NHS Digital Data Release Register - reformatted
Royal College of Anaesthetists
Project 1 — DARS-NIC-355855-R4G6G
Opt outs honoured: Y, N, Yes - patient objections upheld
Sensitive: Sensitive, and Non Sensitive
When: 2016/04 (or before) — 2018/12.
Repeats: Ongoing, One-Off
Legal basis: Section 251 approval is in place for the flow of identifiable data, Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012)
Categories: Identifiable, Anonymised - ICO code compliant
- MRIS - Cause of Death Report
- MRIS - Cohort Event Notification Report
- Hospital Episode Statistics Admitted Patient Care
- MRIS - Flagging Current Status Report
Benefits derived from the research so far: - Data is being used by CQC on their Dashboard (no record level data - all aggregated with small numbers suppressed) - Data being used on MyNHS website (no record level data - all aggregated with small numbers suppressed) - Work has started on introducing a BPT for Emergency Laparotomy using the audit data. - Headlines from reports of the last 3 years: o national 30-day mortality rate falling from 11.8 per cent to 10.6 per cent over three years, representing approximately 300 patients lives saved each year compared to 2013-2014. o Making recommendations in the reports for local participating sites to follow o Running regional NELA Quality Improvement workshops to assist hospital sites in using their local data to improve patient care Reports/Publications Created: - 3 National Patient Audit Reports published in 2015, 2016, 2017 - 2 Organisational Audit reports published in 2014 and 2017 - Quarterly hospital reports provided to participants since the start of 2017 Conferences/Presentations Attended: There are multiple as the NELA Project Team attend many meetings throughout the year. Here are a few of the more recent ones: - -Emergency Laparotomy Collaborative Event - 2017 - -HQIP - Patient First Event - 2017 - -RCoA Patient Safety Conference - 2017 - -AAGBI Winter Scientific Meeting – January 2017 - - Sweden emergency surgery meeting - 14th March 2017 - - Royal Society of Medicine - Anaesthesia & Surgery Mtg – April 2017 - - Age Anaesthesia Association Meeting 25th May 2017 - - ASGBI Surgical Conference – May 2017 - - HSRUK Symposium 2017 - July 6th-7th, 2017
Emergency abdominal surgery (or emergency laparotomy) is associated with significant morbidity and mortality worldwide. The aim of The National Emergency Laparotomy Audit (NELA) is to enable the improvement of the quality of care of patients undergoing emergency laparotomy by providing high quality comparative information of the clinical practice and outcomes of all NHS providers of emergency laparotomy in England and Wales. NELA is a national clinical audit commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical and Patient Outcomes Programme (NCAPOP). The RCoA and RCS wish to link the patient records submitted to NELA with the Hospital Episode Statistics (HES) records for those patients. The NELA records relate only to an individual admission, and by linking to inpatient HES data, the Audit will be able to provide more precise and relevant information to NHS hospitals by allowing the RCoA and RCS to describe longer term outcomes (e.g., readmission rates) and to improve RCoA’s and RCS’s risk-adjustment models by using the extensive information on conditions held within HES. The RCoA and RCS also wish to link the patient records submitted to NELA with the Office for National Statistics (ONS) Death Register on a quarterly basis to enable the Audit to monitor changes in postoperative outcomes (both short and longer-term mortality) for those patients. Access to this linked information will support this national clinical audit to improve the quality of care within NHS hospitals for a high-risk patient group. The objectives of the Audit are: 1. To enable secondary care providers to improve the delivery of care to patients undergoing emergency laparotomy using information produced by the audit; 2. To provide comparative information on the organisation of care by providers of Emergency Laparotomy. 3. To provide comparative information on patient outcomes following surgery for Emergency Laparotomy. 4. To facilitate the development of effective change (quality improvement) initiatives and thereby spread examples of best practice and help local providers make the best possible use of audit results HQIP have commissioned The Royal College of Anaesthetists (RCoA) to deliver the audit. RCoA are working in partnership with the Clinical Effectiveness Unit of the Royal College of Surgeons (RCS). In summary, the purpose of this request is to support national clinical audit, quality improvement within hospital, and research on methods to monitor surgical outcomes. The NELA team is planning to request patient level clinical data from Intensive Care National Audit and Research Centre (ICNARC).
