Death
PU1 % patients with a pressure ulcer of cat. 2,3, or 4 PU2 % patients admitted with or developed pressure ulcer within 3 days PU3 % patients developed ulcer after 3 days PU4 % patients with Cat. 3 or 4 ulcer PU5 % patients developing a Cat. 3 or 4 ulcer PU6 % patients admitted with Cat. 3 or 4 ulcer F1 % patients with fall in last 24 hours F2 Severity of most serious fall C1 % patients with in-dwelling urinary cathete C2 % patients being treated for UTI C3 % patients admitted with existing UTI C4 % patients with catheter being treated fro UTI C5 % of patients admitted with catheter receiving treatment for UTI C6 % patients with catheter insterted pre-28 days C7 % patients with catheter insterted post-28 days V1 % of patients with documneted risk assessment V2 % patients identified 'at risk' V3 % of at risk population on appropriate prophylaxis V4dvt % patients being actively treated for VTE (DVT) V4pe % patients being actively treated for VTE (PE) V4other % patients being actively treated for VTE (Other) V5pre % patients admitted on active treatment for VTE V5post % patients starting treatment for VTE since admission
1%
7% 6%
1%
Severe Harm
5%
1%
Moderate Harm
4%
Low Harm
1%
3% 0%
2% 1%
No Harm
0% No Fall
0% PU1
PU2
PU3
PU4
PU5
PU6
0% F2
F1
Catheters
VTE
25%
70% 60%
20%
50% 15%
40%
10%
30% 20%
5%
10% 0%
0% C1
C2
C3
C4
C5
C6
C7
V1
V2
V3
V4dvt
V4pe
V4other
V5pre
V5post
Page 7 Age Band
South East Coast - Safety Thermometer Results (Survey: % patients being treated for UTI
Sex
<18
18-70
N/A
All Ages
>70
Female
N/A
Male
All
Ward Type: All, Age: All, Sex: Male
Acute Inpatients
Community Inpatients 0.3
0.25
0.25
0.2
0.2 0.15 0.15 0.1
0.1
0.05
0.05 0
0 All Acute ASPH Inpatients
BSUH
D&G
EKHT
ESHT
FP
M&TW Medway Q.Vic
RSC
SASH
All Community Inpatients
WSHT
Eastern & Coastal Kent Community Hospitals
Community Services
Medway Community Hospitals
South Downs Health NHS Trust
Surrey Community Hospitals
West Kent Community Health
Mental Health 0.12
0.35 0.3
0.1
0.25
0.08
0.2 0.06
0.15
0.04
0.1 0.05
0.02
0 All Community Services (Non-IP)
East Sussex Community Services
Eastern & Coastal Kent Community Services
Medway Community Services
Surrey Community Services
0
West Sussex Community Services
All Mental Health Trusts
Kent & Medway Partnership NHS Trust
Surrey & Borders Partnership NHS Foundation Trust
Sussex Partnership NHS Foundation Trust
There is also another dashboard which shows the data from a more operational focus, which looks at basic raw numbers and includes a measure of the proportion of patients who have none of the four harms covered. This second dashboard is still under development but will include an organisational view by county and a view by specialty, based on the type of ward. South Downs Health NHS Trust
Safety Thermometer census: key results for South Downs Health NHS Trust Number of pressure ulcers by category (2 and up) and age
Number of falls by severity
7 6
4 3 2 1
70%
0
30 25 20 15 10
New
Category 2
Old
New
Category 3
Old
New
No Harm Low Harm Moderate harm
Severe harm
Death
Severity
Surgical site infections Number of procedures reported: 0
18% 16% 14%
50% 40% 30% 20%
0% No Falls
Category 4
20%
60%
10%
0 Old
Percentage of patients
35
5
Percentage of patients with VTE risk assessment and prophylaxis
If you would like to know how to access these dashboards please email us at the usual address!
80%
45 Percentage of patients
Number of patients
5
46
Percentage of patients with catheters and UTIs
50
40
Number of PUs
It is hoped that the exercise will be repeated in December, and then again in March 2011, within the intention of it becoming a regular exercise. The data will be used as a test that progress is being made on these key areas of patient safety.
Number of patients surveyed at this
Number of SSIs reported:
0
SSI rate:
0.00%
% of all pts with a % of all pts with a % of patients with a catheter catheter AND a UTI catheter who have a UTI
100% NO HARM
Percentage of patients with no harms 100 % 90% 80% 70%
12% 10%
60%
8%
Please note that data regards SSIs does not come from the 'Safety Thermometer' census data. SSI data is published by the HPA and is a mandated data collection for orthopaedic procedures only. As such, the figures presented here are only indicative of the overall SSI rate in an organisation. Data for community providers is not recorded.
