NHS QIS National Measurement of Audit Acute Coronary Syndrome

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1 NHS QIS National Measurement of Audit Acute Coronary Syndrome Things have changed based on the experience and feedback from the first cycle of measurement and, for the better we think! The Acute Coronary Syndrome (ACS) Audit Development Group has identified the data measures that will need to be collected to show evaluation against the NHS QIS CHD standards. The proforma focuses on the key elements of the management of acute coronary syndrome as set out in Standards 7, 8 and 9. NHS QIS will continue to use the definition of STEMI, NSTEMI and other forms of ACS as previously outlined in Appendix 1 of section 6 of the Resource Pack. The first round of data collection highlighted a number of issues regarding the dataset and the submission of data, especially the high level of missing data recorded. As part of the general review of the conduct of the audits a small group was formed to review and revise the ACS element of the programme. The resulting proforma allows for colleagues to record the details of the direct care they provide. It also incorporates explanatory notes alongside the data items to aid accuracy and completion. The data collected will provide evidence to support compliance against the standards and the wider Heart Disease Improvement Programme, which NHS Boards will be asked to submit to NHS QIS at the end of the year. In taking forward the second cycle of measurement NHS QIS has decided to focus on the process of care provided rather than the patient journey. Participating hospitals should, therefore, only complete the sections of the proforma for the care that they directly provide. Possible completion scenarios are outlined below Patient Treatment Proforma Instructions Patient 1 Patient admitted to hospital 1 and receives all their treatment at that location. Complete all sections of the STEMI or NSTEMI form as appropriate and return to NHS Patient 2 Patient admitted to hospital 1 - receives initial treatment but is subsequently transferred to hospital 2 - intervention centre from where they are discharged. Patient 3 Patient admitted to hospital 1 - receives initial treatment but is subsequently transferred to hospital 2 - intervention centre where they are reperfused and/or invasive strategy and are transferred back to hospital 1 for pre-discharge care, drugs and discharge planning. QIS Hospital 1 to complete relevant sections of STEMI or NSTEMI form and return to NHS QIS Hospital 2 to start new STEMI form and complete sections as appropriate before returning NHS QIS Hospital 1 to complete relevant sections of STEMI or NSTEMI form and return to NHS QIS Hospital 2 to start new STEMI or NSTEMI form. Complete as necessary and return to NHS QIS Hospital 1 to start new STEMI or NSTEMI form.

2 NHS QIS Acute Coronary Syndrome Data Measures MCNs will be asked to provide the following information about the proportions (%) within a sample of patients. Specific Scottish Patient Safety Programme measures that will be introduced later are identified by SPSP: With STEMI receiving reperfusion within 60 minutes (call to needle time) for thrombolysis and within120 minutes (call to balloon time) for primary angioplasty (SPSP) With suspected ACS having troponin assayed: on admission and, if negative 12 hours after onset of symptoms With confirmed ACS having a GRACE score calculated within 24 hours of admission With medium to high risk have coronary angiography within 72 hours of risk scoring With confirmed MI having an assessment of left ventricular function prior to discharge from hospital With confirmed ACS treated with heparin/low molecular weight heparin or fondaparinux At time of admission, administered with: (SPSP) Aspirin Clopidogrel or equivalent At time of discharge: (SPSP) Aspirin Clopidogrel or equivalent Beta blockade ACE inhibitor or angiotensin receptor /ARB Statin therapy With confirmed STEMI complicated by left ventricular dysfunction (ejection fraction <0.40), in the presence of either clinical signs of heart failure or diabetes commenced on long term aldosterone therapy Smoking cessation advice prior to discharge With confirmed ACS who had discharge planning that included: An immediate printed discharge letter Detailed instructions of what to do if their symptoms worsen Written information explaining and providing education about their condition, activity levels, diet, drugs and /or device therapy A date for a follow up appointment With confirmed ACS referred to their local cardiac rehabilitation team during their hospital admission Managed by a specialist cardiac team

