Associated organisations and groups
The Dr Foster Unit's current work includes these areas:
Alerting system for outlier trusts
We continue to alert chief executives of trusts to possible high mortality outcomes for a range of diagnose and procedures. This involves reviewing alerts each month and writing to trusts with clear signals. We are sharing our findings with the Care Quality Commission and meet with the CQC on a bimonthly basis. Partly as a result of our alerts, the Care Quality Commission issued a damning report on the delivery of emergency care at Mid Staffordshire NHS Trust.
-
Collaborative projects with clinical colleagues
-
Development of indicators for orthopaedics
-
Time trends analyses of diagnosis on admission in children under 10
-
Mortality and VTE following hip fracture and hospital prophylaxis policies
-
Return to theatre indicators
-
CUSUMs for LoS as continuous variable (with the maths department)
-
Collaborative projects with Imperial College Healthcare NHS Trust.
Collaborative projects with clinical colleagues
These collaborative projects have helped develop and validate healthcare quality indicators other than mortality, including primary angioplasty rates, CT scans for stroke, orthopaedic redo rates and venous thrombo‑embolism and all have direct application in examining variation in healthcare.
Development of indicators for orthopaedics
These include one-year revision and infection rates following hip or knee replacement.
Time trends analyses of diagnosis on admission in children under 10
To assess the burden of disease and as a precursor into a range of projects using primary care data from our department, we have recently described the reasons for admission for children, including how many admissions might be avoidable (short stay without subsequent readmission). This has been published by the journal PLoS One and received media attention. We are also involved in some related work looking at infectious diseases in children such as RSV with the Health Protection Agency and other groups.
Mortality and VTE following hip fracture and hospital prophylaxis policies
This project combines HES data with information collected by telephone questionnaire by an orthopaedic surgeon at Colchester on each English hospital’s post-NOF prophylaxis policy. There is currently no evidence to suggest that heparin, which is recommended, saves lives in these patients, and this project should be the first to provide such information either to support or to refute the guidance. This analysis was presentation orally at ISQua’s conference in October 2009.
Working with a different orthopaedic surgeon, a paper has been accepted by the journal BJBJS on post-op thromboembolic complications for elective surgery before and after the introduction of NICE guidelines.
Return to theatre indicators
We have been working with Dr Foster Research on a project that aims to involve clinics from the private sector in the application of Return to Theatre indicators. Medical directors of about 95% of private clinics were approached in England.
CUSUMs for LoS as continuous variable (with the maths department)
Currently our analyses and reports monitor LOS as a binary variable (does the patient stay longer than the national upper quartile?) but it is possible to compare the whole LOS distribution for each hospital using CUSUMs in a survival analysis framework. An initial paper on this work in collaboration with the maths department at Imperial and an expert in Norway has been accepted by the journal Biometrika. We are carrying out more work on this, including how to take death into account when comparing LOS (and vice versa).
Collaborative projects with Imperial College Healthcare NHS Trust
These include: hospital mortality by day of the week; primary angioplasty; bariatric surgery; volume-outcome relation for cystectomy and assessment of adherence to IOG guidelines; use of A&E data; thoracoscopy and oesophageal cancer.
Further details of these projects can be found on our ICHNT page.
