national confidential enquiry into patient outcome … confidential enquiry into patient outcome and...
TRANSCRIPT
ACUTE PANCREATITIS STUDY
9 099388 616867
National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
CLINICIAN QUESTIONNAIRE
To identify and explore avoidable and remediablefactors in the process of care for patients withacute pancreatitis.
This form will be electronically scanned. Please usea black or blue pen. Please complete all questionswith either block capitals or a bold cross inside theboxes provided e.g.
Did the patient have any radiological interventionor drainage?
If you make a mistake, please “black-out” theincorrect box and re-enter the correct information,e.g.
NoYes
Grade:
DETAILS OF THE CLINICIAN COMPLETING THIS QUESTIONNAIRE
Specialty:
Information will be collected using two methods; boxcross and free text, where your opinion will berequested.
NoYes
Consultants who complete NCEPODquestionnaires make a valuable contribution to theinvestigation of patient care. It also provides anopportunity for consultants to review their clinicalmanagement and undertake a period of personalreflection. These activities have a continuingmedical and professional development value forindividual consultants. Consequently, NCEPODrecommends that consultants who completeNCEPOD questionnaires keep a record of thisactivity which can be included as evidence ofinternal/self directed Continuous ProfessionalDevelopment in their appraisal portfolio.
If you have any queries about this study or thisquestionnaire, please contact
Or telephone: 020 7251 9060
Thank you for taking the time to complete thisquestionnaire. The findings of the study will bepublished in summer 2016.
NCEPOD number:
If you (the clinician completing the questionnaire)would like email confirmation of the completion ofthis questionnaire for your records, please clearlysupply your email address below.
Inclusions
Patients aged 16 years or older are included in thestudy if they were admitted to hospital between 1stJanuary 2014 and 30th June 2014 inclusive andwere diagnosed with acute pancreatitis
1) Had an inpatient stay of 3 or more nights
2) Were admitted to critical care during thereinpatient stay
3) Died in hospital
In addition patients must meet one or more of
the following criteria
9 099388 6174062
100 = General Surgery101 = Urology
103 = Breast Surgery
104 = Colorectal Surgery105 = Hepatobiliary &
106 = Upper GastrointestinalPancreatic Surgery
Surgery
107 = Vascular Surgery110 = Trauma & Orthopaedics120 = Ear, Nose & Throat (ENT)
130 = Ophthalmology
140 = Oral Surgery145 = Maxillo-Facial Surgery150 = Neurosurgery
160 = Plastic Surgery
161 = Burns Care170 = Cardiothoracic Surgery172 = Cardiac Surgery173 = Thoracic Surgery180 = Accident & Emergency
190 = Anaesthetics
192 = Critical/Intensive Care
Medicine
300 = General Medicine301 = Gastroenterology302 = Endocrinology
306 = Hepatology307 = Diabetic Medicine314 = Rehabilitation
320 = Cardiology
330 = Dermatology340 = Respiratory Medicine350 = Infectious Diseases352 = Tropical Medicine360 = Genito-Urinary Medicine361 = Nephrology
410 = Rheumatology
303 = Clinical Haematology
315 = Palliative Medicine 370 = Medical Oncology400 = Neurology
430 = Geriatric Medicine500 = Obstetrics & Gynaecology501 = Obstetrics502 = Gynaecology
800 = Clinical Oncology
823 = Haematology
810 = Radiology820 = General Pathology
SURGICAL SPECIALTIES
MEDICAL SPECIALTIES
02 – Staff grade/Associate specialist03 – Trainee with CCT 04 – Senior specialist trainee (ST3+ or equivalent)05 – Junior specialist trainee (ST1&ST2 or CTequivalent)
06 – Basic grade (HO/FY1 or SHO/FY2 orequivalent)
08 - Senior staff nurse,enrolled nurse (EN) etc)
01 – Consultant
07 - Specialist Nurse (Nurse consultant,Nursepractitioner, clinical nurse specialist
Levelsof wardcare
Level 1: Patients at risk of their condition deteriorating, or those recently relocated from higher levelsof care whose needs can be met on an acute ward with additional advice and support from the criticalcare team.Level 2: (e.g. HDU) Patients requiring more detailed observation or intervention including support fora single failing organ system or post operative care, and those stepping down from higher levels ofcare. (NB: When Basic Respiratory and Basic Cardiovascular support are provided at the same timeduring the same critical care spell and no other organ support is required, the care is considered tobe Level 2 care).Level 3: (e.g. ICU) Patients requiring advanced respiratory support alone or basic respiratory supporttogether with support of at least two organs. This level includes all complex patients requiring supportfor multi-organ failure. (NB: Basic Respiratory and Basic Cardiovascular do not count as 2 organs if theyoccur simultaneously (see above under Level 2 care), but will count as Level 3 if another organ issupported at the same time).
09 - 1st Level nurse, staff nurse (RGN)
Chronickidneydisease
326 = Acute internal medicine
10 - Non-registered staff (HCA etc.)
