Problems and Issues Surrounding Prospective Cancer Audit Within a Trust

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Problems and Issues Surrounding Prospective
Cancer Audit Within a Trust
Dawn Sturrock Jillian Mackie 29th January 2002
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Background to Audit

• Funding from Tayside Health Board
• Audit Team (ACT) established at Ninewells
  Hospital in February 1999
• Databases acquired from SCTN and Clatterbridge
  (ovary), modified by ACT
• Designed methods of data collection- audit forms,
  access to existing computer systems
• Prospective audit of 4 cancer sites began 1st
  April 1999 (lung), 1st July 1999 (colorectal,
  breast, ovary)

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Clinical audit is about monitoring not policing
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Problems and Issues

• Funding
• Lack of local and national training in audit
• Lack of support at trust level
• Multidisciplinary Working
• Tracking case notes for missing data
• Interpretation of definitions and standards

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Problems and Issues of Data Analysis

• Lack of training in audit data analysis
• Too much data - higher expectations?
• There are always going to be exceptions
• Massaging of figures
• Change in definitions and standards make it
  difficult to compare data like for like

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Data Protection

• CSAGS group - ? Exceptions for clinical audit
• No access to patient identifiable data
• Will not be part of multidisciplinary team
• No follow up - survival rate

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Managed Clinical Networks and Audit
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Problems and Issues

• Tayside part of North of Scotland
• Cancer Network (NOSCAN)
• Three Cancer Centres
• Dundee
• Aberdeen
• Inverness
• Possible to compare audit data
• between the three centres?
• Comparison of data between MCNs

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IT Solutions

• Standard reporting systems

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Central Repository

• Developed in line with Trusts IMT
• strategy and ECCI
• All Oracle databases with web interfaces
• Audit fields added - all data entered at point
• of care or by secretaries from Consultants
• dictation

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IT Solutions
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Cancer Electronic Health Record

• Oncology, Surgery, Laboratory and Palliative care
• Electronic referral and discharge
• Updated each night
• Communication links from acute to primary care
  and ? throughout MCN
• Automated audit information clinical
  effectiveness
• Patient web site
• DARTS model

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Ideal Audit World

• Audit every cancer site?
• Standardise reporting methods across MCN and
  Scotland
• Persuade the Scottish Executive cancer audit
  requires more funding and recognition
• Be budding statisticians
• Head in Clouds?