6% 4% 2% 0%
50% 40% 30% 20% 10%
% of all pts with a VTE risk assessment
% of all patients on VTE prophylaxis
0%
Unify2: reminder on requesting accounts and password resets If you need a Unify2 account the easiest way to do this is to go to the Unify2 homepage: http://nww.unify2.dh.nhs.uk/ Unify/interface/homepage.aspx, click on the ‘Request a Unify account’ link and complete the on-screen request form. The request will then be picked up by Charlene, Nia or Rebecca and you will be emailed with log-in details once your account has been set up. If you have an account but have forgotten your password you can also request a password reset from the Unify2 log-in page—again the request will be picked up by one of us and you’ll be emailed with details once it has been reset. If you have an urgent account or password request please feel free to contact one of us direct— although only one of us at a time please as it gets confusing when 2 people are resetting a password at the same time! The Quality Observatory only have account management access for the Knowledge & Intelligence domain (performance data). For PbR and programme budgeting accounts please speak to one of our finance colleagues—details via the ‘contact us’ link on Unify. Contact Rebecca.matthews@southeastcoast.nhs.uk if you have any queries on Unify2.
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Introduction to SINAP By James Campbell, SINAP Manager, Royal College of Physicians SINAP (Stroke Improvement National Audit Programme) is a new national audit, run by the Royal College of Physicians (RCP), which focuses on the first three days of stroke care in acute hospitals. The aim for SINAP is that data will be collected, and more importantly utilised, for all stroke patients in all acute hospitals. This is an ambitious undertaking, particularly for the hospitals submitting this data. However, the reward for the hard work that stroke and audit teams put into collecting and submitting this information is the ability to act on the findings of SINAP to improve stroke services for patients â&#x20AC;&#x201C; and quickly. Since SINAP is a prospective audit, it allows for timely analysis, both at local level and centrally from the RCP. The reports from the RCP provide participating hospitals with their individual results and benchmarking against national averages, but hospitals are also encouraged to use their own data to look at certain aspects of their stroke service. In this way, the impact of strategic changes and new initiatives can be monitored and conclusions made based on the results â&#x20AC;&#x2DC;before and afterâ&#x20AC;&#x2122;. SINAP went live in May 2010, but is still open for any hospitals which want to participate, so long as they admit stroke patients during the first 72 hours of care. Records are entered onto a secure web tool, with in-built validation, meaning the data quality and completeness is very high. Screen Shots of the SINAP web tool
In mid October, the number of records entered was over 8,700. There is particularly strong participation in the North West and North East and an encouraging number of hospitals in the West Midlands, South East Coast and London SHAs. Participating hospitals which had entered enough records have now had their first preliminary report. This includes national averages, based on the hospitals included in the report. Even though the results do not represent all hospitals, there are striking similarities with published data on stroke, suggesting that the national data in SINAP is useful in giving a benchmark. The first report looks at the first three months worth of records entered into the audit (2,856 records overall). SINAP takes a detailed look at some of the timings in the early part of the stroke pathway. It is clear that there are major discrepancies in the speed of delivering the service, between different patients but also across hospitals, where averages differ vastly. When best practice involves immediate delivery of a standard (e.g. direct admission to a stroke unit bed or immediate access to scanning), it is striking that there are such big differences. For instance, the inter-quartile range for the delay from arrival at hospital to arrival on a stroke bed is from 2 hours 20 minutes to 17 hours 20 minutes (the median is 4.5 hours). The graph on the next page shows the median delay for each hospital (one unit in height per hospital), and whilst many hospitals have an average within 4 hours, only 2 hospitals (less than 5%) have an average time of less than 2 hours. Clearly there is work to do in making sure that as many patients as possible are going directly to a stroke bed.
Page 9 At the other end of the scale, nearly a quarter of the hospitals in this report had an average time of more than 14 hours. These hospitals should be using their individual SINAP reports to look at possible reasons for such long delays. Often, the longer delays are for patients who arrive ‘out of hours’. In the report, some timings and standards are looked at in relation to when the patient arrived in hospital. For example, when patients arrived in ‘normal hours’ (between 8am and 6pm weekdays), the median delay from arrival at hospital to the first contact with the stroke team was 2.5 hours. However, when patients arrived ‘out of hours’ (before 8am, after 6pm, or at the weekend) the median delay was 9.5 hours. This is highlighting a two-tier service in most parts of the country, where patients who arrive out of hours are not only being assessed and treated more slowly, but are also less likely to receive thrombolysis – 50% of patients eligible for thrombolysis received it when they arrived in normal hours, compared with only 32% of patients who arrived out of hours. The ‘out of hours’ problem is not an inevitability though – some hospitals actually had similar or even shorter delays for patients who arrived out of hours – and the hope is that participation in SINAP will highlight that action needs to be taken. A great deal has already been achieved, both within the health community and with wider public awareness, in making sure that stroke is treated as an emergency. However, the early results from SINAP are showing that there is a considerable way to go to make this universal – across all hospitals and regardless of when the patient presents at hospital. For more information about SINAP, or to register to take part, please email sinap@rcplondon.ac.uk
The activity trend explorer tool In the current QIPP climate the focus on demand management has never been greater. To help with some aspects of this, the QO has developed an explorer tool that allows users to view their inpatient activity data, by provider, over a period of almost three years with a forecast to the end of this financial year. Its designed to be intuitive and easy to use and is updated monthly with SUS and MAR data and includes some high level financial information. As ever its available on the website; have a play and let us know what you think……..