Normal kidney function but urine findings and structuralabnormalities or genetic trait point to kidney disease
CKD 1 90+
CKD 2 60-89 Mildly reduced kidney function and other findings (as stage 1)point to kidney disease
Moderately reduced kidney function39-59CKD 3
Severely reduced kidney function15-29CKD 4
CKD 5 <15Very severe endstage kidney failure (sometimes calledestablished renal failure
Estimated GFRStage Urine output criteria
5 099388 6176913
Please use the box below to provide a brief summary of this case, adding any comments orinformation you feel relevant. You may also type on a separate sheet.
2.
NCEPOD attaches great importance to this summary. Please give as much information as
possible about the care of this patient.
Gallstones Alcohol
What was the cause of Acute Pancreatitis?1.
A. CASE SUMMARY
Drugs
Unknown OtherPost ERCP
(please specify drugs)
(please specify)
0 099388 6198124
Age at time of admission3. Gender4. Male Femaleyears
Weight on admission
5a.
kg
OR
st
Not recorded
B. PATIENT DETAILS
BMI on admission
5b.
Height
cm
OR
feet inches
Not recorded
lb
Not recorded
5c.
Smoking history6.
8. Family History: Hereditary Pancreatitis
Cystic Fibrosis
Non smoker Ex-smoker Current smoker
Yes No
packs/week years smoking
Current drinker7a.
Had the patient had a previous admission for Acute Pancreatitis?9a. YesNo (please go toquestion 10
If Yes, when was their most recent admission (prior tothis admission) for Acute Pancreatitis?
9b.
d d m m y y
Unknown
Gallstones Alcohol
What was the cause of the above episode of Acute Pancreatitis?9c.
Drugs
Post ERCP
If the patient had gallstone pancreatitis how was this treated (please mark all that apply)?9d.
Cholecystectomy ERCP No treatment
Other (please specify)
If the patient had alcohol induced pancreatitis werethey referred to an alcohol cessation service?
9f. Yes No
N/A
N/A
Yes No If Yes units/week
When was definitive treatment for gallstonepancreatitis (this might be a subsequentadmission)?
9e.
d d m m y y
N/A
Unknown
No definitive treatment
7b.Unknown
Unknown
Unknown Other
(please specify drugs)
(please specify)
Unknown
Unknown
Unknown
Yes No Unknown
6 099388 6522405
Did the patient have any co-morbid conditions?10a.
COPD/Asthma
Current cancer treatment
Angina/previous myocardialinfarction
Gallstones Stroke/TIA/carotid surgery
Haemodialysis/peritoneal dialysis
Please list othermajor comorbidities
Date of admission:
d d m m y y h h m m
11.
What was the mode of admission?12b.
Via the Emergency department (ED)
Direct from a GP
Following outpatients/telephone consultation
Hospital transfer
Other
Yes No
If Yes, please mark all that apply.10b.
Cirrhosis
C. ADMISSION/RECOGNITION AND DIAGNOSIS OF ACUTE PANCREATITIS
TraumaChronic kidney disease(*grade 3-5)
Time of admission:
(please specify)
Was this admission?12a. Non-elective Elective
* see definitions on pg 2
Following ERCP
13a.
13f.
How long from arrival in ED did patient wait to havebaseline observations done?
h h m m
In your opinion was this appropriate?13b.
13c. Was an EWS completed in the ED? Yes No
If Yes, which scoring system?13d.
Did the score trigger a response? Yes No
13j. How long from arrival in ED did the patient wait to be seen by a doctor?
h h m m13k. How long was the patient in the ED before being moved to a ward?
h h m m
In your opinion was the management of the patient in ED satisfactory?13l. Yes No
13m. If No, why was this?
Yes No
NEWS MEWS Other
What was the score?13e.
If Yes, what?
In your opinion was this appropriate?13h. Yes No
If No, why not?
If the patient was admitted via the emergency department please complete Q13
13g.
13i.
Were comorbidities controlled on admission?10c. Yes No
Was a referral made for specialist input withregard to the patients comorbidities?
10d. Yes No
N/A
Unknown
N/A
(please specify)
0 099388 6546396
15b.
What was the grade and specialty of the Doctor thatfirst assessed the patient (this includes anyassessment in the ED)?
please enter grade codefrom pg 2
Unknown
Unknown15a.
please enter specialty codefrom pg 2
To what location was the patient first admitted?
General Medical Ward
Medical Assessment/Admissions Unit
General Surgical Ward
Surgical Assessment/Admissions Unit
Hepatology Ward
High Dependency Unit (level 2 care)
Intensive Care Unit (level 3 care)
Gastroenterology Ward
Other
(please specify)
Gastrointestinal Surgery Ward
HPB Surgery Ward
Were any problems/delays encountered with the transfer?14c. Yes No
If Yes, please provide details.14d.
If Yes, what was the main reason for the inter-hospital transfer (please mark all that apply)?14b.