The NELA audit is highly relevant to current clinical practice and publications will allow widespread disseminate of the findings amongst health professionals. Linkage to the HES/ONS data allows the Audit to report more extensively on patterns of care beyond the initial hospital admission and longer-term outcomes, such as 90-day mortality. The Audit is able to examine issues such as readmission rates and the most common reasons for these post-discharge complications, e.g.: respiratory complications and anastomotic leaks. The audit will produce useful indicators that describe the standard of care in a variety of clinical areas. The indicators will identify NHS providers that are performing well and those requiring improvement to the quality of care received by patients. Ongoing improvement in the processes of care and clinical outcomes should lead to a reduction in the postoperative mortality rates and thus an overall improvement in patient outcomes. Outcomes will be measured by re-auditing individual sites and therefore regular data linkage would be required. It is hoped that this improvement in care would be identified by the end of the currently proposed commissioned audit period (Dec 2018). The intended audience for the audit annual reports are clinicians, healthcare professionals, Medical Directors, Chief Executives, audit managers, commissioners, NHS England, public and patients. Trusts will use the process indicators and outcomes reported in the annual reports to assess their care against national standards and benchmark against other NHS trusts. This will enable providers to identify areas requiring improvement and take action which in turn will provide a benefit to patient care. Reporting will identify whether NHS trusts are meeting national guidance such as NICE recommendations and will identify variations in the provision of care. The Audit outcomes such as postoperative mortality are risk-adjusted and any potential outlying trusts are identified as part of the Audit outlier policy. Any Trust showing as an alarm will be notified which will allow for investigation into the cause; this can be attributable to either data quality issues or clinical practice. This notification will enable the trust to address the cause and either review the data submitted to the Audit or their clinical practice. Any resultant improvements in clinical practice will directly impact on improvements in patient care. The trust profiles are publically available, providing transparency and enabling patient choice. Publishing in peer-reviewed journals will allow greater discussion of the strengths and weaknesses of the results, and will provide the benefit of peer-review of the work from third parties. It is anticipated that the reports produced as a result of the audit will contribute to clinical guidance and national policy.
The linked dataset will be a product of this process and will enhance the quality of the comparative data for the audit in subsequent years. The NELA is commissioned to produce a "State of the Nation" annual report each year. The first report using patient level information was published in June 2015 and is available to view on the NELA website. Subsequent reports are scheduled to be published June 2016 and June 2017. In order to more widely disseminate the findings of the audit , additional scientific publications will be produced. These outputs will be in the form of peer-review articles and conference presentations. The results of the audit will also be disseminated at professional medical conferences and in peer-reviewed journals (e.g. BMJ, BJA, ASGBI journal, AAGBI journal) at the time of the launch of the report or shortly after. Publications related to the Audit methods (e.g., a risk-adjustment model) rather than information of clinical practice and outcomes will be published on an ad hoc basis. In response to participant feedback a Quality Improvement Report Dashboard has been created on the NELA Online Web Tool to assist sites with audit data collection and to promote local Quality Improvement work (Local hospital data can only be viewed by registered local participants). The first phase of the Dashboard which has now been launched focuses on Case Ascertainment and Patient Demographics. The Patient Demographics section allows local participants to view some basic information on their hospital's population of patients undergoing emergency laparotomy, and how it compares to the audit-wide average. It focuses on characteristics such as patient age and operative urgency. The Case Ascertainment aims at increasing case completeness and submission by providing a monthly list of cases entered/completed/not completed. The next phase of the Dashboard will focus much more on Quality Improvement, feeding back key QI indicators and comparing hospital's local data with national audit-wide averages. Some of the measures reported back will include; Documentation of risk, Direct Admission to critical care etc. The Royal College of Anaesthetists are currently in the process of developing the QI dashboard and hope to make further additions in the next few months. All outputs will be aggregated with small numbers suppressed and will follow the ONS/HES guide on reporting.