Page 10
Payment by Results By Lynn Wilson, Health Performance Lead for South East Coast, Audit Commission Payment by Results (or PbR to those in the know) is the coding system which underpins NHS payments for patient treatments. However, it’s not only about money. The coding provides vital information for planning and monitoring, commissioning, control of epidemics, research, clinical audit and consultant job planning. In other words, the accuracy of this information not only affects the finances of the NHS, but also how and where care is delivered. It’s also used by the Department of Health to inform national health planning, monitor healthcare provision, and inform strategy development. So it’s really important that it’s right. Over the last three years, and for the foreseeable future, the Department of Health has required the Audit Commission to carry out a programme of work to give assurance on the accuracy and completeness of PbR data. Each year we have carried out independent audits of admitted patient care (also known as inpatient) data at all acute and specialist NHS and foundation trusts in England. For this work, we re-code a limited number of patient notes across specific activity areas and compare these with the coding that has been done by the trust. We also look at arrangements to support accurate coding. We publish a report on each audit for the trust and the main PCTs commissioning from that trust, and agree an action plan to help them improve data quality and reduce the number of coding errors. We do something similar for outpatient data, again coding against patient notes and comparing our conclusions with those of the trust to identify errors and gaps. So far, we have done this once at each trust nationally and have produced a report and action plan each time for the trust and its commissioning PCT. We pull all the findings from our work into a national report which compares these year on year. This is available free from our website at http://www.audit-commission.gov.uk/nationalstudies/health/pbr/pbr2010/Pages/default.aspx Our PbR portal at http://extranetportal.audit-commission.gov.uk/(S(xsr33if2q5c02355p315x145))/Homepage.aspx? sys=pbr contains individual trust reports and benchmarking information. We have also produced a summary level report for the whole SHA area, and this is available from the Quality Observatory. So, what do we know about coding in trusts in South East Coast? Payment coding Healthcare Resource Groups (HRGs) are groups of codes which determine payments. Error rates in HRG coding in SEC have reduced overall, but we tend to find slightly more errors than the national average for both inpatients and outpatients coding. Financially, the costs roughly balance out, with over-payments being compensated by under-payments. However, error rates in South East Coast aren’t reducing as quickly as in some other parts of the country. For inpatients for example, we found that trusts had roughly the same numbers of HRG errors this year as last year (between 2 and 22 per cent). We also found that the accuracy of HRG inpatient coding in five trusts had actually got worse over the three years we have been doing the inpatient audit. And seven trusts had less accurate financial coding this year than last year. This is a worrying trend, and the SHA will need to work closely with the health economy and Monitor to achieve consistent improvement, and to ensure good quality legacy data for the emerging GP commissioning consortia. Procedure and Diagnosis Coding
Annual Progress
Procedure and Diagnosis Coding is the best indicator of coding accuracy. In South East Coast trusts, the number of procedures recorded inaccurately for inpatients has reduced from 18.2 per cent in 2007/08 to 11.4 per cent in 2009/10. This is encouraging, even though this year’s figure is up slightly on last year. It is, however, worse than the national average of 9.8 per cent. Diagnosis errors reduced from 16.9 per cent to 13.9 per cent over the same period, which is broadly in line with national trends. Unsafe to audit We found that trusts in South East Coast have high levels of patient records which are unsafe to audit (UTA) – in other words, there is no information in the case notes about the episode being audited. We found records that were illegible, not in chronological order, missing information, papers that were loose or upside down - and some that were really difficult to handle because they were so thick or fell apart when they were picked up! Case notes which lack vital information may present clinical and patient safety risks as practitioners providing treatment may not necessarily have the most upto-date information on the patient or their care.
Page 11 Unsafe to audit Ten out of 12 trusts in our inpatient audit had at least one record classed as UTA (83 per cent). In fact, only one trust in South East Coast had no outpatient records which were UTA. This compares with the 47 trusts (28 per cent) nationally which had no UTAs at all in the inpatient records we reviewed. The quality of patient records is a serious problem and a large number of trusts each year have had recommendations to improve the quality of their patient notes. We do recognise, however, that it takes time and money to make this scale of change effective. Sadly we found that the common themes emerging from the South East Coast trust inpatient reports to reduce coding errors were the same as last year. These are to: • improve the quality of, and access to, case notes, discharge notes and other documentation about the treatment a patient has received; • provide more training to coders to improve the quality of coding and enable coders to gain accredited qualifications; • carry out more frequent internal clinical audit