Surgical Intervention Interventional Radiology
Endoscopic intervention
Other
Specialist critical care
Was the hospital transfer primarily for management of the patient'sAcute Pancreatitis?
14a. Yes No
Specialist AP service
Critical care bed
(please specify)
What was the time since onset of AP symptoms?
(time since patient first noticed symptoms at home relative to presentation at hospital)
< 3 hours >12 - 24 hours >24 - 48 hours
Unknown
>3 - 6 hours >6 - 12 hours
How did the patient present with their AP (please mark all that apply)?16a.
Abdominal pain Raised lipase
Vomiting
Back pain
Other
Raised amylase
(please specify)
Shock
>2 - 5 days >5 - 7days > 7 days
16b.
If the patient was a hospital transfer please complete Q14
see definitions on pg 2
Unknown
4 099388 6546117
On recognition of AP what was the patient's first pulse, systolic blood pressure and O saturation?17a.
bpmPulse mm HgSystolic BP %O sat2
What was the date of the first registrar (ST3 orabove) review post admission?
d d m m y y
Unknown18a.
What was the time of this review?18b. Unknown
No Registrar review
What was the date of the first consultant reviewpost admission?
d d m m y y
Unknown
What was the time of this review?
h h m m
Unknown18e.
18d.
What was the specialty of the consultant? please enter specialty codefrom the list on pg 2
What was the specialty of the registrar?18c. please enter specialty codefrom the list on pg 2
18f.
17e.
17b. Was an EWS performed following admission? Yes No
If Yes, which scoring system?17c.
Did the score trigger a response? Yes No
NEWS MEWS Other
What was the score?17d.
If Yes, what?
In your opinion was this appropriate?
17f.
Yes No
If No why not?
17g.
17h.
Which of the following medication was the patient on prior to their admission for AP?19a.
5-aminosalicylic acid
Other drugs relevant to thepatient's AP
Azathioprine
DiureticsSteroids
(please specify) (please specify) (please specify)
(please specify)
Statins
(please specify)
2
h h m m
0 099388 7110288
Which of the following medications were stopped?19b.
Which of the following investigations were undertaken at the time AP was suspected? (pleasemark all that apply)
20a.
Clotting screen
Full blood count Liver function tests
Urea and electrolytes Group and save
Cross-match
INR/PT APTR/PTT Fibrinogen
Amylase Lipase CRP
Troponin ECG ABGs
In your opinion were all appropriate investigations done?20b. Yes No
If No, what was omitted? (please mark all that apply)20c.
LDH Glucose Serum calcium
Triglycerides Lipid profile
In your opinion was this appropriate?19c. Yes No Unknown
If No, please expand on this19d.
5-aminosalicylic acid
Other drugs relevant to thepatient's AP
Azathioprine
DiureticsSteroids
(please specify) (please specify) (please specify)
(please specify)
Statins
(please specify)
CXR
Clotting screen
Full blood count Liver function tests
Urea and electrolytes Group and save
Cross-match
INR/PT APTR/PTT Fibrinogen
Amylase Lipase CRP
Troponin ECG ABGs
LDH Glucose Serum calcium
Triglycerides Lipid profile CXR
Other
(please specify)
Other
(please specify)
1 099388 7110109
Please complete the table below for the time frames indicated. If the patients CRP level or a risk assessment score altered the management planfor the patient (e.g CT performed, admitted to critical care, transferred for specialist care) please provide details of this the in box provided
21a.
Time from APdiagnosis
CRP mg/L(highest level)
0 hours
ModifiedGlasgow score
Managementimpacted
Details
Yes No
Yes No>0 - 24 hours
Yes No>24 - 48 hours
Yes No>48 - 72 hours
Yes No>3 - 5 days
Yes No>5 - 7 days
Yes No> 7 days
EWS
In your opinion was risk assessment appropriate?21b. Unknown
If No, what was omitted?21c.
(please specify score and local threshold used)
Yes No
4 099388 71097310
How was the AP diagnosed? (please mark all that apply)22.
Pain Raised enzymes Imaging Other
Did the patient receive IV fluids? UnknownYes No25a.
25d. Please indicate the resuscitation fluids (ml) the patient received during the different time framesbelow (if none please put a 0)
Time from APdiagnosis
Hartmann's
0-3 hours
>12 - 24 hours
>24 - 48 hours
>48 - 72 hours
> 72 hours
5% Dextrose DextroseSaline
Other Other
> 3 - 6 hours
> 6 - 12 hours
(please specify) (please specify)
NormalSaline
If No, in your opinion should they have? UnknownYes No25b.
If Yes to 25b, why was this required?25c.
In your opinion was VTE prophylaxis adequate? Unknown23b.
Was the patient prescribed regular prophylactic Low MolecularWeight Heparin?
23a.
Yes No
UnknownYes No
Yes NoIn your opinion, was the above fluid management appropriatefor the the patient's condition?
25e. Unknown
If No, please expand on your answer.25f.
