ICHNT
Developments within Imperial College Healthcare NHS Trust (ICHNT) mean that we are increasingly involved in and leading their program of information-driven healthcare. We have been able to draw upon the considerable body of clinical expertise within the trust, and this has been particularly useful in the development of new indicators. We continue to champion the methods and analyses developed within the unit at the trust. This work with ICHNT gives us an insight into the attitudes and needs in terms of information of frontline clinicians and managers that aids our methodological development.
Use of A&E data
In an ongoing project with ICHNT, we are trying to predict the factors that affect whether the four-hour wait target is met and to model flow from casualty through the assessment unit (MAU) and the rest of the hospital. We recently looked at whether the area within the A&E department (majors, minors or resus) affected the waiting time at St Mary’s Hospital, adjusting for multiple factors. We presented these results recently to the senior A&E staff and plan some further analyses, including looking at to which wards admitted patients are sent.
Quality indicators and outcomes analysis projects
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.
- Volume-outcome relation for cystectomy and assessment of adherence to IOG guidelines
We have been working with a urologist to determine what are the causes of the apparent relation between volume (number of procedures performed) and outcome (mortality, complications, re-operation rates and readmissions). How much is due to the trust-level factors, patient (case-mix) factors and surgeon volume (how many ops the surgeon does annually)? This has not been done properly before in the UK and is relevant to the Darzi reports. The mortality analysis has been accepted by the BMJ. A related article on whether hospitals are adhering to the 2003 IOG guidelines on minimum number of procedures performed annually was published recently. Future related work is planned with the vascular surgeons at Imperial.
- Primary angioplasty
We have examined primary angioplasty rates in England. This procedure is recognised to be the best treatment for a heart attack. However, not every hospital in England is equipped with primary angioplasty facilities. We described the variation in angioplasty rates in those hospitals that are equipped to carry out this intervention, with some hospitals treating almost every patient with primary angioplasty and many other hospitals using less efficient treatments. Our results suggest that this disparity might cause over 1,500 extra deaths per year in England.
- Hospital mortality by day of the week
A joint collaboration with Professor Derek Bell (Chair in Acute Medicine), this project looks at excess weekend mortality. The paper, although accepted, is still awaiting publication in the journal QSHC
- Thoracoscopy and oesophageal cancer
Thoracoscopy is a new surgical approach to oesophagectomy and might have better outcomes than the classical open approach in terms of lower mortality, readmission rates, and others. However, there is no evidence in scientific literature of the benefits of thoracoscopy. We described how this new approach has been exponentially increasing in England for the past 10 years, in spite of the lack of evidence. Moreover we explored the potential benefits or harmfulness of thoracoscopy for the excision of oesophageal cancer. A paper has been submitted to the Annals of Surgery.
- Bariatric surgery
The number of operations to treat severe obesity (bariatric surgery) is increasing dramatically in England. Laparoscopy is a new approach to performing such operations and might have better outcomes than the classical approach in terms of mortality and readmission rates. We have an F2 doctor working with Dr Elaine Burns in the Department of Surgery exploring these data. There has been a dramatic increase in the number of procedures carried out.
