Q: How do Royal Wolverhampton
Hospitals NHS Trust use National
Clinical Audit to Achieve Local
Service Improvement
National Audit – A blunt
Instrument
Standardised Mortality Ratio
Actual Hospital Mortality (%)
divided by Expected Mortality
(%) = SMR
SMR Long Term Trend
SMR and Total Patients Treated
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
1994
1996
1998
2000
2002
2004
Dr C E Corbett
2006
2008
2010
2012
2014
Analysis of Standardised Mortality
Ratio (S.M.R)
 Entire Patient Cohort
 Number of Patients:
 Mean Score (SD):
 Mean Risk of Death (SD):
 Died:
 Mortality %:
 SMR:
 Effective Cost per Survivor:
Dr C E Corbett
597
17.0 ( 8.8)
27.8 ( 25.0)
179
29.98
0.98
£7,778.21
Analysis of Standardised Mortality
Ratio (S.M.R)
 Time on Ward > 3 Days







Number of Patients:
Mean Score (SD):
Mean Risk of Death (SD):
Died:
Mortality %:
SMR:
Effective Cost per Survivor:
Dr C E Corbett
84
20.4 ( 8.4)
39.8 ( 24.1)
38
45.24
1.22
£12,421.96
Action Plan & Introduction of
Changes
 Working closely with the introduction of
“Vitalpac”, continued use of Outreach and
MEWS it is hoped that patients who would
benefit form early ICU admission will be
identified more rapidly. This in turn will
address the key problem area of delayed
ward transfers to ICU.
Dr C E Corbett
Are we doing the right
thing?
&
Are we doing it right?
Clinical Audit in ICU
 We at New Cross have a history and culture
of participation in Local, National &
International Audit & Research projects.
 We have been collecting data since 1994
Daily Patient Flow
Weekly Analysis
Dr C E Corbett
Annual Audit of the Critical Care Unit
2009/2010
New Cross Hospital
Private & Confidential
An Independent Report
Prepared by:
Dr T Chang
Clinical Audit & Research Department
Medical Associated Software House
in Association with
Dr C E Corbett
Clinical Audit Department
New Cross Hospital
Dr C E Corbett
2009/2010
ICNARC Reason for Admission
Discharged Alive
Number
Died in Unit
Mort %
Cardiovascular
170
110
60
35.2
Dermatological
2
2
0
0.0
17
16
1
5.9
238
216
22
9.2
81
73
8
9.9
Haematological/Immunological
9
7
2
22.2
Musculoskeletal
5
5
0
0.0
Neurological
50
39
11
22.0
Poisoning
16
16
0
0.0
Endocrine, Metabolic, Thermoregulation
Gastrointestinal
Genito-Urinary
Psychiatric
0
0
0
0.0
Respiratory
216
187
29
13.4
19
16
3
15.8
823
687
136
16.5
Trauma
Total
2008/2009
ICNARC Reason for Admission
Discharged Alive
Number
Died in Unit
Mort %
Cardiovascular
147
85
62
42.1
Dermatological
5
5
0
0.0
15
14
1
6.6
Endocrine, Metabolic, Thermoregulation
Gastrointestinal
207
189
18
8.7
Genito-Urinary
81
76
5
6.1
Haematological/Immunological
11
9
2
18.2
8
8
0
0.0
Neurological
42
32
10
23.8
Poisoning
27
25
2
7.4
Psychiatric
0
0
0
0.0
Respiratory
218
177
41
18.8
22
19
3
13.6
783
639
144
18.4
Musculoskeletal
Trauma
Total
Dr C E Corbett
2009/2010
2008/2009
Number Ventilated
319
350
% of Total Admissions
38.7%
44.7%
Died In Unit
81
106
Unit Mortality %
25.4%
30.2%
No with Completed Hospital Outcome
319
350
Total Died in Hospital
99
125
Hospital Mortality %
31.6%
35.7%
SMR:
0.96
0.99
APACHE II Risk of Death (SD) – Survivors
27.4 (20.5)
29.1 (19.8)
APACHE II Risk of Death (SD) – Died
44.3 (23.9)
52.3 (20.9)
Days Ventilated - Survivors
5.5
5.8
Days Ventilated – Non-Survivors
8.6
8.4
Days in unit - Survivors
11.0
10.2
Days in unit – Non-Survivors
7.5
7.1
Number of Non-Ventilated Patients
506
433
Died in unit
55
38
Unit Mortality %
10.8%
8.8%
No with Completed Hospital Outcome
495
433
Total Died in Hospital
79
60
Hospital Mortality %
15.9%
13.8%
SMR:
0.45
0.61
APACHE II Risk of Death (SD) – Survivors
15.2 (12.4)
15.4 (12.6)
APACHE II Risk of Death (SD) – Died
34.7 (20.2)
35.8 (20.4)
Days in Unit - Survivors
4.0
4.0
Days in Unit – Non-Survivors
6.0
6.0
Total Number of Patients
823
783
Dr C E Corbett
Conclusion
 The secret of our success:
 This is in maintaining the momentum and
data integrity of the national audit by
utilisation of data set to fuel local audit and
management reporting.
Dr C E Corbett
Q: How do Royal Wolverhampton
Hospitals NHS Trust use National
Clinical Audit to Achieve Local
Service Improvement
A: We Don’t
We make use of the national audit
data to benchmark and measure
success and failure of local
changes in practice .