What was the lowest oxygen saturation prior to resuscitation?24a.
Did the patient have supplemental oxygen prescribed?24b.
Did the patient have supplemental oxygen administered?24c.
If Yes to 24c, did it improve oxygen saturation?
%O sat2
UnknownYes No
UnknownYes No
24d. UnknownYes No
Was management of the patient's oxygenation appropriate?24e. UnknownYes No
(please specify)
D. INITIAL MANAGEMENT
8 099388 71081811
What was their haemoglobin level at the beginning of resuscitation?30a. g/L
Were vasoactive drugs commenced during the initial resuscitation?29a.
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
If Yes to 29a, please state the time and date:29d.
BP improved
29e. If Yes to Q29a, did the patient respond to vasoactive drugs?
BP target reached
If Yes, which vasoactive drug?29b.
What was the maximum dose in the first hour?
Did the patient require organ support? Yes No Unknown
If Yes was this Cardiovascular Respiratory Renal
HaemofiltrationVentilation CPAP
lactate improved lactate normalised
Yes No Unknown
If Yes to Q29e how did they respond? Please mark all that apply
Other
Did the patient have a central line inserted? Yes No
If Yes was one port reserved for TPN?
Yes NoDid they receive a blood transfusion?30b. Unknown
Level 1 Level 2What was the patient's level of careduring initial resuscitation?
31a. Level 3
What was their frequency of monitoring at this time?31b.
In your opinion was transfusion appropriate? Yes No Unknown30d.
>1-2 hourlyHourly (or more frequent) >2-4 hourly >4-6 hourly
>6-12 hourly >12 hourly
What was the pre-transfusion haemoglobin level?30c. g/L
Other
Yes No
Did the patient have hourly urinary output monitoring ?
26a. Unknown
Yes No
Did the patient have a urinary catheter?
26b. Unknown
Yes NoIf Yes to 26c, in your opinion could AKI have been prevented?26d. Unknown
IV fluids OxygenIf Yes to 26d, how could AKIhave been prevented?
26e.
Other
Stopping nephrotoxic drugs
Did the patient develop Acute Kidney Injury (AKI)?26c. Yes No Unknown
27a.
27b.
28a.
28b.
N/A
Haemodialysis
Adrenaline Noradrenaline Dobutamine Dopamine
29c.
(please specify)
Unknown
Yes No Unknown
Yes No Unknown
Other(please specify)
(please specify)
29f.
see definitions on pg 2
Continuous
Unknown
(please specify)
9 099388 71075612
Please complete the table below for each antimicrobial the patient was given during this admission32a.
Datecommenced
Timecommenced
Antibiotic / antifungal Duration (days)Indication
d d m m h h m m
Route
IV Oral
Pro-calcitoninmeasured atoutset
Yes No
d d m m h h m m
IV Oral Yes No
d d m m h h m m
IV Oral Yes No
d d m m h h m m
IV Oral Yes No
d d m m h h m m
IV Oral Yes No
d d m m h h m m
IV Oral Yes No
d d m m h h m m
IV Oral Yes No
d d m m
IV Oral Yes No
In your opinion was the above (antimicrobial management) appropriate for the patient?32b. Yes No
If No, why not?32c.
h h m m
6 099388 71072813
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
Following diagnosis with AP, what was the time/date the patient was first reviewed by a medicaldoctor on the ward?
35a.
What was the grade and specialty of the clinician?35b. (see p.2 for list of grades and
specialties)
h h m m 24 hr clock d d m m y y y y
36a.
Time unknown Date unknown
Following diagnosis with AP, (if different from above) what was the first time the patient was reviewedby a consultant?
Following diagnosis with AP, how often was the patient monitored for standard observations?39a.
Following diagnosis with AP, what was the first time the patient was reviewed by a consultantintensivist?
37a.
h h m m 24 hr clock d d m m y y y y
Time unknown N/A - Not reviewed
Date unknown
Is there evidence of a consistent structuredhandover from the day team and out-of-hoursteam treating this patient? N/A- care was not handed over
Yes No33.
In your opinion was this appropriate? NoYes39b.
h h m m 24 hr clock d d m m y y y y
Time unknown
N/A not reviewed byspecialist nurse
Following diagnosis with AP, what was the time/date the patient was first reviewed by a specialist nurse(eg. an HPB nurse specialist or equivalent) on the ward?
34a.
What was the specialty of the nurse?34b.
Date unknown
Following diagnosis with AP, what was the first time the patient wasreviewed by a trainee intensivist?
38a.
h h m m 24 hr clock d d m m y y y y
Time unknownN/A - Not reviewed
Date unknown
What was the grade of the trainee?38b. (see p.2 for list of grades)
>1-2 hourlyHourly (or more frequent) >2-4 hourly >4-6 hourly
>6-12 hourly >12 hourly Other
Continuous
Unknown
36b. What was the specialty of the consultant? (see p.2 for list specialties)
grade
specialty
0 099388 665017
What response was triggered? Review by critical care outreach team (CCOT)
Review by other emergency team eg:Medical Emergency Team (MET), RapidResponse Team (RRT)
Review by critical care clinician
Other(pleasestate):
If Yes, please state the time/date the patient was first seen:41b.