to help identify and resolve problems sooner; and • improve liaison between coders, clinicians and managers so that the information in case notes and discharge summaries is clearer. We have only reviewed outpatients’ data once at each trust. The key improvements needed to reduce coding errors in South East Coast include: • applying arrangements, guidelines and definitions consistently across all trust outpatient sites and departments; • having a named executive clearly responsible for data quality; • finalising and implementing data quality strategies, policies and guidance; and • improving the quality of patient notes and outpatient records. What happens now? In South East Coast, we have eight trusts in the bottom 20 per cent nationally when account is taken of a lack of improvement in numbers of coding errors, and lack of progress in implementing our action plans. These eight are being reaudited in 2010/11 to help them improve. All trusts and PCTs have their own action plans to help them improve the quality of coding data. The SHA is working with the health economy to ensure these plans are implemented. Resolving the causes of errors will help trusts and commissioners better understand the reasons for patients attending hospital. It will lead to better patient care and management of demand. More accurate data will also mean that users, including the public, get better value from the new government’s plan for greater transparency in NHS performance information. How else can we help? The Audit Commission also produces and maintains the award- winning PbR National Benchmarker tool. This, along with the reports mentioned above, is available free of charge at http:// extranetportal.audit-commission.gov.uk/(S(xsr33if2q5c02355p315x145))/Homepage.aspx?sys=pbr . We have just updated the tool with HRG4 data for 2010/11 quarter 1. It includes inpatient, outpatient and accident & emergency indicators. It can break down inpatient data by elective and non-elective activity types, and it introduces independent sector provider data for the first time. It also has a very short, user-friendly training session that shows how to use the tool and how to draw judgements from the analysis. PCTs and trusts can use the Benchmarker to look at how they perform against national forecasts and trends. It allows them to consider whether their performance is intended (for example, as a result of commissioning plans) or unexpected. If it’s the latter, trusts and PCTs can investigate the reasons they are not performing as expected and can take action to change things if this is appropriate. We also do national research and provide briefings and reports on issues emerging from the audit programme and benchmarking analysis. For example Figures You Can Trust published in April 2009 and our reviews of the quality and uses of reference cost data by NHS bodies, published in February 2010. If you would like any information on our work on the PbR Data Assurance Framework – or help with using the National Benchmarker – please contact me at l-wilson@audit-commission.gov.uk or via the PbR Assurance team at pbrassurance@audit-commission.gov.uk
Page 12
Forecasting– first steps By Katherine Cheema, Specialist Information Analyst So, you have all your historical data all lined up neatly in a spreadsheet. Then someone asks the question- ‘so where is this heading?’ or ‘where will we be at the end of the year?’. Without a crystal ball or a time machine it’s pretty difficult to answer that with complete confidence but we can make a good estimate using one of variety of forecasting techniques. Which technique to use depends on what your data looks like and the definition of the ‘problem’ you are setting out to solve. Here are a few things to consider before you even think abut the data side of things:
•
What do you want to see at the end of the exercise– this may be really obvious, for example, the number of monthly admissions via A&E per month. However, without a clear definition and agreement with the person asking the question, the results may not meet their needs.
•
What time period will you use and how far will you need to forecast– long term (3+ years), short term (up to 12 months)?
•
What assumptions will be built in– for example, if you were forecasting expenditure would you assume that 80% of it would be under PbR?
•
What level of accuracy is acceptable/unacceptable?
•
Will you simplify the forecast, for example by ignoring seasonality?
Most of these kinds of questions can be answered by just discussing things with the person who has requested the work, but they remain a crucial aspect of creating a good forecast. The next stage is to gather your data and look at it, really look at it. The best way to do this is to plot-the-dots so you can identify:
•
Data quality issues such as missing data
•
Key patterns that may influence the forecasting model you use (stationary or non-stationary patterns, seasonal trends etc.)
•
Outliers that you may wish to remove
A few examples of these kinds of patterns are shown below, see if you can identify the issue/pattern with each one and match it to the description in the box on the page opposite (answers at the back!).
C
A 160
100 90
140
80
120
70
100
60
80
50
60
40 30
40
20
20
10
0
0
B
D
35
100 90
30
80
25
70 60
20 15
50 40 30
10 5 0
20 10 0
Page 13 1.
Seasonal data– peaks appear to occur at certain times of the year
2.
Outliers– there are some extreme values that we might want to remove
3.
Discontinuous data– there’s been a shock to the system! (think air traffic pre and post 9/11)
4.
Cyclical data– there’s a cycle that appears over the course of every 6 months
