2. Making sense of stroke audit data Robin Henderson National Stroke Audit Coordinator Royal Infirmary of Edinburgh

3. What do we as Stroke Audit Coordinators? We are involved in PM = ? PERFORMANCE MONITORING

4. How do we do it? We obtain PIs=? PERFORMANCE INDICATORS 1.Measurements 2. Counts

5. What can be done with them? We can assess performance against national standards - Clinical Standards for Stroke Services: Care of the Patient in the Acute Setting March 2004 We can see if performance of a unit improves over time We can compare performance of units Publish in National Report on Stroke Services in Scottish Hospitals

6. What PIs do we use? The ones we’re asked to use, generally Local variation possible

7. Do we miss any cases?

8. SMR01 List …………. * Joe Bloggs …………. # Henrietta Ford …………. SSCAS List …………. # Henrietta Ford …………. Tom Jones ………….

9. SSCAS No strokeStroke SMRO1No Stroken/a * Stroke ●#

10. SSCAS No strokeStroke SMRO1No Stroken/a 0 Stroke 0634 Hospital X Comment: -

11. SSCAS No strokeStroke SMRO1No Stroken/a 27 Stroke 0873 Hospital Y Comment: -

12. SSCAS No strokeStroke SMRO1No Stroken/a 0 Stroke 19721 Hospital Z Comment: -

13. SSCAS No strokeStroke SMRO1No Stroken/a 177 Stroke 517653 The reality - RIE SMR01 identified 1170 strokes Robin entered 830 strokes into SSCAS – a 71% capture rate if SMRO1 is “true”!

14. FACTOR 1 Joe Bloggs Diagnosis: - Analgesia induced tension headache Incidental finding – right internal capsule infarct (established stroke) on SMR01 list only Tom Jones Diagnosis: - Atypical migraine … decided not to give secondary stroke prevention … Recorded as stroke initially so if not careful could end up on SSCAS only

15. FACTOR 2 Data collection at RIE is suspended when I’m on leave! This brings my capture rate up to 80% if SMRO1 is “true”. FACTOR 3 Notes requested sometimes never appear!

16. Julie Bladen Facilitator (Chronic Disease Registers) Diabetes, CHD And Stroke MCN's, NHS Lothian Audit of case ascertainment and coding for SSCAS data and SMR01 data published in the Stroke Care Audit. She is working on this through the Stroke MCN and with Professor Martin Dennis.

17. How do we report PIs? FOR MEASUREMENTS We report: - Mean Median Minimum Maximum LET’S DO A PRACTICAL EXERCISE!!!

18. Length of Stay in ASU (days) 1 10 15 1 6 9 14 14 6 6 1 10 13 15 0 16 1 9 4 27 11 1 7 8 13 7 2 9 13 86 1 17 20 17 13 3 2 22 39 43 6 8 32 1 6 16 1 4 31 11 Minimum = 0 Maximum =86

19. 0 01111111122344666667788999 1 0011333344556677 Please carry on 2 3 4 5 6 7 8

20. 0 0111111112234466666778899  9 1 0011333344556677 2 027 3 129 4 3 5 6 7 8 6 How many patients? Median Stay = 9 days The stay of 86 is thought of as a leaf 6 on the stem 8.

21. 0 0111111112234466666778899  9 1 0011333344556677 2 027 3 129 4 3 5 6 7 8 6 Draw rectangles round the leaves, rotate and erase the leaves and we have a histogram of the data.

22.  Average (Mean) Stay = 12.56

23. How do we report PIs? COUNTS We report: - Observed Percentage 95% confidence interval for “True” percentage LET’S DO A PRACTICAL EXERCISE!!! SEE spreadsheet SSCASCIEx.xls for Data and CI Table

24. The true proportion is 80% - here we have 21/40 = 52% capture. 52% is close to 50%, the confidence level used.

25. The true proportion is 80% - here we have 37/40 =92% capture. 52% is close to 95%, the confidence level used as in SSCAS.

26. At the Flaig McDowall hospital only common cause variation is evident in the monthly percentages.

27. Thank You Very Much! Telephone 0131 242 6934 e-mail Robin.Henderson@luht.nhs.uk