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
At any time, following diagnosis with AP, was this patientseen by the CCOT or other emergency team (MET, RRTetc.)?
41a. Yes No
If No to 41a, was this because:41c.
No CCOT (or equivalent)at this hospital
CCOT (or equivalent) notavailable out of hours
CCOT (or equivalent) did not see patient for other reason - please state:
40h.
Review by other clinician
Not requiredPatient admitted directly tocritical care
14
Did patient observations include monitoring with an Early Warning Score?40a. Yes No
If Yes, please specify which one:40b.
If Yes, is an escalation response required when thescore triggers?
40c. Yes No
40e.
What Early Warning Score triggers a response in this hospital/ward : Unknown
If Yes to 40a, was escalation triggered for this patient?
40d.
Yes No
If Yes to question 40e, what date/time did the patient first trigger EWS?
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
40f.
If Yes to question 40e, what was the date/time of the first documented response?
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
40g.
40i. In your opinion was this response appropriate? Yes No
40j. In your opinion was this response timely for the patient'scondition?
Yes No
NEWS MEWS Other
Was the patient admitted to critical care (HDU or ICU) during this admission?42a. Yes No
If No, in your opinion should they have been?42b. Yes No
9 099388 74209215
In your opinion was analgesia given in a timelymanner?
UnknownYes No
Was the patient's pain score measured onadmission?
44a. UnknownYes No
If Yes what pain score was used?44b.
How long after admission did the patient first receive analgesia?45a.
45e.
E. PAIN MANAGEMENT
In your opinion was the patient given adequateanalgesia?
UnknownYes No45c.
What type of analgesia was the patient given?45b.
oral opiateoral paracetamol oral NSAID IM morphine
IM NSAID IV paracetamol IV NSAID IV opiate (not PCA)
PCA epidural analgesia Other
In No, please expand on your answer45d.
Was the patient seen by the acute pain team? UnknownYes No46.
In your opinion was the patient's pain adequatelycontrolled during their admission?
UnknownYes No47a.
What was the score?
fentanyl
morphine
other
If Yes to 42b, why?42c.
If the patient was admitted to critical care (HDU or ICU) during this admission when was this?43a.
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
How many days in total did the patient spend on critical care (HDU/ICU)?43c.
Was the patient readmitted to critical care at any point after discharge?43b. Yes No
days hours
47b. If No, please expand on this?
(please specify)
(please specify)
6 099388 71490016
Did the patient have a CT to diagnose AP?50a. Yes No Unknown
F. RADIOLOGY
If Yes what did this show?50b.
Did this include?50c.
In your opinion was this appropriate?50d. Yes No Unknown
How many CT scans did the patient undergo during this admission?51a.
d d m m h h m m
Date and time of scan Reason for scan Protocol used
Please complete a row of the table below for each CT or MRI scan undertaken ?51c.
Acute pancreatitis
Pancreatic abcess
Gallstones
Obstructing gall stones Pancreatic necrosis
Pseudoaneurysm
Portal vein thrombosis Acute fluid collection Peri-pancreatic collection
Non contrast Arterial phase Portal venous phase
%
Other
Did the scan resultchange patientsmanagement
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
Did the patient have an ultrasound scan?48a. Yes No Unknown
If Yes what did it show (please mark all that apply)?48b.
Gallstones CBD stones Dilated CBD
Pancreatic collection
Did the patient have an MRCP?49a. Yes No
If Yes to 49a what did it show (please mark all that apply)?49c.
Gallstones CBD stones Dilated CBD
Other
How many MRI scans did the patient undergo during this admission?51b.
CT
MRI
CT
MRI
CT
MRI
Scan type
Unknown
Normal Pancreatitis
Other
Pancreatic calcification
If Yes, was secretin used?49b. Yes No Unknown
Infected necrosis
(please specify)
(please specify)
(please specify)
0 099388 71063217
d d m m h h m m
Date and time of scan Reason for scan Protocol used
Did the scan resultchange patientsmanagement
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
CT
MRI
CT
MRI
CT
MRI
Scan type
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
CT
MRI
CT
MRI
CT
MRI
d d m m h h m m
Yes No
If this scan changed the patients manangement, how?
CT
MRI
In your opinion was the number and timing of scans appropriate for the patient? Yes No
If No, please expand on your answer
51d.
51e.
5 099388 715076
G. ERCP
Did the patient undergo ERCP during this admission?52a. Yes (please goto Q53)
No Unknown
What was the reason for ERCP (please mark all that apply)?53a.
Prevention of gallstonepancreatitis not suitable forlaparoscopic cholecystectomy
Other
Cholangitis CBD stones Stricture
What was the date/time of the first ERCP during this admission?
h h m m 24 hr clockd d m m y y y y
Time unknownDate unknown
54a.