3 How will Data about Acute Coronary Syndrome be Collected? Prior to the second cycle of data collection, MCNs will be provided with pre-printed paper proforma which should be used to collect the data. A copy, is attached, for information only. You are advised to take the first few weeks to trial the proforma ensuring that staff are familiar in its use How Many Patients will this involve? This will be different depending on whether your MCN /NHS board is an Intervention Centre or not. Locations should aim for a total number of submissions that represent at least 30% of the rate experienced for the same months in Data will be collected on: All STEMIs (during admission, intervention and preparation for discharge) A maximum of 100 patients with suspected ACS (troponin positive or dynamic ECG changes) over an 8 week period starting 14 April 2010 You are asked to start a proforma every time a patient is admitted or transferred to your hospital for care. Attach proforma to patient record - it should remain at the front of the record for the duration of the patients care and be completed only for those elements of care you provide. If a patient is discharged or transferred to another hospital then the proforma should be submitted directly to NHS QIS for processing. Q. When should data collection start? A. Start to complete the proforma once you are sure staff are confident in its use. Start your data collection no later than 14 April Q. How long should data be collected for? A. Collect data for eligible patients for 8 weeks. The last date for inclusion of 'new' patients is 13 June For those patients admitted towards the end of the period, continue to complete as many data items as possible. There are 6 weeks from the end of the measurement period to the Due Back date to allow you to finalise information. Q. Who should complete the proforma? A. Responsibility for ensuring the completeness of the proforma should be determined locally and made clear to all relevant staff. Q. What happens if the patient moves to a different hospital? A. The proforma is completed up to the point at which the patient is transferred. Forms should be returned to NHS QIS after that point. Each site is responsible for the collection of data relating ONLY to the care they provide. Q. What happens if the patient dies? A. Complete all information up to time of death and indicate on the proforma under discharged to that the patient died using the appropriate code before submitting the proforma. Proformas should be sent to NHS QIS for processing as soon as the relevant sections have been completed. Final Due Back date for data to be processed is: Friday 30 July 2010 Or Complete SCI CHD-ACS

4 NHS QIS National Measurement of Cardiac Rehabilitation Services The first round of data collection highlighted a number of issues regarding the dataset and the submission of data. As part of the general review of the conduct of the audits a small group, drawn from the cardiac rehabilitation community, was formed to review and revise the cardiac rehabilitation element of the programme. The resulting proforma is therefore much shorter and focused on the key elements of the cardiac rehabilitation standard Standard 10. The data collected will provide evidence to support compliance with the standard. An extract of data will be submitted on behalf of Scottish cardiac rehabilitation services to the National Audit of Cardiac Rehabilitation (NACR). A copy of the revised proforma is attached for your information. Details of the secondary care measures are detailed in the following text. MCNs will be asked to provide the following information about ALL patients seen by cardiac rehabilitation teams. This will be achieved by interrogation of the proforma / database information in order to determine the proportion (%) of ACS, CABG, PCI, patients with new onset or worsening (step change) angina, heart valve surgery, heart transplant, implantable cardioverter defibrillator and chronic stable heart failure: Assessed and offered cardiac rehabilitation Receive a menu based cardiac rehabilitation programme as specified in national guidelines that meet the individual needs of the patient

5 How will Data about Cardiac Rehabilitation be Collected? MCNs will be provided with a supply of pre-printed proforma on which to record data at the beginning of March You are advised to take the first few weeks to trial the proforma ensuring that staff are familiar in its use You are asked to collect data relating to ALL PATIENTS with an initiating event from the 1 April 2010 This data will be collated and made available for local use. It will also be used to contribute to the UK audit Attach proforma to patient record - it should remain at the front of the patient record until discharge. Photocopy completed proforma, retain photocopy in patient record. Completed 'original' forms should be returned in batches at the end of each month to NHS QIS who will confirm receipt. All data returned up to 24 September 2010, will be analysed for the second cycle of measurement. Q. When should data collection start? A. Start to complete the proforma once you are sure staff are confident in its use and no later than 1 April 2010 for all new patients. Q. How long should data be collected for? A. This is a continuous audit so data should be collected until further notice. Q. Who should complete the proforma? A. Responsibility for ensuring completeness of the proforma lies with the healthcare professional responsible for the patient at time of exit from cardiac rehabilitation. Q. What will happen to the data? A. Data from the completed forms will populate a database. This will be analysed by ISD and made available to MCNs. It will also be used to contribute to the NACR audit. MCNs will be able to review their own aggregated data before it is shared with NACR.

