Page last updated: 10-NOV-2009

Surgical Profiles

Statistical Publication Notice

10 November 2009

Surgical Profiles

INTRODUCTION

Surgical profiles is a project involving the Information Services Division of National Services Scotland, NHS Quality Improvement Scotland and all NHS Boards in Scotland.
 
The surgical profiles project aims to contribute to the development of a culture whereby individuals and organisations providing clinical services routinely use data to stimulate reflective practice and are also accountable for using such information to drive improvements in patient care.
 
Specifically, the aim of this project is to lead to better and more widespread use of existing Scotland-wide data sources in guiding improvements to surgical care and outcomes for patients.
 
The approach used for this project has two parts. Firstly, each NHS Board is given a surgical profile - a suite of clinical indicators presented at NHS Board and hospital level. Indicators are presented on Statistical Process Control charts in two ways, so that NHS Boards / hospitals can make comparisons with other Boards / hospitals and they can also monitor their own data over time. Indicators are presented for all surgical specialties, general/vascular surgery, orthopaedic surgery, paediatric surgery, urology, gynaecology and ear, nose and throat surgery. Examples of indicators include, 120 day mortality, readmissions, volume of procedures and post-operative length of stay. A statistical process control chart is a simple way of presenting data that can help guide quality improvement activities, by flagging up areas where there appears to be marked variation and where further local investigation might be beneficial. While the presentation of clinical indicators as league tables is advised against, the use of control charts has become increasingly popular.
 
Secondly, a process has been designed to facilitate the use of these data in practice whereby NHS Boards are asked to provide a formal response to NHS Quality Improvement Scotland explaining how the data are being reviewed and acted upon locally. For this process each NHS Board is given guidance on how to respond to the profile, the responses are then reviewed by an independent clinically-led panel and feedback is provided to each NHS Board on their response.

This is the second cycle of the surgical profiles project. NHS Boards were given their surgical profile in December 2008 and were asked to provide a formal response to NHS Quality Improvement Scotland by April 2009.
 
This release presents a national summary report produced by NHS Quality Improvement Scotland summarising the second cycle of the surgical profiles project and highlighting how data from the second cycle has been reviewed and acted upon locally to guide improvement to surgical care and outcomes for patients.
 
To coincide with this national summary report NHS Boards profiles are now being released into the public domain. The national summary report and the surgical profiles for each NHS Board are available at http://www.indicators.scot.nhs.uk/Index.htm

KEY POINTS

  • Fifteen NHS Boards were given a surgical profile. A review panel concluded that 14 NHS Boards provided a response describing appropriate efforts to review and act upon the data locally.
  • Six NHS Boards provided a response that was considered ‘highly satisfactory’ – three times the number in the initial cycle.
  • One NHS Board did not provide an adequate response.
  • Collectively, the NHS Board responses have improved for the second cycle of the surgical profile and throughout Scotland there have been a wide range of actions to review and respond to the profile and facilitate improvements in patient care.

INTERPRETATION

The surgical profile has been designed to be interpreted and used locally by those providing surgical care, to stimulate reflection on surgical services and to lead to identifying opportunities for improving patient care.
 
Variation across NHS Boards / hospitals in the clinical indicators presented in the surgical profile may reflect a number of different factors, e.g. characteristics of the patients (case-mix), the quality of clinical care, inaccuracies in the coding of the hospital’s data or variation due to chance. It is only possible to understand the reasons for variation by having a good understanding of local circumstances. Even then, sometimes considerable additional work is required (e.g. case note reviews) to understand causes for variation. Therefore, the surgical profiles should not be used alone to make reliable judgements about the quality of patient care in a particular NHS Board / hospital and doing so could lead to incorrect conclusions being made.

DETAILED FINDINGS

  • Of the 15 NHS Boards who were given a surgical profile, six NHS Boards (NHS Fife, NHS Forth Valley, NHS Grampian, NHS Greater Glasgow & Clyde, NHS Highland and NHS Lothian) provided a response that was considered to be ‘highly satisfactory’.
  • Eight NHS Boards provided a response that was considered to be ‘satisfactory’ (NHS Ayrshire & Arran, NHS Borders, NHS Dumfries & Galloway, Golden Jubilee National Hospital, NHS Lanarkshire, NHS Orkney, NHS Shetland and NHS Tayside).
  • One NHS Board (NHS Western Isles) did not provide an adequate response and NHS Quality Improvement Scotland are following this up.
  • The review panel agreed that NHS Board responses have improved for the second cycle of the profiles compared to the initial cycle - with six NHS Boards receiving a ‘highly satisfactory’ response compared to two in the initial cycle.
  • The surgical profiles have been reviewed at boards by senior clinicians and managers, and in many NHS Boards clinical directors and clinical specialty leads played a key role in reviewing the data from their own areas of expertise. Clinical governance and clinical effectiveness staff are also involved in responding to the data.
  • The review panel has been encouraged by the actions carried out by NHS Boards following the review of their surgical profile. These actions include improving the quality of their data (e.g. coding issues), improving governance systems within the Board / hospital and actions related to clinical care.
  • As part of their response each NHS Board was asked to provide an action plan in response to their profile. Each Board has been asked to provide an update to these actions to NHS Quality Improvement Scotland in December 2009.
-----------------------------------------------------------------

MAIN CONTACTS:

Amy McKeon
Senior Information Analyst
0131 275 6559
amy.mckeon@nhs.net

Dr Donald Morrison
Clinical Indicators Programme Manager
NHS Quality Improvement Scotland
0141 225 6994
donald.morrison@nhs.net

-----------------------------------------------------------------

PRE-RELEASE ACCESS:

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
NHS QIS
Surgical Profiles Review Panel
NHS HPS
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
 
-----------------------------------------------------------------

HISTORY OF THIS PUBLICATION:

Last Published: September 2007
Next Due: 2011
Data Available Since: Most of the charts are for year ending September 2007. Trend data is presented for October 2002 – September 2007.
 

 


Main contact: Email Amy McKeon