Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Project #1677

Transcription

1 Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Project # Implement change 1. Agree best practice 5. Action plan Action Planning 2. Define methodology Audit 4. Analysis and reporting 3. Pilot / data collection Dr Samantha Hamer, Lead Consultant Dr Orlin Michev, Locum Consultant Psychiatrist Dr Soghra Ather, Locum Consultant Psychiatrist Dr Hadi Peivandi, Locum Trust Doctor Stuart Kennedy, Lead Nurse Memory Services (East) Audit Period: May 2018 June 2018 Report Date: July 2018

2 Executive Summary Why the audit was undertaken The Memory Service is a diagnostic service for Dementia, and its sub-types. Whilst a diagnosis of Dementia is based on clinical presentation, results from CT brain scans give valuable information contributing to the conclusion in terms of sub-type, which in turn affects management. The objectives of this re-audit are: Assessing the re-audit standard of relevant information to be included on CT brain request forms Supporting staff in gaining an update in identifying symptoms of Dementia, specifically symptoms suggestive of a particular sub-type Encouraging inclusion of relevant clinical information that may facilitate Radiologists in interpreting CT brain scans How the audit was carried out The sample was selected from all new referrals received by the Memory Service (East) in March and April The patient records to be audited were selected by choosing every third patient. The patient list was supplied by administrative staff to the clinicians undertaking the data collection. Data was then collected by accessing scanned information on RiO. Key findings Criteria N Compliance 2018/19 Progress The CT request form includes: information about the nature of the memory problem 82 95% 43% information about other cognitive deficits 54 81% 47% Cognitive Assessment Score 71 89% 36% indication of pathway % 24% indication of Referral type (e.g. Diagnostic/ follow up) % 17% Key actions Change of CT Request Form To present Audit results at Memory East CPD session Re-audit date Not required 2 of 10 Executive Summary Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19

3 Contents Executive Summary... 2 Why the audit was undertaken 2 How the audit was carried out 2 Key findings 2 Key actions 2 Re-audit date 2 Contents... 3 Abbreviations 3 Background... 4 Criteria & Standards... 4 Page Page Method... 5 Findings... 6 Comments... 7 Recommendations... 8 References... 8 Appendix 1 Audit tool... 9 Appendix 2 Distribution list Appendix 3 Action plan Abbreviations CT LPT MHSOP NICE RTT Computerised Tomography Leicestershire Partnership NHS Trust Mental Health Services for Older People National Institute for Health and Care Excellence Referral to Treatment Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Contents 3 of 10

4 Background The Memory Service is a diagnostic service for Dementia, and its sub-types. Whilst a diagnosis of Dementia is based on clinical presentation, results from CT brain scans give valuable information contributing to the conclusion in terms of sub-type, which in turn affects management. There is a national drive for early identification of Dementia, with initiation of treatment if appropriate, within a fixed time-frame. As the result of CT brain impacts on sub-typing Dementia and subsequent initiation of treatment, timely comprehensive reports are required. The quality of information on these reports is affected by the quality of clinical information submitted on the request form. There is currently considerable diversity in the quality of clinical information submitted. Some forms have been returned by the Radiology Department, requesting further information, leading to delay in diagnosis and initiation of treatment. Accurate completion of CT scan request forms will lead to reduced delay in bookings of the scans for patients and subsequent return of the results by the Radiology department. Also, by including relevant clinical symptoms/ information on the request form, this will help the Radiology team interpret the scan. Both of these actions will benefit the patient by facilitating early diagnosis which will lead to early initiation of treatment (if appropriate), which has the potential for better prognosis. The objectives of this re-audit include: Assessing the re-audit standard of relevant information to be included on CT brain request forms Supporting Staff in gaining an update in identifying symptoms of Dementia, specifically symptoms suggestive of a particular sub-type Encouraging inclusion of relevant clinical information that may facilitate Radiologists in interpreting CT brain scans Criteria & Standards Table 1 - Criteria and standards Criteria Standard Evidence base The CT request form includes: information about the nature of the memory problem information about the onset of the memory problem information about the duration of the memory problem information about other cognitive deficits relevant information suggesting a Dementia sub-type Demographic information of Full Name Demographic information of Date of Birth Demographic information of Address Demographic information of ID number legible signature and name of referrer 100% NICE CG irefer Guidelines 4 of 10 Background Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19

5 Criteria Standard Evidence base Contact details of referrer examination requested Referring Hospital Referring Department Referring Consultant indication of pathway indication of breach date indication of Referral type (e.g. Diagnostic/ follow up) indication of Urgency Thresholds of compliance Key: Full compliance x 90% Partial compliance 80% x <90% Minimal compliance x < 80% Method This was a retrospective case-note re-audit. The sample was selected from all new referrals received by the Memory Service (East) in March and April The patient records to be audited were selected by choosing every third patient. The patient list was supplied by administrative staff to the clinicians undertaking the data collection. Data was then collected by accessing scanned information on RiO by the auditors. If the patient had been discharged without being seen (for example if the patient died prior to assessment), they were excluded and the next patient selected until 100 patient records had been reviewed. Having reviewed guidelines suggested in various national sources, 2 data collection tools were designed. Tool A was screening for relevant clinical information in the GP referral letter and in the initial assessment done by the clinician from Memory Service East. Tool B was screening for relevant information (clinical and demographic) on the CT brain request form submitted. Information collected on form B was analysed to answer the audit criteria. Form A was just to help the auditors fill in form B, i.e. if anything was marked Yes on form A, was it included on Form B. See Appendix 1 on p.9 for a copy of the audit tool Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Method 5 of 10

6 Findings 100 patient records were reviewed. 91 forms were included in the analysis. 9 forms were excluded for the following reasons: Reason Frequency Request postponed for after assessment 1 CT/ MRI available 3 CT not requested. Not necessary 1 Re-referral. Previously scanned 1 No need for CT. Discharged 1 Not Stated 2 Table 2 Audit results (in comparison with a previous audit) Criteria 2017/18 Compliance 2018/19 Compliance Progress The CT request form includes: information about the nature of the memory problem 52% 95% 43% information about the onset of the memory problem 54% 80% 26% information about the duration of the memory problem 64% 86% 22% information about other cognitive deficits 34% 81% 47% Cognitive Assessment Score 53% 89% 36% relevant information suggesting a Dementia sub-type 53% 78% 25% Demographic information of Full Name 99% 100% 1% Demographic information of Date of Birth 99% 98% 1% Demographic information of Address 100% 100% Demographic information of ID number 93% 100% 7% legible signature and name of referrer 98% 100% 2% Contact details of referrer 40% 36% 4% examination requested 94% 100% 6% Referring Hospital 98% 100% 2% Referring Department 98% 100% 2% Referring Consultant 93% 100% 7% indication of pathway 76% 100% 24% indication of breach date 63% 10% 53% indication of Referral type (e.g. Diagnostic/ follow up) 83% 100% 17% indication of Urgency 64% 99% 35% How compliance was calculated Compliance = number of YES number of YES and NO of 10 Findings Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19

7 Comments Areas of good practice Our data confirms that with the new forms and a single person being responsible to populate them, we significantly increased the compliance. There are no breaches, as the forms are filled immediately after the referral is received. The overall compliance is 95% (Previously 52%). The form is subjectively faster to fill and facilitates compliance. Areas for improvement The Referrer Contact Details compliance appears to be worse at first glance. We discussed that the forms are sent from the same fax and Imaging have the contact number on the facsimile. Decision has been taken to alter the form and include the details of the team Administrator as contact details for the Team Consultants. This will secure 100% compliance on this item. The Dementia subtype information is not provided by the GPs and is in most cases unavailable at the time of populating the form. We felt that this criteria is beyond the control of our team and should not be included if there are further re-audits. The compliance on Nature of Memory Problems, Onset, Duration, Information About Other Cognitive Deficit improved significantly but full compliance is impossible as this information is provided by the GP surgery at the time the forms are filled. Indications of Breach Date are no longer relevant, as the forms are populated as soon as the referral is received and results are available before the RTT breach time. Areas of risk/mitigation There are no areas of notable risk/ mitigation at present. Some concerns were raised that if the person populating the forms changes, there could be deterioration in the quality of submissions. There is now a relevant policy in place and on several occasions other members of the team stepped in to fill the forms. It seems that the system is robust and results are consistent. Lessons learnt The implementation of a simplified referral form, with prompts and pre-populated areas improved the level of compliance. A single person being responsible for the submission of these forms to the Imaging Department increased the speed and the level of compliance. There are no longer breaches and rejected scan requests caused by poor quality of the referral form. The system provides consistency and accountability, avoiding delays of treatment. The team had serious concerns that the clinical information from the GP referral letter is frequently insufficient. Our results confirm that this arrangement actually increased the speed of the CT scans and there is subjective impression that the quality of the reports improved too, as the forms ask more detailed questions to be answered. Ethical / professional issues The audit team did not identify any possible ethical issues through data collection. See Appendix 2 on p.10 for the distribution list for where the results are to be presented and discussed Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Comments 7 of 10

8 Recommendations See Appendix 3 on p.10 for the action plan. References NICE CG42 Dementia: supporting people with dementia and their carers in health and social care International Consensus Criteria for Dementia in Lewy Body disease. Lund-Manchester Criteria for Fronto-Temporal Dementia irefer Guidelines of Royal College of Radiologists regarding Dementia. 8 of 10 Recommendations Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19

9 Appendix 1 Audit tool Quality of Information on CT brain request forms in Memory Service East (#1677) (B) Screening Tool for CT request forms Information regarding: Memory - nature Memory - onset Memory - duration Other Cognitive deficit Cognitive Assessment score Not Applicable Yes No Relevant information (from Referral Screening Tool (A)) suggesting sub-type Clinical Questions to be answered Demographic Information: Full Name Date of birth Address ID Number Legible signature and name of referrer Contact Details of referrer Examination requested For Pathway: Referring hospital Referring Department Referring Consultant Indication of Pathway Indication of Breach date Indication of Referral type e.g. Diagnostic/ Follow up Indication of Urgency 9 of 10 Quality of Information on CT Brain Request Fo

10 Appendix 2 Distribution list Target audience CHS Clinical Audit and Effectiveness Group For review and adoption of the report and action plan. MHSOP Clinical Network meeting For review of the results and action plan To (for action) Name, designation Heather Darlow, Divisional Clinical Governance Lead To add to CAEG agenda and to circulate to members Sarah Smith, PA to Sharon Hames, Zayad Saumtally & MHSOP Clinical Directors To add to Clinical Network agenda and to circulate to members Cc (for info) Name, designation Appendix 3 Action plan (It is the audit leads responsibility to agree any actions with relevant stakeholders) Objective Agreed Action By Whom By When Comments Evidence of completion Contacts of Referrer Change of CT Request Form Stuart Kennedy 01/08/2018 Administrator Telephone will be included Possible re-audit To be discussed in 1 Year at MDT meeting Soghra Ather 01/08/2019 Discussion during MDT meeting will be organised. If there are concerns about the quality of Imaging referrals, re-audit could be organised. Presentation of To present Audit results at Memory East CPD Soghra Ather 30/10/2018 To present and discuss results with the Audit Results session team. Increase accuracy Prism form to be implemented Stuart Kennedy 01/09/2018 of referrals & Andrea Clark Monitoring number of scan returned to service Simon Guild 30/09/2018 for further information through bimonthly business meeting CT Request Form MDT notes MDT notes 10 of 10 Quality of Information on CT Brain Request Forms in Memory Service East (MHSOP) 2018/19 Distribution list