Why collect data?
Data can be used for quality assurance, proving to others (your hospital, Care Quality Commission or other external organisations) and to yourself, that your service is delivering care to an accepted standard. It also be used as a tool to drive quality improvement, comparing your service’s performance over time or with other peer units, to identify either where improvements can be made or where practice changes were effective, or ineffective, in improving care.
So, what data to collect?
Ideally, the data metrics chosen should represent the spectrum of care e.g., antenatal assessment, labour analgesia and anaesthesia for caesarean section, obstetric critical care, and postpartum follow-up. The metrics should reflect many aspects of quality i.e., safety, effectiveness, timeliness, efficiency, equity and patient centeredness. But the metrics need to be balanced, to prevent a well-intentioned improvement in one area leading to an undetected deterioration in another. For example, an improvement in timeliness (reduced time to site a labour epidural) might result in worsened safety (increased rate of accidental dural puncture).
However, the metrics chosen will be influenced by local priorities and relevance, and the ease of collecting the data will be an important factor. A national survey found that while many lead obstetric anaesthetists wanted to collect and use data, they had little support within their hospitals to access and process this data. To help identify what data metrics maybe the most useful to collect for quality improvement, the OAA together with the National Perinatal Epidemiology Unit undertook a Delphi survey of key stakeholders including service users.
How do you collect data?
Ideally the data required would already be routinely collected and stored in a unified hospital electronic health record (eHR) system. The reality is that many hospitals still use paper for collecting some data and even where eHR are available, there may be different eHR used for different stages of the care pathway, for example maternity care and theatre care may use separate systems. It may be necessary to extract unlinked data from multiple data sources. Finding data is easier if it has been coded using standard clinical coding systems but information on anaesthetic care is often not coded and not collected. This is because standard coding systems such as OPCS and ICD have poor nomenclature to describe anaesthetic care, and there is also little incentive for hospitals to routinely collect data on any aspect of anaesthetic care. The introduction of the SNOMED-CT clinical coding system into eHR may help as it has a wide anaesthetic nomenclature. These issues have been recently highlighted.
Collection of data may have information governance implications and therefore the data collection should be registered with the hospital clinical audit team.
How do you present the data?
You may want to collect the data on a dashboard to visualise it. These can be created using MS Excel or dedicated software. The data can be displayed as RAG (red-amber-green) or as a run chart to flag deviance from an agreed standard. However, to set-up a useful dashboard it may be best to engage the help and support of the hospital analyst units.
How do you benchmark?
Data can be used to compare performance of your service over time, but it can be valuable to compare performance with other peer hospitals. Such benchmarking is used by the National Maternity and Perinatal Audit (NMPA) for obstetric care. For benchmarking to work it requires hospital to collect the same data metrics and then to share anonymised aggregated data. The OAA undertook this work until 2015 with the National Obstetric Anaesthetic Database (NOAD) and recently has published an analysis of UK data collected between 2009-2014. More recently there is the ‘GOALPOSTs’ initiative based in London to allow obstetric anaesthetic services in London and surrounding regions to submit and share data.
There is an impetus from the Government to focus on using data to improve patient care but whether that manifests in better data support in hospitals to enable you to provide better care is yet to be seen.
For more information on the GOALPOSTs initiative send an email to bartshealth.goalposts@nhs.net
