Comparisons between hospitals

Many hospitals which are currently collecting data are not included

because too few data are available.

How can these data help improve patient care?

• By identifying methods which increase performance?

• By highlighting services requiring more investment or re design

A normal distribution

02

4

68

10

12

1416

18

20

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Mean = 10Median = 10

Days

No.

A skewed distribution

02

4

68

10

12

1416

18

20

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Mean = 7.3Median = 6

Days

No.

A very skewed distribution

02

4

68

10

12

1416

18

20

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Mean = 4.9Median = 3

Days

No.

Inpatients

Dates of Data Collection

Hospital Date Started End DateARI 01/09/2000 31/10/2003DGRI 01/01/2003 01/07/2003Raigmore 09/06/2003 21/11/2003RIE 16/05/2001 21/03/2003St Johns 01/04/2001 30/10/2003WGH 01/07/2001 30/06/2003

No. of Stroke admissions available for analysis

0

200

400

600

800

1000

1200

1400

ARI DGRI Raigmore RIE St J WGH

Measures of Access to Stroke Unit

• Proportion admitted to any stroke unit

• Proportion of in patient stay spent on stroke unit

• Delay from admission to entry to stroke unit

Could add

• Proportion entering stroke unit within 1 day of admission

Proportions admitted to Stroke Unit

01020304050

60708090

100

ARI DGRI Raigmore RIE StJ WGH

Mean Delay in accessing SU

0

0.5

1

1.5

2

2.5

3

ARI DGRI Raigmore RIE StJ WGH

St Johns Hospital

• St Johns had only 47% accessing stroke unit– have now obtained funding to increase beds

from 11 to 17– Have employed a staff grade doctor and

therapists to help run additional beds

Proportions scanned within 2 days of admission

01020304050

60708090

100

ARI DGRI Raigmore RIE StJ WGH

Length of Stay in HospitalMean Median

05

10152025

3035404550

ARI DGRI Raigmore RIE StJ WGH

Proportion of ischaemic stroke discharged on secondary prevention

0102030405060708090

100

DGRI Raigmore RIE St J WGH

AntiplateletStatinDiureticACE I

Proportions of patients with ischaemic stroke and AF discharged on Warfarin

01020304050

60708090

100

DGRI Raigmore RIE StJ WGH

Royal Infirmary of Edinburgh

• Low rates of discharge on secondary prevention

• Need to check some notes to see if contraindicated

• Need to introduce a secondary prevention protocol and police it

Neurovascular clinics

Dates of Data Collection

Hospital Date Started End DateDGRI 01/01/2003 01/07/2003St Johns 01/04/2001 30/10/2003WGH 01/07/2001 30/06/2003

No. of Neurovascular Clinic patients available for analysis

0

200

400

600

800

1000

1200

1400

1600

1800

DGRI St J WGH

Diagnoses in Neurovascular clinic

0

10

20

30

40

50

60

DGRI StJ WGH

StrokeTIAEyeOther

Median delay from referral to assessment (days)

0

2

4

6

8

10

12

14

DGRI StJ WGH

Delays from Assessment to Duplex (days)

0

5

10

15

20

25

DGRI St J WGH

MeanMedian

Delays from Assessment to Brain scan for stroke (days)

0

1

2

3

4

5

6

7

8

DGRI St J WGH

MeanMedian

Delays from Assessment to Echo for stroke/TIA (days)

0

5

10

15

20

25

30

35

40

45

DGRI St J WGH

MeanMedian

Delays to investigation

• WGH has got Duplex system sorted

• DGRI - have got CT scanning sorted

• St Johns has got echo system sorted

Treatment of Definite Ischaemic events with aspirin

0102030405060708090

100

DGRI St J WGH

At eventAssessmentRecommended

Treatment of Definite Ischaemic events with dipyridamole

0

10

20

30

40

50

60

70

80

DGRI St J WGH

At eventAssessmentRecommended

Treatment of Definite Ischaemic events with clopidogrel

0

2

4

6

8

10

12

14

DGRI St J WGH

At eventAssessmentRecommended

Treatment of Neurovascular clinic patients with definite ischaemic

events with BP lowering

0102030405060708090

100

DGRI St J WGH

At eventAssessmentRecommended