The RCoA are the principal data processors for NELA and manage the extraction of the records from the NELA IT system. RCoA will send the file of patient identifiers and the NELA ID to the HSCIC for linkage to HES and ONS fields. RCoA will receive Pseudonymised files from the HSCIC that contain the HES and ONS fields with the NELA ID variable added. In all cases, the data received from HSCIC will not be linked back to the identifiable NELA database which contains date of death for patients that have died in hospital from hospital reports. An extract of anonymised data which includes date of death is taken from the NELA database. This data will be linked to the HES-ONS data via the NELA ID. A copy of the pseudonymised data fields along with the unique NELA ID will be sent to RCS. The only identifiable fields received by RCS are ONS Date of Death and Cause of death. The full Date of Death is required to be able to calculate survival at multiple time points (30 day, 90 day, etc.). RCS will not use ONS Date of Death to identify any individual patients. Analysts from RCS who work on the pseudonymised data set do not have access to the identifiable data set held by the RoCA. All individuals with access to the data are employed by RCoA or RCS. RCoA or RCS will not be linking HES/ONS data with any other dataset. Linkage with any other datasets would be subject to a future application and would be supported by an appropriate legal basis. The majority of the analysis will be conducted by the RCS statisticians who form part of the NELA Project Team. Statisticians from RCoA will be involved in some of the data analysis however this is restricted to the preparation of NELA National Reports.
Project 2 — DARS-NIC-63347-R8J2M
Opt outs honoured: N (Reasonable Expectation)
Sensitive: Non Sensitive, and Sensitive
When: 2017/12 — 2018/09.
Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Categories: Anonymised - ICO code compliant, Identifiable
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Critical Care
- Office for National Statistics Mortality Data
- Civil Registration - Deaths
Perioperative Quality Improvement Programme (PQIP) is a new study run by the National Institute of Academic Anaesthesia, Health Services Research Centre (NIAA-HSRC), and the Royal College of Anaesthestists (RCoA), and the Health Foundation, with a planned initial duration of 5 years. NIAA and NIAA Health Services Research Centre are departments within RCoA. University College London is the sponsor and the Health Foundation is funding the study. Neither the University College London nor the Health Foundation is acting as Data Controllers in relation to this application. University College London Hospitals NHS Foundation Trust is a joint data processor with RCoA. All processing of data is carried out at RCoA. PQIP will measure risk-adjusted morbidity and mortality, as well as process and patient-reported outcome data in patients undergoing major surgery. The dataset has been informed by previous systematic and structured reviews, and over 60 UK NHS hospitals have so far volunteered to take part. RCoA will collect objective risk, process and outcome data on patients during their inpatient stay. The PQIP database will only collect data for the primary admission when patients undergo their planned operation. By linking to Hospital Episode Statistics (HES) data and Office of National Statistics (ONS) mortality data at record level RCoA will be able to analyse a more complete dataset. This is necessary to track adverse outcomes which occur after discharge from hospital (e.g. readmission within 30/90 days of surgery - from HES data; longer term mortality - from ONS). The objectives for PQIP are: Primary Objective - To measure the rate of postoperative complications after major inpatient surgery in the UK and how it varies between hospitals. RCoA primary analysis will measure risk-adjusted variation between providers (comparing observed: expected ratios) in morbidity, mortality and failure to rescue rates. Secondary Objectives – (a) What is the failure to rescue rate in NHS hospitals and how does it vary? (b) What is the relationship between short-term complications and longer-term health related quality of life (HRQOL), and can longer-term HRQOL be improved through reducing postoperative complications? (c) Can the quality of care for patients undergoing surgery in NHS hospitals be improved through the feedback of data to clinicians and managers, leading to improvements in complications and failure to rescue? Aggregated outcome data will be reported back to participating hospitals to inform of their outcomes (hospital length of stay data, mortality data), together with data collected within the PQIP dataset. In summary, the purpose of this request is to support a UK wide clinical study, involving quality improvement within hospitals, and research on methods to monitor surgical outcomes. Through measuring process and outcome measures for patients undergoing major surgery the aim is to improve the quality of care for patients throughout the UK. The NIAA-HSRC is a body which sits within the remit of the Royal College of Anaesthetists. UCL (University College London) are acting as sponsors for the study, with the joint research office (a partnership between UCL and UCLH). The Health Foundation have supplied grant funding for the project but have no involvement in the design, day to day running of the project, or the outputs created from the study.
