NDAU

National Neonatal Audit Programme

2011-13

Mike Watkinson

National Neonatal Audit Programme 2011-13

• Communication• Identity• Consolidation• Change• Two year follow up data• Outliers

National Neonatal Audit Programme 2011-13

• Communication with contributors

– Not just one way

– Not just with NNAP leads

– Data checking

– Clearer definitions and guides

National Neonatal Audit Programme 2011-13

• Communication with parents

– Not just one way

– PREMS and PROMS – how do we achieve them?

National Neonatal Audit Programme 2011-13

• Identity

NDAU

National Neonatal Audit Programme 2011-13

NDAU

National Neonatal Audit Programme 2011-13

• Consolidation

– Existing Audit Questions:• Nail them down• Clarify fields used for data• Use of ad hoc fields

– New Questions• Fewer• Reduce lag between introduction & flagging on screen

National Neonatal Audit Programme 2011-13

• Change

– From without:• Not everyone will always use Badger• Challenges of clarity and data mapping

– From within:• Different questions• Completing the audit cycle

National Neonatal Audit Programme 2011-13

• Different questions – 2012

– Catheter related blood stream infections

– ad hoc fields for data collection

National Neonatal Audit Programme 2011-13

DATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long

lineAd hoc scans, ROP screening, blood cultureEpisodic discharge destination, milk at discharge

National Neonatal Audit Programme 2011-13

• CaDATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long

lineAd hoc scans, ROP screening, infectionEpisodic discharge destination, milk at discharge

catheterStay/episode

1 5 14 30 days

National Neonatal Audit Programme 2011-13

• CaDATA EXAMPLEStatic birth weight, gestationDaily HRG, CPAP, neurological status, presence of long

lineAd hoc scans, ROP screening, infectionEpisodic discharge destination, milk at discharge

catheterStay/episode

+ -

1 2 5 8 14 30 days

National Neonatal Audit Programme 2011-13

catheterStay/episode

+ -

The wrong use ofepisodic data

1 2 5 8 14 30 days

National Neonatal Audit Programme 2011-13

catheterStay/episode

+ -

1 2 5 8 14 30 days

The correct use of ad hoc data

National Neonatal Audit Programme 2011-13

Outliers

The National Clinical Audit Advisory Group (NCAAG) has requested that national audits identify outliers.

National Neonatal Audit Programme 2011-13

Outliers

NNAP will identify outliers starting with the 2011 report.

Detection of potential outliers

• NNAP will create funnel plots of outcomes and approach units whose performance is >2 SDs below the mean with an ‘alert’ and those >3 SDs below the mean with an ‘alarm’.

• NNAP may also approach units >2 SDs above the mean to check their data, and to learn from their good practice.

National Neonatal Audit Programme 2011-13

Some audit measures may be more robust than others, and these will be used for the detection of outliers:

1. Measurement of temperature within an hour of birth in babies <28+6 weeks

2. First ROP screening within one week of the window designated by national guidelines

3. Breast milk feeding at discharge home for babies who stay in one unit all the time

4. First consultation with parents within 24 hours of a baby’s admission

National Neonatal Audit Programme 2011-13

• Funnel plots will show the percentage of babies for whom the audit standard is achieved in each NNU.

• For each audit standard, some units will fall 2 SDs below the mean on a purely statistical basis.

• As there are 4 audit standards, individual units will fall >2 SDs below the national mean 0 to 4 times.

• NNAP will approach those under-performing on 4 standards, and possibly some underperforming on 3 standards if their performance raised alarms (>3 SD below mean) in any of the 4 individual audit standards.

• Using this approach, NNAP expects that those units with a broad range of difficulties will be recognised and helped first.

National Neonatal Audit Programme 2011-13

Management of a potential outlier: www.rcpch.ac.uk/nnap Stage What action? Who? Working days?

1

Providers with a performance indicator ‘alert’ or ‘alarm’ require careful scrutiny of the data handling and analyses performed to determine whether there is: ‘No case to answer’ ‘Case to answer’

NDAU in liaison with Clevermed and TNS

10

2 The Lead Clinician and Clinical Governance Lead in the provider organisation informed about the potential outlier status and requested to identify any data errors

NNAP Clinical Lead

10

3 Lead Clinician to provide written response to NNAP. (Project Coordinator/Clinical Lead)

Provider lead clinician

25

4

Review of Lead Clinician’s response to determine: ‘No case to answer’ ‘Case to answer’

NNAP Lead with NDAU or NNAP

Work’ Party

30

5

Contact Lead Clinician by phone, prior to written confirmation of potential outlier status; copied to clinical governance lead, medical director and chief executive. Chief executive advised to inform relevant bodies about the NNAP’s concerns: PCTs, SHAs, CQC. Informed that the NNAP will proceed to publish information of comparative performance that will identify providers.

NNAP Lead Project

Coordinator

10

6 Acknowledgement of receipt of the letter.

Provider CEO

10

7 Public disclosure of comparative information that identifies providers (e.g. annual).

NDAU

NNAP Project Board members 2011

Mike WatkinsonAlan Fenton BAPMNeena Modi RCPCH / NDAUAndrew Wilkinson BAPMRoshan Adappa WalesJane Abbott BLISSMary Passant Networks representativeEugene Statnikov NDAUSridevi Nagarajan NDAUYvonne Silove HQIP Kim Davis RCPCHRita Ranmar RCPCH

NDAU

www.rcpch.ac.uk/nnap

Any questions?

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