Understanding these patterns in the context of the system or problem you are looking at is as important as being able to draw the graphs themselves; it can’t be said too often that in order to produce a good forecast you need to involve the person asking the question and make sure you have a good understanding of what you are forecasting! Once the groundwork has been done you can start to think about what forecasting model you actually need to use. In broad terms there are two types of forecasting that would be useful to someone looking to forecast the majority of healthcare data and have some historical data to use: 1.Time series forecasts 2.Cause-and-effect forecasts
The first of these projects the data forward using an appropriate method (which include, moving averages, weighted moving averages, exponential smoothing and decomposition– more on these in the next issue!). All these methods work on the same basic premise– that historical patterns will continue into the future. The usefulness of the time series approach is clear when you have nice, smooth or at least consistently variable data, such as a regular seasonal pattern, for which you can adjust. However, you may want to forecast forward taking into account a planned specific change, for example a significant change in service provision such as a hospital closure. In this case you couldn't use a time series approach because the change is a one-off and not a consistent aspect of the data that you can adjust for. In this case, you use the second method, looking at cause and effect where you make the assumption that the ‘driver’ (e.g. hospital closure) will have a direct and measureable relationship on whatever outcome you are looking to forecast (e.g. emergency activity) and look forward on this basis. It should be clear now why it’s so important that you have a good handle on the data before you start! Both types require historical data to create and are not without their flaws– however, very little is and, as mentioned at the start, without a time machine we’re unlikely to get anything absolutely perfect! If you would like any advice on forecasting before the next issue please do get in contact! quality.observatory@southeastcoast.nhs.uk
New QIPP Dashboards developed…... A number of additional QIPP dashboards have been developed since the August edition of Knowledge Matters. The new dashboards cover the following work streams: NHS SOUTH EAST COAST
Planned care
200
300
0.4
10
150
200
0.3
100
0.1 0 0
10
0
0.2
0 -1
0
-1 0 O ct10 D ec -1 0 Fe b-1 1
0
Ap r-
50
100
Ju n
5
10
Au 0 g-1 0 O ct1 D 0 ec -1 Fe 0 b-1 1
0 r-1
n-1
Ap
Ju
7
9 08 /0
6
5
8 20
20
07 /0
06 /0
04 /0
05 /0
20
20
20
1
-1 0
Fe b-1
0
10
-1 0
-1
O ct-
Au g
0.6 0.5
15
20,000
10,000
1,000
0
0
£200,000 £0
£-
50
£15,500
40 30
-1 0 O ct10 D ec -1 0 Fe b-1 1
n-1 0
Ap r-1 0
Ju
Au g
O ct10 De c-1 0 Fe b-1 1
-1 0
n-1 0
Ap r-1 0 Ju n-1 0 Au g-1 0 O ct10 D ec -1 0 Fe b-1 1 £16,000
FINANCE
60
Ap r-1 0
c-1 0 Fe b-1 1
De
10
O ct-
0 -1
0
10
-1
Ju n
Au g
Ap rJul-10
WORKFORCE
£600,000 £400,000
£0.10
Ju
FINANCE
Jun-10
£800,000
£0.20
£16,500
Low Intensity
£15,000 £14,500 £14,000
20 £13,500 £13,000 £12,500
20 04 /0 5 20 05 /0 6 20 06 /0 7 20 07 /0 8 20 08 /0 9
09/10 Q4
09/10 Q3
0 09/10 Q2
0.5
£1,000,000
In development
£17,000
High Intensity
09/10 Q1
0.00%
70
08/09 Q4
0.7
9
0
80
£1,200,000
£0.30
Programme Budget £0Spend per population
10
200
4,000 30,000
t-1 0 ec -1 Fe 0 b-1 May-10 1
0.8
0.20%
10/11 10/11 10/11 10/11 0.6 Q1 Q2 Q3 Q4
10%
D
Au 0 g-1
400
5,000
20%
TBA
0.40%
PbR Value of VTEs (SUS) £1,400,000
£0.70
£20,000
Trained Staff IAPT
£0
0
0.60%
£1.00
10/11 Q1 10/11 Q2 10/11 Q3 10/11 Q4£0.60 £0.50
£40,000
£500,000
1.20% 1.00%
PbR Value of Falls (SUS)
£0.40
0.80%
0.4
3,000
0.3 2,000 0.2 0.1 0.0 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
1011 Q1
0910 Q4
0910 Q3
0910 Q1
0910 Q2
0809 Q4
0809 Q3
0809 Q2
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
0809 Q1
0%
0
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
High Risk TIA %24 Hr
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
Stroke 90% on Unit
50
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
0.7
400
250
£0.80
£80,000 0 £60,000
£1,000,000
1.0 0.9
Employment
£1,500,000
1000
Occupied 32 30
£2,000,000 Settled Accommdation
% on MH Register
0 Apr-10 Oc
0
Beds Open
600
30%
100 2
0
0.8 500
£0.90
2009/10
1 0.9
600
In
PbR Valuedevelopment of CAUTIs (SUS)
0.4 £120,000
2000
36
150
4
300
20
2000
£100,000 0.2
2008/09
08/09 Q3
40,000
0
3000
08 /0
50,000
WTE inAvailable Post
May-10
800
1000 6,000 0
5
Apr-10
1000
3000
1000
6 200
5000 4000 8,000 7,000 2000
38
7
Jul-10
Apr-09
40%
250
6000
1200
2000 60,000 10
0 Jul-09
0
Value £000's
7000
0 £2,500,000
150
1600WTE Plan 1400
6000
8
50%
300
8
1800
7000
07 /0
100
LoS - SUS No. - SSNM No. - SUS
700
0.6
10 £3,000,000
42 5000 10/11 Q1 10/11 Q2 10/11 Q3 10/11 Q4 40 4000
200
Number of50Beds 34
48,600
30
44
06 /0
200
1
4000
0 Prescriptions Cost
0.8
40
20
300
350
30
25 PbR 4000 70,000 20 3000 15
400
60%
10
35
5000
Vital Signs Stroke / TIA
70%
350
6000
0 1.2
PbR Value of Pressure 20 Ulcers (SUS)
8000
20
500
6000
40
Number Deaths
46
100
48,500 Admissions 8000 48,400
LoS
Jun-10
SECAMB Rolling 52 Week Urg Trans '000s
400
Apr-10
450
600
Oct-09
Emergency LoS 2+ Days
700
0%
2%
Admissions 70000%
Dec-09 Feb-10 Apr-10
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
0.245
LoS
Type 1 A&E Admissions
Aug-09 Oct-09
0
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
0
1% Type 1 A&E Atts
0.25
Jan-10
% Dir Amb Care 0 LoS
Admisssions & Beddays - MH
4%
Apr-09 Jun-09
Emergency Adm
Admissions & Beddays - Acute
250
48,700
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
200
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10
0.255
D ec
10
6%
ACTIVITY
Dir Amb Care Adm
12
48,800
0.26
Ju n
Ap r-
48,900 8%
0.265
10,000
5,000
49,000
10/11 Q1
10%
0.27 15,000
350 0 300
10
12%
49,100
48
450 0.2 400
49,200
0
Ap r-