In your opinion was this an appropriate time frame?54b. Yes No Unknown
If No what was the reason for the delay?54c.
Where was the ERCP undertaken?55c.
Endoscopy unitICU (level 3) HDU (level 2) Theatre
Was the ERCP carriedout under:
55d.Generalanaesthesia
Conscioussedation
Was the patient intubated?55e. Yes No
What was the grade of the endoscopist?55a.
Consultant
Senior trainee (SpR or fellow)directly supervised by consultant
Senior trainee indirectlysupervised by consultant
Senior trainee performed alone
Was a trainee assisting?55b. UnknownYes No
Unconscioussedation
Nosedation
18
Radiology department
If No, in your opinion should they have?52b. Yes No Unknown
If Yes to 52b, why?52c.
In your opinion was this appropriate?53b. Yes No Unknown
If No, please expand on this53c.
Suspected ampullary lesion/ pancreatic mass
(please specify)
5 099388 710422
Was there an endoscopy nurse present?57. Yes No Unknown
58.
bpmhighest
pulsemm Hgsystolic BP %O2
What was the highest pulse, lowest systolic BP and lowest oxygen saturation during ERCP (pleaseinclude the other 2 observations recorded at the time of each measurement)?
What were the findings of the ERCP?59a.
What treatment was undertaken?59b.
Total number of ERCPs duringthis admission?
60.
Were there any complications of ERCP?61a. Yes No
If Yes, what?61b.
CBD stones Stricture Ampullary lesion Pancreas divisum
Normal
Biliary sphincterotomy
Sphincteroplasty
Balloon trawl Plastic stent
Pre-cut sphincterotomy Other
19
Exacerbation of Acute Pancreatitis
Cholangitis
Significant bleeding Death
Other
None
Was the ERCP technically successful?59c. Yes No
What monitoring was used? (Please mark all that apply)56d.
PulsePulse oximetry Blood pressure ECG
Other
In your opinion was documentation ofmonitoring adequate?
56e. Yes No
(please specify)
If No, was sedation undertaken by the endoscopist?56b. Yes No
If Yes to 56b, who undertook themonitoring?
56c. Unknown
Was sedation undertaken by an anaesthetist?56a. Yes No
(please specify)
lowest
systolic BPbpmpulse %O2
%lowest O2bpmpulse mm Hgsystolic BP
mm Hg
Septic shock
(please specify)
Visceral perforation
(please specify)
4 099388 71567120
If the patient had gallstone pancreatitis did they havedefinitive management of their gallstones during thisadmission?
62a.Yes No
H. DEFINITIVE GALLSTONE TREATMEMT
N/A - patient did not havegallstone pancreatitis
What definitive management did thepatient have?
64a. ERCP and sphincterotomy Cholecystectomy
Other
(please specify)
In your opinion was this appropriate?64b. Yes No
If No to 62a, what was the reason for deferral?62b.
Severe pancreatitis withongoing complications
Lack of access to ERCPLack of access toemergency theatres
Other
What was the date/time of the first definitive treatment of gallstones?
h h m m 24 hr clockd d m m y y y y
Time unknownDate unknown
63a.
In your opinion was this acceptable?63b. Yes No
What was the grade of the primary surgeon?65a.
Consultant
Senior trainee (SpR or fellow)supervised by consultant (scrubbed)
Senior trainee supervised byconsultant (unscrubbed)
Senior trainee performed alone
Unknown
Was a trainee assisting?65b. UnknownYes No
What was the grade of the anaesthetist anaesthetising the patient?66.
What was the specialty of the primary surgeon?65c. Please enter the specialty codefrom the list on pg 2 Unknown
What was the sub-specialty interest of the primarysurgeon?
65d. Please enter the specialty codefrom the list on pg 2 Unknown
If the primary surgeon was not a consultant, whatwas the sub-specialty interest of the supervisingconsultant?
65e. Please enter the specialty codefrom the list on pg 2 Unknown
Consultant
Senior trainee (SpR or fellow)supervised by consultant
Senior trainee performed alone
Unknown
Please complete this section if the patient underwent laparoscopic cholecystectomy for management
of their gallstones (during this admission or subsequently)
If No to 62a, in your opinion was this appropriate?62c. Yes No
If No, did waiting list pressures contribute to this?63c. Yes No
(please specify)
5 099388 74978121
To what location did the patient go immediately post recovery?68a.
Upper GI surgery ward
General surgical ward
HPB surgery ward
High dependency unit (level 2 care)
Intensive care unit (level 3 care) Other (please specify)
In your opinion was this location appropriate?68b. Yes No
If No, pleaseexplain why not?
68c.
Did the patient suffer any post-operativecomplications after this surgery?
69a. Yes No
Sepsis
Enteric leak/fistula Intra-abdominal abscess
Wound infection/dehiscenceReturn to theatre Bleeding
Other
If No, what was the reason?67b. Not attempted Technical failure
Did the patient have intraoperative cholangiogramduring laparoscopic cholecystectomy?
