ndau national neonatal audit programme 2011-13 mike watkinson
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NDAU
National Neonatal Audit Programme
2011-13
Mike Watkinson
National Neonatal Audit Programme 2011-13
• Communication• Identity• Consolidation• Change• Two year follow up data• Outliers
National Neonatal Audit Programme 2011-13
• Communication with contributors
– Not just one way
– Not just with NNAP leads
– Data checking
– Clearer definitions and guides
National Neonatal Audit Programme 2011-13
• Communication with parents
– Not just one way
– PREMS and PROMS – how do we achieve them?
National Neonatal Audit Programme 2011-13
• Consolidation
– Existing Audit Questions:• Nail them down• Clarify fields used for data• Use of ad hoc fields
– New Questions• Fewer• Reduce lag between introduction & flagging on screen
National Neonatal Audit Programme 2011-13
• Change
– From without:• Not everyone will always use Badger• Challenges of clarity and data mapping
– From within:• Different questions• Completing the audit cycle
National Neonatal Audit Programme 2011-13
• Different questions – 2012
– Catheter related blood stream infections
– ad hoc fields for data collection
National Neonatal Audit Programme 2011-13
DATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long
lineAd hoc scans, ROP screening, blood cultureEpisodic discharge destination, milk at discharge
National Neonatal Audit Programme 2011-13
• CaDATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long
lineAd hoc scans, ROP screening, infectionEpisodic discharge destination, milk at discharge
catheterStay/episode
1 5 14 30 days
National Neonatal Audit Programme 2011-13
• CaDATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long
lineAd hoc scans, ROP screening, infectionEpisodic discharge destination, milk at discharge
catheterStay/episode
+ -
1 2 5 8 14 30 days
National Neonatal Audit Programme 2011-13
catheterStay/episode
+ -
The wrong use ofepisodic data
1 2 5 8 14 30 days
National Neonatal Audit Programme 2011-13
catheterStay/episode
+ -
1 2 5 8 14 30 days
The correct use of ad hoc data
National Neonatal Audit Programme 2011-13
Outliers
The National Clinical Audit Advisory Group (NCAAG) has requested that national audits identify outliers.
National Neonatal Audit Programme 2011-13
Outliers
NNAP will identify outliers starting with the 2011 report.
Detection of potential outliers
• NNAP will create funnel plots of outcomes and approach units whose performance is >2 SDs below the mean with an ‘alert’ and those >3 SDs below the mean with an ‘alarm’.
• NNAP may also approach units >2 SDs above the mean to check their data, and to learn from their good practice.
National Neonatal Audit Programme 2011-13
Some audit measures may be more robust than others, and these will be used for the detection of outliers:
1. Measurement of temperature within an hour of birth in babies <28+6 weeks
2. First ROP screening within one week of the window designated by national guidelines
3. Breast milk feeding at discharge home for babies who stay in one unit all the time
4. First consultation with parents within 24 hours of a baby’s admission
National Neonatal Audit Programme 2011-13
• Funnel plots will show the percentage of babies for whom the audit standard is achieved in each NNU.
• For each audit standard, some units will fall 2 SDs below the mean on a purely statistical basis.
• As there are 4 audit standards, individual units will fall >2 SDs below the national mean 0 to 4 times.
• NNAP will approach those under-performing on 4 standards, and possibly some underperforming on 3 standards if their performance raised alarms (>3 SD below mean) in any of the 4 individual audit standards.
• Using this approach, NNAP expects that those units with a broad range of difficulties will be recognised and helped first.
National Neonatal Audit Programme 2011-13
Management of a potential outlier: www.rcpch.ac.uk/nnap Stage What action? Who? Working days?
1
Providers with a performance indicator ‘alert’ or ‘alarm’ require careful scrutiny of the data handling and analyses performed to determine whether there is: ‘No case to answer’ ‘Case to answer’
NDAU in liaison with Clevermed and TNS
10
2 The Lead Clinician and Clinical Governance Lead in the provider organisation informed about the potential outlier status and requested to identify any data errors
NNAP Clinical Lead
10
3 Lead Clinician to provide written response to NNAP. (Project Coordinator/Clinical Lead)
Provider lead clinician
25
4
Review of Lead Clinician’s response to determine: ‘No case to answer’ ‘Case to answer’
NNAP Lead with NDAU or NNAP
Work’ Party
30
5
Contact Lead Clinician by phone, prior to written confirmation of potential outlier status; copied to clinical governance lead, medical director and chief executive. Chief executive advised to inform relevant bodies about the NNAP’s concerns: PCTs, SHAs, CQC. Informed that the NNAP will proceed to publish information of comparative performance that will identify providers.
NNAP Lead Project
Coordinator
10
6 Acknowledgement of receipt of the letter.
Provider CEO
10
7 Public disclosure of comparative information that identifies providers (e.g. annual).
NDAU
NNAP Project Board members 2011
Mike WatkinsonAlan Fenton BAPMNeena Modi RCPCH / NDAUAndrew Wilkinson BAPMRoshan Adappa WalesJane Abbott BLISSMary Passant Networks representativeEugene Statnikov NDAUSridevi Nagarajan NDAUYvonne Silove HQIP Kim Davis RCPCHRita Ranmar RCPCH