Society for Cardiothoracic Surgery
National Adult Cardiac Surgery Audit
The Society has pioneered collection of surgical information in the UK, having run a register of all major heart operations since 1977. Surgeons are rightly proud of what has been achieved through this approach. The comprehensive collection and feedback of clinical outcomes to members and the public has demonstrated a 25% reduction in mortality for adult cardiac surgery since 2003. There is also international benchmarking of our results showing a 25% better risk adjusted mortality for cardiac surgery than the European average. The SCTS is recognised widely as having been at the forefront of innovation and quality improvement in the NHS for the past decade.
The aim of the Society’s National Adult Cardiac Surgery Audit is to collect information about all major heart operations carried out in the UK and through that to improve quality of care for patients. The audit allows appropriate comparison of clinical performance with national and international standards, and provides useful data on changing trends within the specialty. We are international leaders in the field, having published data down to individual surgeon level since 2005.
The National Institute for Cardiovascular Outcomes Research (NICOR) at UCL, commissioned by the Healthcare Quality Improvement Partnership, is now responsible for running six cardiac national audits in conjunction with the associated professional societies. NICOR is a unique partnership of clinicians, IT experts, analysts, academics and managers, which provides project, technical and analytical support for all of its audits and registries.
The public should be reassured that there are systems in place whereby NICOR contact surgeons and their teams in advance of publication to help them check / validate their data for accuracy (see background note below). For trusts and individual surgeons, it is important that data are risk adjusted appropriately and that steps are taken to ensure the data are accurate prior to publication to avoid misleading patients and the public.
A statement from NICOR regarding data validation in the National Adult Cardiac Surgery Audit can be found at the following link:
Background note: Database validation
The database validation process is as follows:
1. The database currently involves systematic collection of data from trusts across the UK, taken from over 30,000 patients each year. The dataset has over 100 pieces of information so the dataset as a whole is very large, at more than 3m pieces of information submitted each year.
2. There is an agreed required dataset at each contributing centre on all patients undergoing heart surgery.
3. The individual surgeon and their hospitals are responsible for inputting their data and this is then sent into NICOR at UCL. All patient identifiers are anonymised in compliance with data protection legislation and patient confidentiality principles, but this is done in a way that allows long-term mortality to be tracked.4. The data are then aggregated and checked, and then sent back to each trust’s heart unit for validation. This is an important part of the process as the trusts must check the data themselves. This process is in addition to the systems that the Trusts should already have in place for monitoring data quality and outcomes.
5. The data are then corrected as needed, returned to NICOR and there is analysis and development of risk stratification models for outcome measures. There is also regular feedback of risk adjusted clinical outcomes to contributing heart units. The programme followed by the SCTS involves continuous evaluation of outcomes, changing practice and the influence of risk factors.
6. The data are available for patients to see on our website, and to look at the information relating to their local hospital trust and their surgeon.
SCTS makes a major contribution to worldwide cardiovascular surgery research
Two research papers prepared by SCTS from the adult cardiac surgery database, have been listed as some of the most important contributions to cardiovascular surgery research worldwide in 2013 by the leading journal Circulation. The Editors have reviewed all papers published in Circulation and the Circulation subspecialty journals and highlighted 18 of the most important, and the list includes 2 from SCTS; a paper on dynamical modelling approaches for risk adjustment in cardiac surgery and a paper on the performance of the EuroSCORE models for emergency cardiac surgery. The full reference is available at Circulation. 2014;129:e401-e406. doi: 10.1161/CIRCULATIONAHA.114.009715.
SCTS release look-up and iPhone Application for decision support
Today the SCTS, in conjunction with NICOR and the University of Manchester, launch a novel window into the SCTS database to support patient information and clinical decision making. The web-based and iPhone applications allow the SCTS database to be queried in real time by filtering on the various fields in the database, to find out how many patients have undergone surgery in recent years with similar characteristic along with their in-hospital mortality, average length of hospital stay and 1 year mortality rates. We hope this will be a useful addition to the data we have provided previously to support patient care. The website can be accessed by clicking here. The iPhone App is now available from the Apple App store (and can be found by searching on SCTS iData).
SCTS publish iBook manual for patients
SCTS publish a manual for patients on what they can expect from their heart surgeon.
In a drive to put patients first in all their activities, the Society for Cardiothoracic Surgery (SCTS) is today publishing UK Heart Surgery: What Patients can expect from their Surgeons in partnership with the National Institute for Cardiovascular Outcomes Research (NICOR). The report aims to enable patients to understand far more about their recovery after an operation, and the nature of a surgeon’s work.
The document is available both as a downloadable PDF and an iBook. To view the iBook click here. Designed entirely for a patient audience, it describes the procedures heart surgeons undertake, why and how the results of hospitals and surgeons are communicated to the public, and the steps surgeons are taking to continually improve patient experience. This is the first report of its kind to come from one of the surgical specialty associations in the UK. Until now the SCTS, like the rest of the surgical societies, have included information for patients within their publications and communications that are primarily aimed at members in a bid to raise standards among the profession. The SCTS firmly believe that healthcare professionals have a duty to make available to patients as much easy to access, accurate and clear information as possible to help inform their choices. Mr James Roxburgh, President of the Society of Cardiothoracic Surgery, said:
“Producing guidance solely for patients is an important milestone for the Society. We sincerely hope that patients will find this manual helpful and we welcome any feedback on how we can improve it.”
Blue Book online updated
The blue book online is a website to give access to activity data and outomes of adult heart surgery in the UK. We have recently updated the site to include data for all operations up to the end of March 2012. There is inevitably some delay between the operations being undertaken, and us having the data ready to publish, but we hope to have the information for the year to March 2013 available by the end of September 2013.
Adult cardiac surgery is safe 24/7
A study by SCTS and published in the BMJ http://www.bmj.com/content/344/bmj.e67/rr/575993 showed that the excellent results of cardiac surgery in the UK are just as good on Monday as they are on Friday, as well as the weekend. The commitment of cardiac surgeons in the UK to deliver professionally led high quality clinical governance is at the core of our work and we encourage all other specialties to follow our example.