PQIP will produce indicators that describe the standard of care for patients undergoing a variety of major surgical procedures throughout the UK. These indicators will identify NHS providers that are performing well and those needing to improve the quality of care provided to patients. Ongoing improvement through feedback of this data should lead to a reduction in the postoperative morbidity and mortality rates and thus an overall improvement in patient outcomes. Outcomes will be measured by ongoing data collection at hospital sites throughout the project duration and therefore regular 6-monthly data linkage would be required. It is hoped that the data collected will lead to steady, continuous improvement in care throughout the whole duration of PQIP, but within this period, a clear signal of improvement by the publication of the second annual report planned for March 2019 . Linkage to the HES/ONS data allows PQIP to report more extensively on patterns of care for patients undergoing major surgery beyond the initial hospital admission to longer-term outcomes, such as 90-day mortality. PQIP will be able to examine issues such as complication rates across different types of surgery and hospital trusts in order to identify areas for improvement in patient care. The intended audience for the PQIP annual reports are clinicians, healthcare professionals, Medical Directors, Chief Executives, audit managers, commissioners, NHS England, public and patients. Trusts will use the process indicators and outcomes reported in the annual reports to assess their care against national standards and benchmark against other NHS trusts. This will enable providers to identify areas requiring improvement and take action which in turn will provide a benefit to patient care. PQIP has been designed as a quality improvement programme (based on work previously done in the US - NSQIP). RCoA will be reporting performance over time back to NHS trusts through quarterly reports. As part of the study there will also be qualitative research work, which will assess the uptake of PQIP, and look at barriers to adoption. RCoA will also use feedback from trusts on the reporting structure and metrics and adapt these if required to maximise impact. RCoA have initially deliberately chosen not to benchmark trusts against each other, instead choosing to look for continuous improvement from trusts. We will provide national references for metrics as that data becomes available. Reporting will identify whether NHS trusts are meeting national guidance such as NICE recommendations and will identify variations in the provision of care. Trusts showing poor performance will be notified to allow for investigation into the cause; this can be attributable to either data quality issues or clinical practice. RCoA will report metrics back to trusts, and look for continuous improvement. As part of the qualitative research taking place within PQIP the study will assess quality improvement interventions undertaken by trusts, and offer local support for initiatives to improve quality. The annual reports and trust profiles will be openly available, providing transparency and enabling patient choice. The initial planned quarterly reports will be made available to trusts taking part in PQIP. The format of larger annual reports is yet to be decided, but these are likely to be openly available. There is also a desire to make the quarterly reports openly available but RCoA are assessing the views of local teams. Publishing in peer-reviewed journals will allow greater discussion of the strengths and weaknesses of the results, and will provide the benefit of peer-review of the work from third parties. It is anticipated that the reports produced as a result of the audit will contribute to clinical guidance and national policy.
The purpose of the NHS Digital linkage is to reduce the data collection burden of local sites with regards to readmission rates, allow RCoA to collect mortality data, and to validate their sampling strategy. The NHS Digital linked data will be used to produce quarterly/annual reports and academic outputs. Quarterly reports will be produced reporting type of surgery or hospital level outcomes. These will be targeted to specific groups involved within the PQIP research team (nurses, research team, anaesthetists, surgical team, and hospital managers). A full PQIP report and executive summary will be produced annually, with the first planned for March 2018. In addition, research manuscripts using PQIP data will be submitted to open access peer reviewed journals. Wider dissemination to the surgical and anaesthetic profession will be achieved using the resources of the RCoA and other stakeholder Royal Colleges and the NIAA-HSRC, including websites, press releases, written and electronic communications. Different resources will be used to disseminate information to different stakeholders, using a multi-media approach and lay representation to ensure effective communication to the public. RCoA will be submitting journals to Anaesthesia, British Journal of Anaesthesia, The New England Journal of Medicine, or The Lancet. There may also be publications to other journals that are produced using the PQIP data. The target dates for these publications will be in years 2-3 of the study onwards (November 2018-2019 onwards).
