Hospitals are encouraged to capture data through the web tool as patients progress through the pathway: at pre-op, during the operation, at post-op stages and at discharge.
“If it is live, each site can see in real-time what is happening to this patient cohort,” says Lourtie. This also means that problems can more easily be highlighted early to minimise impact on patients.
“We flag when organisations need to improve,” he explains. “We provide them with quarterly reports, so they can see if there is an issue. And we have implemented a reporting mechanism, so that if metrics fall below a threshold they trigger an unofficial alert to the organisation’s lead, for them to act on quality improvement.”
“Sites can then do their analysis and change processes. We as a royal college can make recommendations, but it is for the hospitals to implement change.”
Having an effective technology partner has proven to be an important part of the audit’s success, Lourtie explains.
The people behind CaseCapture, in this case providing bespoke clinical audit tools, “became part of the team”, he says. “They have been very responsive from the moment we started the audit. They would attend project team meetings and provide insight. If clinicians were discussing what data they wanted to collect, we had a partner that would advise on what that could look like, and how it could be pushed out.”
“The team came with expertise in building audits, and that has meant that those inputting the data have found it simple and easy to use,” he adds. “We have been working with the experts in creating tools to collect data at a national level, who know how to make that work within the NHS, which can be a difficult environment to operate from an IT perspective.”
The royal college has continued to engage with the team behind CaseCapture on other important audit projects. This includes the Perioperative Quality Improvement Programme (PQIP), which is used to understand complications, mortality and patient reported outcomes associated with millions of operations carried out in the NHS each year.
The audit is not mandatory, but approximately 140 hospitals participated at the time of the most recent report. “This has allowed us to create improvement tools and to outline priorities nationally and for each site locally,” says Lourtie.
The National Audit Project, or NAP, has also been built using CaseCapture. This is providing new understanding on complications of low incidence, but high risk. “A CaseCapture dataset was created so hospitals can log their case, so that it can be examined by a review panel.”
And a series of snapshot audits, have also been created to help improve outcomes in particular areas – for example frailty and delirium.