67a. Yes No
Surgeon unableto perform
Lack of radiologyequipment
Lack ofradiographer Other
Did this alter the management of the patient?67c. Yes No
If Yes, how?67d.
Post-op ERCP Trans-cystic removal CBD stone Lap CBD exploration
Open CBD exploration Other
Bile duct injuryBile leak
N/A
(please specify)
(please specify)
(please specify)
If Yes, which of the following complications (please mark all that apply)?69b.
N/A
0 099388 716023
Did the patient undergo needle aspiration of necrosis?71a. Yes No Unknown
If Yes, what was the indication for this?71c.
In your opinion was this appropriate?71d. Yes No Unknown
If Yes to 71a, was this decision discussed with aspecialist centre prior to performing?
71f. Yes NoN/A, patient atspecialist centre
Did the patient undergo radiological drain insertion?72a. Yes No Unknown
If Yes, what was the indication for this?72c.
In your opinion, was this appropriate?72d. Yes No Unknown
If Yes to 72a, was this discussed with a specialistcentre prior to insertion?
72f. Yes NoN/A, patient atspecialist centre
Did the patient undergo another IR procedure?73a. Yes No Unknown
If Yes, what procedure?73b.
22
In No, please expand on this?71e.
Did the patient have any radiological intervention ordrainage?
70a. Yes No Unknown
If No, in your opinion should they have?70b. Yes No Unknown
If Yes to 70b, please explain?70c.
Was a sample sent for microbiological examination?71g.
If Yes, what organism was identifed?71h. None
I. MANAGEMENT OF PANCREATIC NECROSIS/COMPLICATIONS
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
If Yes, please state the time and date this occurred71b.
h h m m 24 hr clock d d m m y y y y
Time unknown Date unknown
If Yes, please state the time and date:72b.
If No, please expand on this?72e.
Yes No Unknown
2 099388 71031923
Was surgery undertaken for pancreatic complications74a. YesNo, please go toquestion 87
If Yes what was the reason for surgery?74b.
Infected necrosis Sterile necrosis with worseningmultiple organ dysfuntion syndrome
Other
(please specify)
Suspected infected necrosis
Pancreatic abscess Pancreatic pseudocyst Massive haemorrhage
Gastric outflow obstructionPancreatic fistula
UnknownDate
d d m m y y
Time
h h m m
What was the date and time when surgery was considered?75a.
UnknownDate
d d m m y y
Time
h h m m
What was the date and time when surgery was performed?75b.
In your opinion was timing of surgery appropriate?75c. Yes No Unknown
What type of surgery was undertaken?76.
Percutaneous necrosectomy
Other
(please specify)
Open necrosectomy
Were any of the following considered prior tosurgical intervention?
77a.
Surgical drainage
Endoscopic drainage Radiological drainage
In your opinion should they have been?77b. Yes No
Was the case discussed with a specialist centre?78a. Yes No
Was the patient transferred for surgery?78b. Yes No
If No, please expand75d.
Bowel ischaemia
Endoscopic necrosectomy
Unknown
Unknown
N/A, patient atspecialist centre
9 099388 70973624
Was a pre-op risk assessment performed?79a. Yes No
What scoring system was used ?79b.
What was the grade of the primary surgeon?80a.
Consultant
Senior trainee (SpR or fellow)supervised by consultant (scrubbed)
Senior trainee supervised byconsultant (unscrubbed)
Senior trainee performed alone
Unknown
Was a trainee assisting?80b. UnknownYes No
What was the grade of the anaesthetist anaesthetising the patient?81.
What was the specialty of the primary surgeon?80d.Please enter the specialty codefrom the list on pg 2
Unknown
What was the sub-specialty interest of the primarysurgeon?
80e.Please enter the specialty codefrom the list on pg 2
Unknown
If the primary surgeon was not a consultant, whatwas the sub specialty interest of the supervisingconsultant?
80f.
Please enter the specialty codefrom the list on pg 2
Unknown
Consultant
Senior trainee (SpR or fellow)supervised by consultant
Senior trainee performed alone
Unknown
In your opinion was this an appropriateprocedure for the patient?
What surgical procedure was performed?82a.
82b. Yes No
If No, please expand on your answer?82c.
ASA P-Possum APACHE II
ACSNSQIP risk score Other
Were antibiotics commenced/continued at the time of surgery?83a. Yes No
In your opinion was this appropriate?83b. Yes No
If No, why not?83c.
If Yes, what was the grade of the trainee?80c.Please enter the grade from thelist on pg 2
Unknown
3 099388 70968825
To what location did the patient go immediately post recovery?84a.
Upper GI surgery ward
General surgical ward
HPB surgery ward
High dependency unit (level 2 care)
Intensive care unit (level 3 care) Other (please specify)
In your opinion, was this appropriate?84b. Yes No
If No, why not?84c.