2%
0.4 500
08/09 Q3
3%
400
VTE
49,300
10/11 Q1
600
09/10 Q4
0.275 20,000
49,400
40 20
14%
0% 08/09 Q3
0.28
In 50 development LoS
0.6
60
20
5%
0.285
25,000
Staff in Post 49,500
80
16%
09/10 Q4
4%
18%
10%
Jun-10
800
20%
15%
09/10 Q3
30,000
28 Day Readmission 100
20%
09/10 Q3
5%
SECAMB Paramedic Practitioners
0.8
ACTIVITY
6%
1,000
09/10 Q2
0.29
09/10 Q2
1,200
0.295
1
60
400
8000
Reduction in Anit50 Psychotic Medication
Falls 500
50
120
Crude In-Hosptial 25% Emergency Admission
09/10 Q1
0.3
35,000
30%
08/09 Q4
40,000
Type 1 A&E Rolling 52 Week Totals '000s
140
250 200 100
People in Settled Accommodation & Employment
0.0% 70
0 1.2
-1
35%
Emergency Admission Activity
of Untreated Psychosis
Finance 160
09/10 Q1
SEC
180
08/09 Q4
SEC QIPP Acute Dashboard
0.5%
10Duration
The number of people moving off sick pay and benefits (IAPT)
300
150
J Jul-10 un
% of people accessing psychological therapies 45% who move to clinical 40% recovery Quality Activity Workforce
25
10000
Number
450
-1
20
12000
LoS
-1 0 O ct10 D ec -1 0 Fe b-1 1
1.0%
30
Ap r-
30
350
35
14000
Ju n
1.5%
16000
Au g
400
ACTIVITY
NHS SOUTH EAST COAST 40 QUALITY
2.0%
Actual (cumulative) MRSA Objective
50
450
10/11 Q1
QIPP Dashboard: Mental Health
Safe care Mental health
LoS - SUS No. - SSNM No. - SUS
500 60
Catheter Associated UTIs
Pressure Ulcers
Inpatients IP & Readmissions
2.5%
70
Au g
Urgent care
Au g
Surgical Site Infections
MRSA Cumulative actual
QUALITY
• • • •
QIPP Dashboard: Safe Care
All QIPP dashboards are updated on a monthly basis and as always, the dashboards are available to download from the Quality Observatory website .
Page 14
Validation Lists — Part 2 Application: Microsoft Excel 2003 Dear Quality Observatory I have a spreadsheet a that contains validation rules. I have activated List validation in some cells. Unfortunately it is a rather large spreadsheet and the text in the validation list comes out very small (see example) Is there any way I can get excel to display larger text in the validation in list without fiddling with the zoom settings? I’m using Excel 2003 -Vince O’Mahoney Information Analyst, Surrey PCT
Solution: Complexity 4/5 — Uses Macros and Forms Last Issue we showed you how to create a popup form validation box that allows you to control the input into a single cell. This Time Here is an example using VBA to trigger an event that will allow you to apply the validation list to more than one cell: As with the previous example you will need to create a form in VBA editor in this Example I have Created a form with a list box in it.
Once You have Created Your List box Open the property Explorer (F4) In the property Explorer you will be able to set the following values : Bound column: if you are displaying more than one column in the list box you will need to use this to select which column contains the data you want to use
Control Source: This sets the cell that you want to control. This time we want to control more than one cell. It is best to leave this blank
RowSource: This sets the Cells that contain the listbox values e.g.” ’sheet name’!a2:b2’ ” The row source does not have to be on the same sheet as the control source it can link to any sheet in the workbook
Page 15
The next Step is to create a script that will show the form when the cell(s) are clicked. In the worksheet that contains the cell (e.g. Sheet1) create the following macro: Private Sub Worksheet_SelectionChange(ByVal Target As Range) ‘the first thing to do is to prevent the code launching when more than one cell is clicked If Target.Cells.Count > 1 Then Exit Sub ‘Then create a trigger for our cells, you can list individual cells(A2,B5) or a range (B2:B9) If Intersect(Target, Range("B1:B3,D9")) Is Nothing Then Else ’manually set the Control source of the list box in Userform1 to equal the cell that has been clicked Target_cell = Target.Address UserForm1.ListBox1.ControlSource = Target_cell ‘show the form UserForm1.Show End If End Sub This will activate the userform when cells in our specified range are activated on the worksheet and will dynamically set the ControlSource of Listbox1 Finish off the userform with two command buttons : One to hide the userform after a selection has been made: Private Sub CommandButton1_Click() UserForm1.Hide Unload UserForm1 End Sub one to cancel the selection and clear the values in the cell Private Sub CommandButton2_Click() UserForm1.Hide Unload UserForm1 ‘clear the clicked cell value as we have pressed the “cancel” button Range(ListBox1.ControlSource).Value = "" End Sub
Page 16
A comprehensive stroke service for East Kent By Dr David Hargroves, Consultant Physician and Clinical Lead for Stroke Medicine Many months ago, a project was set up to transform the patient pathway and to rescue stroke and TIA (Transient Ischaemic Attack) sufferers in East Kent, from a life time of paralysis, slurred or non existence speech and difficulty in walking. Until recently it was a general acceptance that nothing much could be done for stroke patients until the episode had run its course, and then the focus was on rehabilitation. For this reason there was no sense of urgency in getting the patient to a place of treatment. It is now recognised that early intervention and treatment prevents the stroke from developing or extending and thus the patients recovery is quicker and more complete. There is an evolving change in culture where stroke should be seen as a ‘brain attack’ (much in the same way as ‘heart attack’) and therefore the need to treat is urgent. Preventing the stroke from worsening means the patient stays in an acute bed for a lot less time and the care required in primary care is also considerably less - thus not only providing for better patient outcomes but also having a benefit to the whole health economy.
