Audit of the BHF Arrhythmia Coordinator Posts
Cardiac arrhythmias affect over 700,000 people in England, with atrial fibrillation affecting up to 1% of the population (4% of people aged over 65 years) resulting in sending of almost 1% of the entire NHS budget (Stewart et al, 2004). The addition of chapter 8 on 'Arrhythmias and sudden cardiac death' to Coronary Heart Disease: National Service Framework (NSF) for Coronary Heart Disease (CHD): Modern Standards and Service Models (DH, 2005) heralded the government's acknowledgment of this (previously omitted) important area of cardiac disease.
In response to the situation highlighted by chapter 8, the British Heart Foundation (BHF) decided to award funding for three years to establish 28 coordinator posts in arrhythmia teams across NHS hospitals in England and Wales. The main aim of these roles is to improve the delivery of services.
The BHF Care & Education Research Group - based at the University of York's Department of Health Sciences - will audit the work of these arrhythmia coordinators, over a two-year period, to measure their contribution. The research group will evaluate if primary, secondary and tertiary care services are working together; if all those who are part of the care pathway, including patients, families and carers, are receiving the education and training they need; if an effective holistic patient assessment process is in place; and if ongoing monitoring and auditing of the service is taking place.
How will the audit be conducted?
The audit consists of two parts - a minimum dataset and a special computer database that is in the process of being designed.
The minimum dataset consists of a set of questionnaires and information collected about each patient. It collects the most relevant medical, lifestyle and psychological data (anxiety, depression, quality of life). You can see all of the information that is collected by downloading this MDS Proforma. The patients complete most of the information themselves. Before the audit is launched it will be piloted in a number of sites and necessary adjustments will be made. Previous experience with other audits has demonstrated that collection of data and entry into the specialist database has been carried out with ease. The most up-to-date versions of everything will be made available from the download centre below, or by contacting the project manager Hanif Ismail.
The project database is now complete and consists of a specially written programme that collects the data and can also help you run your programme. It is linked to the computers at CCAD (see below) and the data is automatically uploaded to that system. The version on your desk or laptop PC has the following features:
- easy to use - most people can enter a patient's data in a couple of minutes
- easy to find patients and track them
- can link different workers in different locations over the internet or NHS net (this feature coming)
- can write letters about and to patients (this feature coming)
- new and improved versions updated to your computer overnight
- same system as MINAP which is installed in every acute trust in the UK
- simple 'report buttons' you can press to print out a variety of summaries
- simple search facilities to look for groups of patients
- the ability to output all or some of your data to Excel or other programme for local reports
Why should we audit the work of arrhythmia co-ordinators?
In addition to assessing the value of the BHF's investment, the audit also seeks to:
- yield information to improve the role of the arrhythmia co-ordinators for current and future appointments so that patients are better served and have better outcomes
- provide nurses with ongoing real-time audit of their workload and outcomes
- provide evidence to ensure continuity of funding for the present BHF arrhythmia co-ordinators and create an evidence base and the economic information required for a business case for the employment of an arrhythmia co-ordinator in all arrhythmia tertiary centres
- develop the method of audit that all future arrhythmia co-ordinators could use to benchmark their local service against that of other centres
- fulfil the DoH's requirement that clinicians audit their results
- demonstrate what arrhythmia co-ordinators achieve and to have the evidence to demand better resources
- improve services
What is CCAD?
At present CCAD (Central Cardiac Audit Project) currently covers six clinical "domains". These are:
MINAP | Myocardial infarction National Audit Project (all patients admitted to UK hospitals with a suspected or actual heart attack). Version number has been changed to 5, dataset is unchanged from version 3. |
BCIS | British Cardiac Intervention Society (all patients in UK hospitals undergoing coronary angioplasty) |
NPDB/ICD | National Pacing/Implantable Cardiac Defibrillators DataBase (all patients in UK/Eire hospitals receiving implanted pacemakers/Implantable Cardiac Defibrillators) |
PAEDS | Paediatrics (all children in UK hospitals undergoing surgery or catheter based intervention for heart disease) |
SCTS | Society of CardioThoracic Surgeons (all adults in UK hospitals undergoing cardiac surgery) |
EPS | Cardiac Ablation procedures (all patients in the UK receiving ablation treatment for arrhythmias) |
A Data Set for each clinical domain is collected when a patient undergoes an event or procedure. The data sets are defined by the projects or professional groups listed above. Data is entered directly using the CCAD web based database. Accessed through (https://www.ncasp.org.uk) or (http://ncasp1.ic.nhs.uk)- via secure NHS hospital sites.
The potential benefits of being in the CCAD 'club' go far beyond simple acknowledgement that we are an important part of the patients treatment. It will be possible to link to data such as national mortality databases so you will be able to see if your patient is still alive at any time. Eventually it may be possible for all of the medical data about the MI or surgery to be automatically ‘filled in’ on your database. We will be able to see exactly where patients are not getting rehab are being treated. The dream is that one-day the whole patient journey will be available on-line.
Who is supporting it?
Arrhythmia co-ordinators are being funded by the British Heart Foundation (for the first 3 years) with the expectation and hope that NHS trusts and local PCTs will provide future funding.
How can I find out more?
If you would like further information please contact Hanif Ismail by email (hi502@york.ac.uk), telephone (01904) 321826 or post:
Hanif Ismail
Department of Health Sciences
First Floor, Research Section
Seebohm Teaching Building
University of York
York YO10 5DD
Download Centre
Downloads
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To
save, right click on DOWNLOAD and select "Save Target As..." |
Patient Questionnaires |
Patient Questionnaires. |
DOWNLOAD (DOC) |
Frequently asked questions document explaining eligibility criteria. |
DOWNLOAD (DOC) |
Scoring of Questionnaires. |
DOWNLOAD (DOC) |
Entry instructions for patient questionnaire. |
DOWNLOAD (DOC) |
Audit Information |
Minimum dataset for arrhythmia. |
DOWNLOAD (DOC) |
Arrhythmia CCAD database user guide. |
DOWNLOAD (PDF) |
Password instructions for the arrhythmia database. |
DOWNLOAD (DOC) |
Detailed information for arrhythmia sites. |
DOWNLOAD (DOC) |
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