The RCoA are the main data processors for PQIP and manage the extraction of the records from the PQIP IT system (which is stored on UKFast servers). The RCoA are requesting two separate linkages the first will include sending patient identifiers for the consented cohort to NHS Digital for linkage and the second request involves a linkage via OPCS procedure codes where no patient identifiers will be sent to NHS Digital and RCoA will receive back pseudonymised HES data. No patient identifiers will flow back to NHS Digital for this second linkage. For the first data linkage the RCoA will send the file of patient identifiers and the PQIP ID to NHS Digital for linkage to HES and ONS fields. Patients who RCoA supply identifiable data to NHS Digital for the linkage (those included in the PQIP study) have been consented. The second linkage (via OPCS procedure codes) will not have consented, this linkage does not involve identifiable data being shared or linked. No ONS mortality data is being requested for this second linkage. In order to allow this, a file (P) containing these patient identifiers only will be extracted from the full dataset hosted in the PQIP webtool, and will be sent securely to a trusted Data Linkage Service (TDLS). For mortality tracking data and HES data, this would be NHS Digital. File (P) will contain the following identifiers: • PQIP study identifier • NHS number • Date of Birth • Sex • Postcode For each patient in the file, NHS Digital will identify the matching ONS or HES ID. NHS Digital will then return to the Royal College of Anaesthetists a ‘look-up’ file (L) containing only the PQIP identifier and the HES or ONS ID identifiers, and a MATCH_RANK field which indicates the strength of the match. An extract of pseudonymised HES or ONS mortality data will then be requested from NHS Digital for all the list of IDs contained in file (L). The file (L) will be placed in the secure RCoA server accessible only to the project data manager. It will then be used to link the pseudonymised ONS or HES data to the pseudonymised PQIP data for analysis. The pseudonymised PQIP extract will not contain NHS number, postcode or date of birth. Patients will be labelled with the PQIP identifier only. The pseudonymised dataset is analysed to produce results for PQIP reports and other PQIP outputs. All outputs produced will be pseudonymised aggregated level data with small numbers suppressed in line with HES analysis guidelines. RCoA will also request a second linkage as part of the same data sharing agreement, this is separate to the consented cohort. This will be to enable the PQIP team to obtain denominator data for the PQIP patient cohort. This data will be used to ensure the sampling technique for PQIP is representative of the total population of patients undergoing major surgery across the UK. This second linkage will be done via OPCS procedure codes. The PQIP team will provide NHS Digital with a list of OPCS procedure codes that are included within the PQIP study. RCoA will then ask for pseudonymised, non-sensitive record level data for those patients including HES data such as hospital length of stay, 30-day readmission and 30-day/90-day mortality flags. The pseudonymised data NHS Digital supply will be used by the PQIP research team (the PQIP research team consists of NIAA-HSRC employees who are substantive employees of the RCoA and also substantive employees of UCLH) to produce hospital reports and academic outputs. The only access to patient identifiable data held within the PQIP database will be from substantive employees from the RCoA and only for the purpose of completing the NHS Digital linkages. The pseudonymised data (only containing PQIP identifier) will be passed on to the PQIP research team for data analysis. RCoA will not link the HES/ONS data with any other dataset other than the PQIP data. Linkage with any other datasets would be subject to a future application and would be supported by an appropriate legal basis. RCoA also plan to link to PEDW in Wales, and to NHS Scotland. These other linkages will be performed separately to the NHS Digital linkage and will not involve the sharing of NHS Digital data with Wales or Scotland. The linkages to central NHS held data will only involve the transfer of data for patients recruited in those nations, so for example there will be no data transferred to NHS Digital for patients recruited in an NHS Scotland institution. NHS Digital data will not be disseminated to Wales or Scotland for the purpose of this data linkage. Once RCoA have received data from NHS Digital, this will be linked via PQIP patient study number to the data held within the PQIP webtool, and this will be exported (pseudonymised with only PQIP patient number, no other identifiable data) to the PQIP team who will be performing the data analysis. The analysis of pseudonymised linked data will be conducted by the RCoA statisticians/fellows who form part of the PQIP research team. The PQIP data analysis/research team are either substantive employees of UCLH or the RCoA. All processing of ONS data will be in line with ONS standard conditions. All outputs and publications contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.