Clinical Outcome Report - The Royal Wolverhampton Hospitals NHS ...

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All figures shown are Relative Risk scores comparing observed outcomes to expected outcomes (casemixadjusted). A score of 100% represents observed outcomes that are the same as the expected. A score below100% represents better observed outcomes and above 100% represents poorer observed outcomes.Dr Foster Real Time MonitoringDr Foster Real Time Monitoring aims to supply hospital managers and clinicians with critical information tosupport clinical governance. The system enables them to recognise where there is variation in activity oroutcomes in particular hospitals; to see whether or not that variation is statistically significant; to analysepatterns in terms of different patient groups, different hospital site or different clinician teams; and to see howpatterns of activity are changing over time.The information can be used for a range of purposes including:• Clinical safety: Tracking significant divergence in outcomes or activity in a hospital is a valuablemechanism for helping to identify if problems arise that affect patient safety.• Efficiency: Efficiency improvements can be identified by tracking use of hospital beds; the numbers ofpatients that have particular procedures; and the pattern of admissions and discharges either home or toother facilities.• Performance improvement: Tracking key measures of patient outcome and activity in close to real timecan help provide rapid feedback to identify whether restructuring of processes is having the desired resultand avoiding any unintended consequences.The Dr Foster system aims to meet the following criteria:• Comprehensive: The most comprehensive overview of the activity inside NHS hospitals in England.The system tracks patients from their admission to hospital, to the end of their journey through the NHS.• Intelligent: The most “intelligent” analysis using state-of-the art statistical analyses to benchmark thedata. Using appropriate adjustments and comparisons, the system discounts difference that are simplyexplained or which are of no statistical importance. It focuses on the differences that require explanation.• Timely: The system provides the most up-to-date analysis possible and uses analyses that provide theoptimal sensitivity and specificity over any time period.• Data quality: The system provides the most effective means to ensure the accuracy and completeness ofofficially recorded dataThe system currently uses a Common Data Set derived from inpatient records (issued either as the annualHospital Episode Statistics or as monthly release from the Nationwide Clearing Service) and 2001 census datafor population figures. ONS death records will be added to the system during the course of 2004.Monitoring analyses of these datasets is important because:6 of 8 8-Apr-08
• They provide the most comprehensive information on healthcare in the UK (all inpatients in England).This creates to provide a statistically solid benchmark against which to understand variations in patternsof care between providers.• They are also used to generate official performance indicators and are used in the calculation of resourceallocation. Ensuring the quality of these datasets is therefore a high priority. Also, it can help avoidunnecessary confusion and is more economically efficient if the internal monitoring and management ofhealthcare organisations is based on the same data as is used for external scrutiny.• These Common Data Set is being developed and improved and with the introduction of the ICR willsignificantly expand. This data set will become of increasing importance over time.• The data set allows linkage of patient spells in one NHS facility to another and can provide a commonbasis for an information system for the whole health economy.2. The real time monitoring system – what does it do?• Highlight where the data show significant divergence from national benchmarks at the earliest possibleopportunity• Track whether measures of process and outcome are diverging from or converging towards benchmarks• Make appropriate adjustment for case mix using age, sex, method of admission, deprivation and selectdiagnostic subgroups• Allow comparison of performance data against national benchmarks and against any other selected trustin England.• Allow timely checking and correction of the underlying dataFormats: The system displays data in the following formats:• Alerts: The alerts display draws attention to where there has been significant divergence from expectedlevels. Users are able to adjust alert limits to suit local priorities and targets. Data is presented with rawnumbers, relative risk values and confidence intervals, with red and green icons to show significantnegative or positive divergence.• Statistical process control charts. These track data over time and are designed to identify at the earliestopportunity a significant divergence in outcomes. Alerts are signalled when one is detected.This analysis is designed to draw managers and clinician’s attentions to those issues raised by the data.The system provides a way to track whether a hospital, department or consultant performance isconverging towards or diverging from the rest of the NHS over time given the patient mix. Alerts can becustomised to trigger at different levels.• Relative risk charts. These allow comparative analysis of data over selected time periods and selectedpatient groups, both against national averages and against selected trusts.7 of 8 8-Apr-08
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