The initial imperative to redesign Stroke services came from a Multi disciplinary team under the auspices of the East Kent Stroke Forum. This forward thinking group looked at new developments world wide in order to design a pro-active service. They were also aware that a National Stroke Strategy was under development and wanted to be in a position to implement the recommendations as early as possible. The aims for the programme were as follows: -
• To expedite the assessment, investigation and intervention where appropriate of TIA. • To provide hyper acute stroke care (including Thrombolysis) to the population served by East Kent Hospital Univer• • • • • • •
sity NHS Foundation Trust by using a model with all three acute sites and use of telemedicine (a remote system that be accessd 24/7 even when the Consultant is at home). To promote early rehabilitation and supportive discharge. In order to redesign the service a working party was convened and six work streams established. To provide Thrombolysis on all 3 acute sites 24/7 by use of telemedicine To establish TIA clinics 7 days a week To ensure an MRI/MRA scan was undertaken within 24 hours for TIA To provide carotid surgery within 48 hours of diagnosis To provide 7 day working for therapy staff To ensure early rehabilitation and appropriate discharge
One of the challenges facing East Kent was the sheer size geographically of the population served and the fact that there were three acute sites. Providing 24/7 services on all three sites seemed impossible with the available specialist staff unless services were concentrated on one site. This in itself would give rise to the problem of equal access to all East Kent residents if they did not live near the site that had the centralised service. In addition it was impossible to provide On call cover to all three hospitals. By the innovative use of horizontal telemedicine an equal service can be provided on all three sites, with the Consultants having access via broadband that provides a two way response to any one of the three acute sites.
Page 17
Through a combination of training staff in the new pathway including new techniques and use of new technology and the adaptation of staff rotas, it has been possible for us to develop a 24/7 Thrombolysis service and 7 day a week TIA clinics. Specialised equipment including telemedicine and IT has been purchased. Joint planning for patients is now established with input from staff in the acute sector, primary care and social services. The new pathway has been commissioned by the PCT and is fully self funding under PBR.
The successful implementation of this programme has meant that now patients who are having symptoms of stroke (which can include paralysis, blurring or lack of speech, unconsciousness) which in some cases leads to death, can be seen immediately in an A&E, diagnosed and thrombolysis given. Literally patients can be seen to get better before your eyes, speech returns paralysis reverses. The patient may be discharged home within 24 to 48 hours and return to normal life.
Previously patients who had a stroke could spend weeks in an acute hospital then months or years of rehabilitation in the community. Now, patients displaying symptoms of TIA, which may mean they will go on to have a stroke, can be referred either by their GP or via A&E to the next TIA clinic, which will ideally be within the next 24 hours. Within the one visit they will be examined by a Specialist Consultant, have diagnostic tests completed and will be given a diagnosis and treatment commenced. Previously patients could wait up to 8 weeks for a clinic appointment in which time they may go on to have a Stroke. The benefits to patients are enormous. Paralysis, loss of speech, months of rehabilitation, loss of job and loss of income are all prevented. Other benefits include reduction in the length of stay in the acute sector and the need for rehabilitation in primary care which in turn frees up funding that can be invested elsewhere. The benefit to staff is in the use of new innovative technology as well as the obvious one of satisfaction in seeing patients get better, quicker.
Improved results as evidenced on the stroke dashboard populated by the Quality Observatory % Stroke P atients Admitted from UP R & Discharged to UP R
Length of Stay (Days)
M ortality
A l l LoS
30
35%
UP R LoS Nat A l l LoS
70%
Nat A l l LoS UP R
25
20
30%
60% 25%
50%
20%
40%
15 30%
15%
20%
10%
10
5
10%
Site 5%
National 0
0%
0%
7 Day
30 Day
Nat 06/ 07 7 D
Nat 06/ 07 30 D
Page 18
Analysis, Ancient and Modern Following up on Adam’s impassioned prose to Florence Nightingale in the August edition of Knowledge Matters was always going to be tough and whilst I can’t pretend to have the same affection for it’s author, I must admit to a certain partiality towards Minard’s chart of Napoleon’s Russian campaign of 1812. The chart is also a map and shows the advance into (in gold) and the retreat out of (in black) Russia by the Grande Armee. It brings together several different sets of data:
•
The geography of the campaign including river names and key cities and towns
•
The course and direction of the army indicated by the gold and black colours and the direction of the lines
•
The number of soldiers remaining in the army, shown by the width of the lines; each millimetre is equal to 10,000 men
•
The time and temperature, shown on the bottom line chart (the temperature is in the Imperial measure of the time, Reamur– multiply the Reamur by 1.25 to get degrees Centigrade)
The human cost of the campaign is painfully evident; according to the width of the bands, Napoleon entered Russia with around 442,000 men, only had 100,000 left when he reached Moscow and returned Westwards to cross the Niemen River with only 10,000 remaining, 6,000 of which had rejoined the main army from the North. Whilst tragic (although the English may not have won Waterloo if not for the losses incurred in this campaign) the disastrous nature of the effort to conquer Russia is beautifully and concisely represented here.