Did the patient suffer any post-operativecomplications after this surgery?
85a. Yes No
Sepsis
Enteric leak/fistula Intra-abdominal abscess
Bleeding
Wound dehiscence
Wound infectionReturn to theatre
Other
If Yes, please mark all that apply:85b.
(please specify)
Pancreatic fistula Bile leak
Did the patient undergo further surgical, IR orendoscopic procedures for treatment of pancreaticcomplications?
86a. Yes No
If Yes please provide details below86b.
4 099388 71640126
Was a nutrition team involved with this patient?
91.
UnknownYes No
Was a nutritional assessment performed?87a. UnknownYes No
When was this performed?87b.
Who performed assessment?87c. Not specifiedQualified Nurse Healthcare Assistant
Other
Was supplemental nutrition considered?
90b. If Yes, when was supplemental nutrition started?
90c. Nasogastric feedingOral diet Build up drinks
What assessments ofnutritional status were used?
92a.
d d m m y y y y
Was the patient referred to a dietitian?88a. UnknownYes No
If Yes, what date was this?88b.
d d m m y y y y
Was the patient seen by a dietitian?88c. UnknownYes No
If Yes, what date was this?88d.
d d m m y y y y
UnknownYes No
How many days was the patient nil by mouth?
d d m m y y y y
What nutrition was used?
Nasojejunal feeding Peripheral parenteral nutrition
Parenteral nutritionvia central line
MUST score Weight BMI
Anthropometricmeasurements
Other
89.
90a.
J. NUTRITION
Were there any delays in initiating nutrition support? UnknownYes No90d.
Were these assessments carried out weeklyduring the admission?
UnknownYes No92b.
If No to 88c, in your opinion should they havebeen?
88e. UnknownYes No
If Yes, why?88f.
In your opinion, was assessment of the patient'snutritional status adequate?
UnknownYes No92c.
Other
(please specify)
(please specify)
Unknown
Not started
None Unknown
(please specify)
3 099388 70915227
Did the patient need pancreatic enzymesupplementation?
UnknownYes No
In your opinion was the blood glucoseadequately monitored?
96a. UnknownYes No
Did the patient require blood glucose control?96b.
What method was used?96c.
IV sliding scale (variablerate insulin infusion)
oral hypoglycaemics subcutaneous insulin
Other
In your opinion, was pancreatic exocrine functionadequately assessed?
In your opinion was blood glucosecontrol adequately managed?
96d. UnknownYes No
UnknownYes No
97a.
97b.
In your opinion, was this adequately treated? UnknownYes No97c.
UnknownYes No
Was the patient commenced on pancreatic enzymes? Yes No
Was the patient advised to follow a low fat diet? Yes No
93.
94.
What enteral feed was used?95.
Unknown
Unknown
(please specify)
Unknown N/A
5 099388 74178528
What was the date of discharge or death?
d d m m y y y y
Unknown98a.
What was the discharge location?98b.
Discharged to previous place of residence
Discharged to other hospital
Patient died during this admission (please go toquestion 101)
Other
K. DISCHARGE
Were further investigations or treatmentsconcerning the patients AP planned for asubsequent appointment?
100a. UnknownYes No
If Yes, what?100b.
In your opinion should the patient have undergoneany further investigations, in addition to anydetailed in 100a, regarding their AP?
100c. UnknownYes No
If Yes, whatand why?
100d.
Was the patient discharged on nutritional support?99a. UnknownYes No
If Yes, what nutritional support was given?99b.
Enteral feeding Oral supplementsParenteral feeding
(please specify)
1 099388 70904829
What was the cause of death recorded?103.
1a
1b
1c
2
Was this case reported to the coroner?104. UnknownYes No
Please return a copy of the coroners report if available
Was a hospital or coronial autopsy performed?105. UnknownYes No
Was death anticipated?101a. UnknownYes No
Was treatment limited or withdrawn?101b. UnknownYes No
Was CPR attempted?101d. Yes No
What level ward was the patient on when they died?102.
Level 3Level 0 Level 1 Level 2 Unknown
What was the patient's resuscitation status?101c. For resuscitation
Not for resuscitation Unknown
Not considered
Please see definitions on pg 2
Was the death discussed in a M & M meeting?106a. UnknownYes No
Please answer the following questions if the patient died during this admission
Please return a copy of the autopsy report if available
If Yes were remediable factors in the care of thispatient identifed?
106b. UnknownYes No
If Yes what action was taken?106c.
If the patient was not discussed at a M & Mmeeting, having now reviewed the case, in youropinion are there lessons to be learned?
107a.
Unknown
Yes No
If Yes, please describe these107b.
N/A
Thank you for taking the time to complete this questionnaire
Unknown
6 099388 709081
NCEPOD
Ground Floor, Abbey House
74 - 76 St John Street
London
EC1M 4DZ
Funding for this study was provided by The Healthcare Quality Improvement Partnership (HQIP) as part ofThe Clinical Outcome Review Programme into medical and surgical care.