Cohort review

I wouldn’t recommend it to a dog!

What are the benefits of cohort review said to be?

• Accountability– Already accountable for our practice as per NMC

• Improved management of cases– Those managing cases not always present at CR

• Improved contact tracing– We can only screen those identified to us

• Improved outcomes– Our outcomes are already good

Origins of cohort review

• First implemented in Tanzania in 1980s

• Used in NYC in 1993• London 2010• NW region 2012

We have a different starting point

• We have been doing this for years

• “The health visitor’s constant, most particular concern is with the contacts of respiratory tuberculosis.”

• …..”knows the degree of infectivity to which they have been exposed…the conditions under which they live.”

We are already too busy

• Not enough TB Nurses• 50% of cases need ECM• Many TB Nurses work in isolation• It takes too long to fill in the data collection

forms• Difficulty fitting CR in between clinics and

visits, especially DOT

Has cohort review improved anything?

• HIV testing• Entry on to ETS• Standardised risk

assessment

1 2 3 4 5 6 7 80%

10%20%30%40%50%60%70%80%90%

North West

Can it really change management?

• Cases are closed so there is no going back to correct mistakes

• Some patients have not completed treatment when we present them – we are only guessing at their outcome

Is it a true representation of our outcomes?

• We present our own cases

• We may embellish the facts

• Shouldn’t we audit each other’s cases?

Can it really improve contact tracing

• Patients don’t always tell us when we ask who contacts are

• We might as well just drag passers-by off the street

Key people do not attend

• Nurses are left defending their clinicians’ management

• Clinicians don’t attend – case managers are left presenting to themselves

Summary

• Do the benefits justify the effort?• More colleagues from the TB MDT need to attend• Will evidence from cohort review ever translate

into more TB nurses?

No dogs were harmed in the making of this presentation