1. Stacey Farrow TB Nurse Specialist The Royal Bolton Hospital

3. Cohort review is a systematic quarterly review of the management of every case of TB for treatment completion and contact investigation. RCN 2012

4. TB cohort audit is a collaboration between TB nurses, TB physicians, epidemiologists, public health specialists and analysts, to collate and review clinical, epidemiological and service-related information with the aim of improving clinical and public health outcomes and identifying systematic issues relating to workforce, education and training, or quality of care. North West TB Cohort Audit 2014

5. New York Experience Munstiff,ahuja, king,Udeagu,Dorsinville, frieden and Fujiwara, 2006)  Reduced numbers by 72%  Focused on treatment completion rates London Experience NCLDN 2010  Increased completion rates  Increased HIV testing  Led to improved patient and public health outcomes

6. The Royal College of Nursing: Tuberculosis Case Management and Cohort Review: Guidance for health professionals National Institute for Health and Clinical Excellence (NICE) : Identifying and management of tuberculosis in heard to reach groups.

7.  Improves patient outcomes

10.  Improves data collection  Improves case management  Increases accountability for outcomes  Enables work force planning  Forum for discussion  Peer review/support

11.  Reveals Strengths and weakness  Identify/ sharing good practice  Friendly rivalry  Motivates staff

12.  Is it a witch hunt?  Is it time consuming?

14.  Is it a witch hunt?  Is it time consuming?  Only as good as Data  Is it cost effective?  Difficult to implement

15.  Outcomes focused on identified areas of practice which need support/improvement  Educational opportunity  Peer support

16. “I feel like it's a safety net” “I think cohort review keeps us on track and I think it really has a direct impact on patient safety” “It’s sort of a reflective learning exercise for us and the TBNSs to see what could have been done better or what could have been done differently” “It's sort of built this idea of collegiate working, you know that you want to work together, that you are colleagues and you can help each other out” “It was refreshing just to go through patients from all over the region and see the TB nurses presenting their patients, how much work they put in to achieving good outcomes” “You can raise issues and challenge decisions in a positive way”