6 NHS QIS National Measurement of Primary Care Atrial Fibrillation, Heart Failure and Secondary Prevention The majority of data measures can be sourced through primary care, general practice computerised systems as they are routinely collected as part of the Quality and Outcomes Framework of the General Medical Services Contract. These data are based on the eight CHD markers. A search tool has been developed that will identify appropriate patients with Atrial Fibrillation, Heart Failure and pre-existing CHD and extract the required data directly into a spreadsheet/database format. The search tool is available for a variety of systems, specifically GPASS, EMIS and VISION. The extraction tool will be sent to MCNs to distribute to general practices in their locality. The data tool will extract the following information about the proportion (%) of patients with AF: Having had an ECG With a referral to cardiology (within 6 months before or after diagnosis) With a documented record of Stroke risk in their case record (e.g. NICE 36 stroke risk stratification algorithm or CHADS2) Currently receiving aspirin Currently receiving warfarin Not on antithrombotic therapy with a reason/contraindication documented in their case record With a documented measurement of blood pressure With a documented measurement of TFTs (1 month before and any time after diagnosis) The data tool will extract the following information about the proportion (%) of patients with Heart Failure: Those marked with SPSP will also contribute to the Scottish Patient Safety Programme. Having had an echocardiogram recorded within 6 months before or after diagnosis carried out within 14 working days of referral (SPSP) CHD & LVSD confirmed by echocardiogram (QOF LVD2) Chronic heart failure on: (SPSP) o Diuretics o ACEi and / or ARB o Beta blockers o Warfarin o Spironolactone therapy Chronic heart failure having had immunisation between Sep Mar 09 (SPSP). Influenza (within the last year). Pneumoccocal (any time) On the primary care palliative care register On the palliative care register with an individualised care plan placed in the patient s emergency care summary With atrial fibrillation

7 The data tool will extract the following data information on the long term management of CHD patients in primary care. Measures will include the proportion (%) of: Patients on CHD register currently on: Asprin or similar drug, or contraindicated ACEi, Beta-blocker CHD patients with cholesterol <5mmol/l recorded within the last 15 months CHD patients with BP recorded 150/90 or less within the last 15 months CHD patients receiving flu immunisation between Sept March 09 (or declined). In addition to extracting the data the programme will, at the same time, provide feedback to individual participating practices on the measures outlined above. Full details of the reports to be produced together with the extraction programmes will be made available to MCNs by 1 April. March April 2010 General Practice Recruitment It will be the responsibility of MCNs to recruit general practices. We strongly advise that recruitment starts as soon as possible. For MCN populations in excess of 250,000 and served by more than 50 general practices, data will be required from: A minimum of 20% of general practices which are representative of the geographical and socio economic characteristics found within the MCN/NHS Board area. For MCN populations of less than 250,000 and/or served by 50 or fewer general practices: MCNs are asked to contact NHS QIS to determine the exact size of sample required. Mel.miller@nhs.net or

8 How will Data about Atrial Fibrillation, Heart Failure and Secondary Prevention Measures be Collected? Electronic search and full instructions issued via to MCNs by 1 April 2010 Participating Practices run the search as outlined. Depending on the system running times will vary. For GPASS this will be approx. 10 minutes and for VISION and EMIS practices approx. 60 minutes. All three extractions will run at the same time. The search will identify all patients with a diagnosis of Atrial Fibrillation, Heart Failure and CHD within the time parameters set and extract the required anonomysed data. Completed Extractions to be returned to MCNs by 25 June 2010 MCN s to return all information to NHS QIS by 30 June 2010 Q. When should the search be run? A. We suggest that you run the search towards the end of May Q. How will practices do this? A. When we send out the electronic search, we will provide detailed information for practices as to how to execute the search and what to do with the results. Q. Will this be time consuming for practice staff? A. Depending on the system running times will vary. For GPASS this will be approx. 10 minutes and for VISION and EMIS practices approx. 60 minutes. Results will automatically populate a spreadsheet / database. Q. How secure is the data? A. The spreadsheet does not contain any patient identifiable information, just the location of its source. It can then be very safely ed to NHS QIS via the secure nhs.net. We have made significant efforts to ensure that this method does not compromise patient confidentiality in any way.