ncepod / cepod national confidential enquiry into post operative deaths

National Confidential Enquiryinto Patient Outcome and Death

21 years of promoting improvements in health care

The Precursor- Lunn & Mushin studyInception- 19881st report- 1990StandardsRecommendationsClassification of intervention

Principal precursor to NCEPOD The confidential and anonymous pilot study of mortality associated

with anaesthesia (Lunn and Mushin, 1982)

Covered inpatients from five regions in England, Wales and Scotland

AIMS:

To assess peri-operative information - to improve clinical practice of anaesthesia

To provide comparative figures between regions to facilitate this

To establish an index of contemporary standards - to permit future comparisons

INCEPTIONLunn & Mushin study- Hoped to combine surgical and anaesthetic enterprise but

this proved impossible.

1982 a joint venture between surgical and anaesthetic specialties initiated –

1 yr – 3 regions

CEPOD:Estd 1988Confidential Enquiry into Perioperative Deaths

Reviewed surgical and anaesthetic practice over one year in three regions

NCEPOD - purposeundertaking confidential surveys & research

Publishing the results for -reviewing the management of patients -maintaining & improving standards care -the protection and monitoring of public

health -benefits the public -For research, audit and training

NCEPOD Studies

NCEPOD states that its work:

*Does not involve new treatments

*Does not involve additional therapies/investigations

*Does not involve allocation to treatment groups

*Does not involve randomisation.

How does it select studies?Organizations or individuals wishing to

submit a study complete a Study ProposalProposals should be relevant to the current

clinical environmentShortlist proposalsProposal is developed,Literature

review,Methods exploredProposals presented to SteeringGroupScore proposals and vote best two6

GOAL

“Does this service reach a predetermined standard?”

“What standard does this service achieve?”

Modified nominal group technique

NCEPOD can therefore state that its work:DOES NOT INVOLVE

new treatments

additional therapies or investigations

allocation to treatment groups

randomisation

research ethical approval is not required for its studies

NCEPOD is independent of the Department of Health and the professional associations

Trustees- oversee charitable & corporate governance

Steering Group-nominated representatives of the various medical Royal Colleges & Associations

Five observers- ensure clinical integrity -National Patient Safety Agency (NPSA) -the Coroners Society -the Institute of Healthcare Management -the Scottish Audit of Surgical Mortality -The Institute for Health and Clinical Excellence

NCEPOD is mainly funded by the Department of Health via NPSA

How NCEPOD helps ?Completing NCEPOD questionnaires make a

valuable contribution

Review their clinical management

Personal reflection

Continuing medical and professional development value for individual consultants

Self directed Continuous Professional Development in their appraisal portfolio.

How does NCEPOD select studies?

What happens if it finds a case that gives cause for concern?

Can an individual refer a case to NCEPOD?

How does NCEPOD's work affect patients?

Classification of InterventionIMMEDIATE

URGENT

EXPEDITED

ELECTIVE

I M M E D I A T E

CODE – 1

Life-saving orLimb/organ-saving intervention.

Resuscitation <> with Surgical Rx

Within minutes OPERATE

Next available operating theatre, even “break-in”

to existing lists

U R G E N TCode 2

Acute onset or deterioration

Threatens life, limb or organ survival

Within hours OPERATE

Day-time Emergency listOr Out of hours Emergency theatre

EXPEDITEDCode 3

Stable patient requiring early intervention

Not life threatening

Within days- OPERATE

Elective list “spare” capacity or Day time “emergency”(Not Night)

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E L E C T I V E

Code 4

Planned, Booked , Routine Admission

Time of surgery – Planned

Elective Theatre List

NCEPOD comply with the Data Protection Act, Confidentiality and Ethical Approval

There are two Government Acts, related to confidentiality

*The Data Protection Act 1998

*The NHS Act 2006

ReportsDeaths in Acute Hospitals:

Caring to the End? (2009)

Acute Kidney Injury: Adding Insult to Injury (2009)

Systemic Anti-Cancer Therapy: For better, for worse? (2008)

Coronary Artery Bypass Grafts: The heart of the matter (2008)

Sickle: A sickle crisis? (2008)

Trauma: Who Cares? (2007)

Emergency Admissions: A journey in the right direction? (2007)

The Coroner's Autopsy: Do we deserve better? (2006)

Abdominal Aortic Aneurysm: A service in need of surgery? (2005)

An Acute Problem?(2005)

Scoping our practice (2004)

Who Operates When? II (2003)

Functioning as a Team? (2002)

Changing the Way we Operate (2001)

Then & Now (2000)

Percutaneous Transluminal Coronary Angioplasty (2000)

Interventional Vascular Radiology and Interventional Neurovascular Radiology (2000)

Extremes of Age (1999)

Perioperative Deaths - The 1996/7 Report of NCEPOD






Perioperative Deaths - The 1990 Report of NCEPOD



ncepod / cepod national confidential enquiry into post operative deaths

Documents