Charles Joseph Minard was a French civil engineer whose most remembered legacy is in the field of statistical graphics. This is a translation of the legend at the top of the map: Figurative chart of the successive losses in men by the French army in the Russian campaign 1812-1813. Drawn up by Mr Minard, inspector-general of bridges and roads (retired). Paris, 20 November 1869. The number of men present is symbolised by the broadness of the coloured zones at a rate of one millimetre for ten thousand men; furthermore, those numbers are written across the zones. The red signifies the men who entered Russia, the black those who got out of it. The data used to draw up this chart were found in the works of Messrs. Thiers, de Ségur, de Fezensac, de Chambray and the unpublished journal of Jacob, pharmacist of the French army since 28 October. To better represent the diminution of the army, I’ve pretended that the army corps of Prince Jerôme and of Marshall Davousz which were detached at Minsk and Mobilow and rejoined the main force at Orscha and Witebsk, had always marched together with the army.
Page 19
NEWS Daily Sitreps
ROCR Fundamental Review of Data Returns
This year’s Daily Sitreps are due to start next week—first data return is due on 2nd November. The return has changed slightly from last year so you will need to download a new template from Unify. As the return includes some additional information, trusts now have until 11am to upload data.
Data from the CQC 2009/10 periodic review Although the CQC will not be publishing an overall assessment of organisations’ performance for 2009/10, all the raw data has been made available on their website. Benchmarking tools have also been published for acute, ambulance and mental health trusts—all available via the CQC website.
Understanding the Health needs of migrants in the South East region A report by the South East Migrant Health Study Group which included SEPHO commissioned by the Department of Health. The report focuses on groups of migrants, including economic migrants, international students, irregular migrants and the health needs of asylum seekers, failed asylum seekers and refugees in the South East. The recommendations are practical for health and social care colleagues.
NICE Quality Standards—COPD & Chronic Kidney Disease The consultation on the draft quality standards closes on 10th November at 5pm. NICE are keen to receive feedback from as many people and organisations as possible so we would like to encourage those of you who have not yet responded to do so. Further information on NICE Quality Standards can be found on the NICE website http://www.nice.org.uk/ aboutnice/qualitystandards/qualitystandards.jsp and the first draft of the NICE quality standard for COPD and CKD can be found at http://www.nice.org.uk/aboutnice/ qualitystandards/indevelopment/ qualitystandardsindevelopment.jsp.
The recent White Paper ‘Equity and Excellence: Liberating the NHS’ gave a commitment that; “…the Department will initiate a fundamental review of data returns, with the aim of culling returns of limited value. This will ensure that the NHS information revolution…is fuelled by data that are meaningful to patients and clinicians when making decisions about care, rather than by what has been collected historically.” This review covers all collections of data made by the Department of Health (DH) and its Arms Length Bodies (ALB) to reduce the burden of data collection on the NHS. A project team drawn from the NHS Information Centre for Health and Social Care (IC) and DH are working with the National Quality Board Information Committee (NQBIC) to carry out this fundamental review. The dates for the workshops are listed below – if our NHS colleagues are interested in finding out more or attending a workshop, please contact the data review mailbox - fundamentaldatareview@ic.nhs.uk Proposed dates for the workshops are as follows: -
Good bye to Faz It is with sadness that the team bid farewell to Faz Dar who left the Quality Observatory in October. Faz has taken up a new role with the Rail Regulator. As parting gifts Faz was awarded with a train money box, Railway Children with glowing lanyard and of course a personalised Quality Observatory mug!
Safety thermometer On the 15th September this year, The Safety thermometer did premiere. As an assessment of safety it's fair To do an audit of patients in care. Pressure ulcers - numbers and grade, Falls that are in need of first aid. UTIs assciated with catheters
Another Quality Observatory outing On 1st October, two halves of the Quality Observatory went head to head in a team building exercise—a treasure hunt around the historic city of London. The ‘Quality Quacks’ were gallantly lead by Charlene, however unfortunately they narrowly lost out to the ‘Observatory Outlaws’ (led by Kiran). In honour of Faz leaving the Observatory, Charlene arranged for the Quality Quacks to each have a Faz mask for the day which they wore with pride. It certainly made for a memorable end to Faz’s time with the team which was (in Faz’s words) ‘the best send off he’s ever had’.
VTEs - PE, DVT and all others. Data by age, sex and ward, counted compiled and stored. Gathered up together to see, A snapshot of patient safety. To be used as a good indication Of quality, outcomes, innovation. The first results are encouraging, and have been most interesting. To make it so much better - remember To do it again in December
Answer to skills builder Graph A = 3 Graph B = 4 Graph C= 2
Graph D= 1
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Knowledge matters is the newsletter of NHS South East Coast’s Quality Observatory, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone:
01293 778899
E-mail: Quality.Observatory@southeastcoast.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk