National Data Analysis

Transcription

1 National Data Analysis Dr Maeve Skelly QI Programme Working Group Member 30 th November 2017

2 National Data Reporting 2 nd National Data Report released today Data set covers the full training year from 30 th of June 2016 to 7 th of July Hospitals contributed data for the 2016/2017 report. 100% of data uploaded for the year. Thank you! The National Data Report should be used as a tool to use to drive reflection on your own local data

3 Compliance and Data Available for Analysis Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 *Data on 186,906 cases collected in NQAIS-Endoscopy from 30 th of June 2016 July 7 th of 2017

4 Key KPIs All KPI targets in the QI Guidelines are on a per Endoscopist basis. National Data Report (NDR) looks at these where possible, but also investigates National and Hospital statistics where appropriate (e.g. Bowel Preparation rates).

5 Key KPIs KPIs covered in the 2 nd National Data Report: Caecal Intubation Rate Comfort Score Polyp Detection Bowel Preparation Duodenal 2 nd Part Intubation Retroflexion Sedation

6 Key Quality Data: Caecal Intubation Rate Number of colonoscopies where the terminal ileum / caecum / anastamosis has been reached expressed as a % of total colonoscopies per Endoscopist. Key Quality Target: Minimum Target: 90% of colonoscopy cases should reach the terminal ileum/caecum or anastomosis (adjusted only for obstructing lesions) Achievable Target: 95% of colonoscopy cases should reach the terminal ileum/caecum or anastomosis (adjusted only for obstructing lesions) Clear photographic evidence of the terminal ileum/caecum/anastomosis must be obtained

7 Caecal Intubation Rate An Endoscopist s Caecal Intubation Rate is calculated based on the number of times caecum was intubated as Endoscopist 1 or Endoscopist 2 as a percentage of the total amount of colonoscopies performed as Endoscopist 1 or Endoscopist 2.

8 Caecal Intubation Rate Endoscopist 1 (E1): The clinician who performs the majority of the procedure. Endoscopist 2 (E2): A clinician present in the procedure room during the course of the procedure and who also provides some support to the primary Endoscopist (verbal or physical).

9 Caecal Intubation Rate National Average Caecal Intubation Rate: 92.6%

10 45 Endoscopists 7.5% 113 Endoscopists 18.9% Caecal Intubation Rate Colonoscopy - Percentage and Number of Endoscopists by CI Rate Category (E1 or E2) 60 Endoscopists 10.0% 183 Endoscopists 30.6% 197 Endoscopists 32.9% Endoscopists with a CI rate of >=95% Endoscopists with a CI rate between 90%-95% Endoscopists with a CI rate between 85%-90% Endoscopists with a CI rate between 80%-85% Endoscopists with a CI rate of <80% 64% of Endoscopists are meeting the Caecal Intubation Rate Target

11 Caecal Intubation Rate Colonoscopy - Percentage and Number of Endoscopists with < 10 cases by CI Rate Category 6 Endoscopists 5.6% 11 Endoscopists 10.2% 25 Endoscopists 23.1% 66 Endoscopists 61.1% Cases performed by an Endoscopists with a CI rate of >=95% Cases performed by an Endoscopists with a CI rate between 90%-95% Cases performed by an Endoscopists with a CI rate between 85%-90% Cases performed by an Endoscopists with a CI rate between 80%-85% Cases performed by an Endoscopists with a CI rate of <80%

12 Caecal Intubation Rate Colonoscopy - Percentage and Number of Endoscopists with > 100 cases by CI Rate Category 15 Endoscopists 5% 8 Endoscopists 3% Cases performed by an Endoscopists with a CI rate of >=95% 58 Endoscopists 19% 81 Endoscopists 27% 141 Endoscopists 46% Cases performed by an Endoscopists with a CI rate between 90%-95% Cases performed by an Endoscopists with a CI rate between 85%-90% Cases performed by an Endoscopists with a CI rate between 80%-85% Cases performed by an Endoscopists with a CI rate of <80%

13 Caecal Intubation Rate 100% Colonoscopy - Endoscopists by CI Rate and Case Amount 90% 80% 70% CI Rate 60% 50% 40% 30% 20% 10% 0% Number of Cases

14 Caecal Intubation Rate 100% Colonoscopy - Caecal Intubation Rate by Hospital 80% 60% 40% 20% 0% % Caecal Intubation by Hospital Achievable Target Minimum Target 31/36 Hospital s are recording 90 Colonoscopies with successful Caecal Intubation

15 Caecal Intubation Rate Yearly Comparison Number of Endoscopists Endoscopist CI Rate Categories -Year on Year 33% 31% 35% 24% 19% 21% 11% 10% 8% 10% >=95% 90%-95% 85%-90% 80%-85% <80%

16 Caecal Intubation Rate Caecal Intubation Rates continue to improve. The CI Rate data shows a correlation between number of procedures performed and likelihood of meeting CI Rate target.

17 Caecal Intubation Rate Further Data Quality Improvements: Ensure to enter the Endoscopist 1 and Endoscopist 2 correctly for each procedure. Endoscopist 1 (E1): The clinician who performs the majority of the procedure. Endoscopist 2 (E2): A clinician present in the procedure room during the course of the procedure and who also provides some support to the primary Endoscopist (verbal or physical).

18 Key Quality Data: Comfort Score Median comfort level score per Endoscopist Key Recommendation: Use the modified Gloucester scale Comfort scores should be assessed by a third party who will usually be an endoscopy nurse and agreed with the Endoscopist before recording Key Quality Target: 80% of colonoscopy cases should have a comfort score of a 1 or 2

19 Comfort Score Modified Gloucester Scale: 1 - No: No discomfort resting comfortably throughout. 2 - Minimal: One or two episodes of mild discomfort, well tolerated. 3 - Mild: More than two episodes of discomfort, adequately tolerated. 4 - Moderate: Significant discomfort, experienced several times during the procedure. 5 - Severe: Extreme discomfort, experienced frequently during the procedure.

20 Comfort Score Colonoscopy - Percentage and number of Endoscopists Above and Below Comfort Score Target 207 Endoscopists 36% Number of Endoscopists Above Target 371 Endoscopists 64% Number of Endoscopists below Target

21 Comfort Score Colonoscopy - Percentage and Number of Cases by Comfort Score nationally 8819 Cases 10% 2904 Cases 4% 707 Cases 1% 1 - No Discomfort 2 - Minimum Discomfort 3 - Mild Discomfort Cases 30% Cases 55% 4 - Moderate Discomfort 5 - Severe Discomfort 85% of Cases recorded a Comfort Score of a 1 or a 2

22 Comfort Score 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colonoscopy - Comfort Score Rates by Hospital % Comfort Score Rate by Hospital Target

23 Comfort Score Some mapping issues that were present last year have been rectified, accounting for some of the increase in national comfort score for the year, which is up 2%, to 85% of cases with a 1 or 2. Further Improvements: Check mapping tables. Ensure that Modified Gloucester Scale is being used.

24 Key Quality Data: Bowel Preparation Record the bowel preparation for each colonoscopy. Express the total number of colonoscopies with Adequate and Excellent scores as a % of all colonoscopies Key Quality Target: Bowel preparation described as excellent or adequate in 90% of colonoscopies

25 Bowel Preparation 100% Colonoscopy - Percentage of Cases meeting Bowel Prep target by month 96% 92% 88% 84% 80% % Bowel Preparationby Month Minimum Target

26 Bowel Preparation 100% Colonoscopy - Bowel Preperation rate by Hospital 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % Bowel Preparation by Hospital Minimum Target Achievable Target 14 out of 36 Hospitals meeting Bowel Preparation Target

27 Bowel Preparation Bowel Preparation rates are consistently below target for both National Data Reports. Further improvements: Check mapping table accuracy

28 Key Quality Data: OGD Duodenal 2 nd Part Intubation Number of cases in which Duodenal 2nd part intubation was achieved expressed as a % of total OGD cases per Endoscopist Key Quality Target: Intubation of Duodenum Second Part in 95% of cases

29 OGD Duodenal 2 nd Part Intubation

30 OGD Duodenal 2 nd Part Intubation 100% OGD - Percentage of 2nd Part Intubation - By Hospital 80% 60% 40% 20% 0%

31 OGD - Retroflexion Key Quality Data: Number of cases in which retroflexion was performed expressed as a % of all OGD cases per Endoscopist Key Recommendation: Retroflexion (J manoeuvre) in stomach to visualise fundus in 95% of cases

32 OGD - Retroflexion

33 OGD - Retroflexion 100% OGD - Percentage of Retroflexion - By Hospital 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

34 OGD Duodenal 2 nd Part Intubation & Retroflexion Increase in Data Recording Quality rather than increase in amount of Duodenal 2 nd Part Intubations and Retroflexions. Can use NDR to identify if your hospital varies in its Duo2 Intubation and Retroflexion Rates. Further Improvements: Hospitals that are reported as being below the target should check to ensure these measures are being performed and recorded correctly.

35 Sedation Key Recommendations: Sedative should be used to achieve conscious sedation; where the patient displays purposeful response to verbal stimulation. The median level of sedation for older patients ( 70 years of age) should be approximately half that of patients under that age. The use of reversal agents should be minimised. Its use should require that case be reviewed. Key Quality Targets: Median quantity of Midazolam: 5mg for patients under 70 years of age 3mg for patients 70 years of age and above

36 Sedation Midazolam 83 Endoscopists 14.69% Colonoscopy - Midazolam - Number of Endoscopists above and below target (under 70s) 3 Endoscopists 0.53% 479 Endoscopists 84.78% No Midazolam used Median 5mg of Midazolam or less Median Greater than 5mg Midazolam Colonoscopy - Midazolam - Number of Endoscopists above and below target (70 and over) 6 Endoscopists 1.12% 243 Endoscopists 45.51% 285 Endoscopists 53.37% No Midazolam used Median 3mg of Midazolam or less Median Greater than 3mg Midazolam

37 Sedation Midazolam

38 Sedation Midazolam

39 Sedation Roughly the same amount of Midazolam is being used for patients under 70 and over 70. Fentanyl: O.25% of patients receive more than 100mcg of Fentanyl. Data recording issues in some hospitals. 3% of OGD, and 6% of COL cases using Fentanyl contained unreliable data on fentanyl. E.g. a number that is not a multiple of 25 or a number less than 1 (0.25 etc.)

40 Summary of National Data Analysis Variation and areas in need of improvement identified in the National Data Report should be confirmed locally and used as a tool to drive improvement. Endoscopists should continue to monitor their own statistics Each Clinical Lead and Hospital Group Clinical Lead will be made aware of their Hospital s ID number. Data Quality is at a high level and increasing for those KPIs which may have been subject to data entry mistakes in the past Consistently unrealistic data reporting can also be a flag to review local data (e.g. 100% CI Rate consistently with high volume of procedures)

41 Thank you