Embed Size (px)
DESCRIPTION
Experiences of Benchmarking and the effect of new patients. Mrs Dorothy Shaw Chief BMS Stepping Hill Hospital Stockport. STEPPING HILL HOSPITAL. District general hospital near Manchester 815 Beds Excluding Mental Health And Maternity. Anticoagulant Service Run by Haematology. - PowerPoint PPT Presentation
Citation preview
Experiences of Benchmarking and the effect of new patients
Mrs Dorothy ShawChief BMS
Stepping Hill HospitalStockport
STEPPING HILL HOSPITALSTEPPING HILL HOSPITAL
District general hospital near Manchester District general hospital near Manchester
815 Beds Excluding Mental Health 815 Beds Excluding Mental Health
And MaternityAnd Maternity
Anticoagulant Service Run by Anticoagulant Service Run by HaematologyHaematology
BMS StaffBMS Staff ChiefChief SeniorSenior Total of 5 BMS Staff who can dose at Total of 5 BMS Staff who can dose at
clinicsclinics 2 Part time MLA staff2 Part time MLA staff 3 Hospital Clinics + 10 Outreach clinics3 Hospital Clinics + 10 Outreach clinics 2670 active patients on DAWN Oct 20022670 active patients on DAWN Oct 2002
DAWN System Purchased DAWN System Purchased Jan1999Jan1999
Joined Benchmarking At Same Joined Benchmarking At Same TimeTime
Before DAWN Audit of stable patientsBefore DAWN Audit of stable patients
60% INRs in Range60% INRs in Range
Decision to put all available information Decision to put all available information onto dawn to aid dosing includingonto dawn to aid dosing including
a) New patientsa) New patients
AFs started in hospital outpatient clinic AFs started in hospital outpatient clinic baseline INR, 9 mg on 2 days test 3baseline INR, 9 mg on 2 days test 3rdrd day day All patients loaded in hospital, inpatient All patients loaded in hospital, inpatient dosage by hospital doctors, discharge dosage by hospital doctors, discharge dosage by laboratorydosage by laboratory
Transfers from other hospitalsTransfers from other hospitals
b) Existing patientsb) Existing patients
Dosage information from hospital stay Dosage information from hospital stay
% INRs within 0.5 units of Target INR for April 2001 Run, Site 14 and All Ranges
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
Rs
This chart shows the % INRs within 0.5 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% INRs within 0.75 units of Target INR for April 2001 Run, Site 14 and All Ranges
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
RS
This chart shows the % INRs within 0.75 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% INRs within 0.5 units of Target INR for April 2001 Run, Site 14 and Range 2.50
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
Rs
This chart shows the % INRs within 0.5 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% Time In Range Comparison for April 2001 Run, Site 14 and Range 2.50
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% T
ime
In R
ange
This chart shows the time in range for all sites in ascending order.The bar below the line shows the time below range; the bar above the line shows the time above range.
Your site is highlighted in red.
Benchmarking Run: April 2001Participating Site: 14Target INR Range: 2.50
Your Site – Split by Weeks from Start of Treatment
Weeks TherapyAll 1 - 3 4 - 9 10 - 21 22+
Number of patients 2360 398 413 444 1958
Number of INRs 16292 2018 1265 1433 11576
% Time in range (Rosendaal) 66.49 40.28 49.60 59.88 69.06
% Time above range (Rosendaal) 15.92 19.88 11.51 14.52 16.18
% Time below range (Rosendaal) 17.59 39.83 38.90 25.60 14.76
% Time in 2.0-4.4 (Rosendaal) 81.00 55.93 59.55 72.87 83.95
% Time in range (Duxbury) 63.76 40.75 47.87 56.16 65.81
Mean % Time in Range (Rosendaal) 64.68 39.69 47.53 56.69 69.17
SD % Time in Range (Rosendaal) 26.13 27.54 33.32 32.81 24.82
% INRs in range 52.88 35.23 44.07 49.57 57.89
% INRs above range 18.87 17.52 12.89 16.50 20.16
% INRs below range 28.26 47.25 43.04 33.93 21.95
% INRs within 0.5 units of target 52.88 35.23 44.07 49.57 57.89
% INRs within 0.75 units of target 67.43 48.42 59.88 66.30 72.29
% INRs > 5 2.07 3.62 1.72 2.42 1.76
% INRs < 1.3 4.29 17.92 3.44 3.44 1.77
BENCHMARKING BENCHMARKING
Monitoring of performanceMonitoring of performance site - site comparisonsite - site comparison BSH guidelinesBSH guidelines internal auditinternal audit
OUTSIDE INFLUENCESOUTSIDE INFLUENCES
Afs started in hospital clinic baseline INR Afs started in hospital clinic baseline INR and loading doses recorded onto and loading doses recorded onto commentscomments
Start with INR on 3rd dayStart with INR on 3rd day record inpatient doses onto commentsrecord inpatient doses onto comments record information from transfers onto record information from transfers onto
commentscomments
RESULTING IN RESULTING IN
Information on DAWN related only to inrs Information on DAWN related only to inrs and dosages done in anticoagulant clinicand dosages done in anticoagulant clinic
% INRs within 0.5 units of Target INR for April 2002 Run, Site 14 and All Ranges
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
Rs
This chart shows the % INRs within 0.5 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% INRs within 0.75 units of Target INR for April 2002 Run, Site 14 and All Ranges
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
RS
This chart shows the % INRs within 0.75 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% INRs within 0.5 units of Target INR for April 2002 Run, Site 14 and Range 2.50
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
Rs
This chart shows the % INRs within 0.5 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% INRs within 0.75 units of Target INR for April 2002 Run, Site 14 and Range 2.50
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% IN
RS
This chart shows the % INRs within 0.75 units of the Target INR for all sites in ascending order.The red line across the chart shows the BSH target. Sites below the target are blue.
Sites above the target are gold. Your site is highlighted in red.
% Time In Range Comparison for April 2002 Run, Site 14 and Range 2.50
1972
1057
1576
5283
1055
1989
1161
149
899
262
1468
5481
2432
2225
93 810
1744
1234
2230
994
1619
1231
1566
2393
1287
2875
2764
1559
1171
1027
618
1758
826
748
2282
1845
1784
371
225
1781
2906
913
357
851
1245
1525
1374
1478
2533
2418
1473
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
% T
ime
In R
ang
e
This chart shows the time in range for all sites in ascending order.The bar below the line shows the time below range; the bar above the line shows the time above range.
Your site is highlighted in red. The numbers of patients for each site are shown at the bottom of the chart.
Benchmarking Run: April 2002Participating Site: 14Target INR Range: 2.50
Your Site – Split by Weeks from Start of Treatment
Weeks TherapyAll 1 - 3 4 - 9 10 - 21 22+
Number of patients 2418 361 416 428 2024
Number of INRs 14081 832 1171 1226 10852
% Time in range (Rosendaal) 76.35 52.13 57.00 68.46 78.39
% Time above range (Rosendaal) 8.82 16.08 6.70 6.80 8.93
% Time below range (Rosendaal) 14.83 31.79 36.31 24.75 12.68
% Time in 2.0-4.4 (Rosendaal) 84.37 65.21 62.96 74.54 86.54
% Time in range (Duxbury) 73.64 52.82 55.38 67.29 75.20
Mean % Time in Range (Rosendaal) 73.04 50.86 53.80 64.14 76.66
SD % Time in Range (Rosendaal) 25.34 35.86 34.75 34.35 23.57
% INRs in range 63.33 51.42 48.67 59.26 66.56
% INRs above range 12.87 19.28 9.66 8.66 13.18
% INRs below range 23.80 29.30 41.67 32.07 20.27
% INRs within 0.5 units of target 60.83 48.70 47.35 57.70 63.83
% INRs within 0.75 units of target 75.35 63.91 65.25 73.55 77.74
% INRs > 5 1.40 2.72 0.85 0.92 1.40
% INRs < 1.3 1.17 2.10 1.99 1.57 0.94
Benchmarking Run: April 2002Participating Site: 14Target INR Range: 2.50
Your Site – Comparison with Previous Runs
This Run Last Run But 1
Number of patients 2418 2360
Number of INRs 14081 16292
% Time in range (Rosendaal) 76.35 66.49
% Time above range (Rosendaal) 8.82 15.92
% Time below range (Rosendaal) 14.83 17.59
% Time in 2.0-4.4 (Rosendaal) 84.37 81.00
% Time in range (Duxbury) 73.64 63.76
Mean % Time in Range (Rosendaal) 73.04 64.68
SD % Time in Range (Rosendaal) 25.34 26.13
% INRs in range 63.33 52.88
% INRs above range 12.87 18.87
% INRs below range 23.80 28.26
% INRs within 0.5 units of target 60.83 52.88
% INRs within 0.75 units of target 75.35 67.43
% INRs > 5 1.40 2.07
% INRs < 1.3 1.17 4.29
Comparison for new patients Comparison for new patients weeks therapy 1 -3weeks therapy 1 -3
April 2001 April 2002April 2001 April 2002 no of pts 398 361no of pts 398 361 no of INRs 2018 832no of INRs 2018 832 % time in range 40.28 52.13% time in range 40.28 52.13 % INRs in range 35.23 51.42% INRs in range 35.23 51.42 % INRs below range 47.25 29.30% INRs below range 47.25 29.30 % INRs > 5 3.62 2.72% INRs > 5 3.62 2.72 % INRs <1.3 17.92 2.10 % INRs <1.3 17.92 2.10
CONCLUSIONSCONCLUSIONS
Monitoring of clinic performanceMonitoring of clinic performance Hospital and outreach clinicsHospital and outreach clinics disregard other influencesdisregard other influences improve performance in appropriate INR improve performance in appropriate INR
rangesranges Internal audit - Inpatient dosing auditInternal audit - Inpatient dosing audit Dawn is working well in the clinicDawn is working well in the clinic
