Neurosurgical National Audit Programme
The Neurosurgical National Audit Programme (NNAP) was established by the Society of British Neurological Surgeons last year. The aim of this programme is to engage units in a comprehensive audit programme that reflects the full spectrum of elective and emergency neurosurgical activity, and to provide a consistent and meaningful approach to reporting on national clinical audit and outcomes data.
NNAP as a key driver of quality improvement
The SBNS recognises national clinical audit as a key approach to improving patient care, outcomes, safety and experience and sees the NNAP as a key driver of this process. Following the lead of our cardiac colleagues who demonstrated dramatic improvements in mortality rates since the national publication of the data, the first step in this process is the establishment of robust databases, audits and registries that can provide reliable data for accurate analyses and reporting.
Promoting a coordinated approach to data submission to the various national datasets, two IT platforms have been selected to host spinal and cranial neurosurgical activity. The ORION platform will host all cranial neurosurgical activity, while the Bluespier/Spine Tango platform will host all spinal neurosurgical activity through the British Spine Registry.
NNAP Governance Committee
A NNAP Governance Committee has also been established comprising representatives from all SBNS nations, an academic advisor, an external medical advisor and a layperson. The role of the NNAP Governance Committee will be to oversee the quality assurance of the programme; to liaise with regional units and advise on the management of outliers; to publish reports; and liaise with public bodies. Separate committees will manage audits and benchmarking based on national datasets including HES data, cancer registries and a full range of subspecialty audits.
A formal performance monitoring process is outlined in the NNAP outlier policy.
NNAP informatics partner
In order to develop the high-level generic aspects of NNAP, the SBNS has chosen to partner with University Hospitals Birmingham Health Informatics Department. The informatics team will provide technical and statistical services including the analysis of HES data together with the linkage of that data to SBNS specialist audits. The partnership will also support the provision of benchmarking data and reports at unit and individual surgeon level.
Consultant Level Outcomes Publication 2014
An integral component of the Neurosurgical National Audit Programme is the Consultant Level Outcomes Publication Programme 2014. In March this year, NHS England announced neurosurgery amongst three new specialties that will be included in the second round of individual consultant outcomes publication. Neurosurgery will join the 10 specialties that last year published nationwide patient mortality results for individual consultants based on national clinical audit data.
For the first phase of this activity, the SBNS is working with the University of Birmingham Hospitals informatics team to compile individual consultant and unit level reports based on HES data. Outcome data will be embedded within searchable consultant profiles on the SBNS-NNAP website and on the NHS Choices website, as stipulated by the Healthcare Quality Improvement Partnership. The SBNS will ensure all neurosurgeons for whom data will be published will be given the opportunity to check and validate their data prior to publication.
Public facing portal and surgeon profiles
With the support of our informatics partner, the SBNS is directing the development of a public facing portal that will host consultant and unit level outcome data. In comparison with the specialties that published last year, the SBNS is more ambitious in its aims and envisages more detailed surgeon level profiles including information about training, subspecialisation, publications, and national clinical audits/registries that individual consultants are currently submitting to. It is envisaged that there would be an interactive map of the British Isles that identifies each of the neurosurgical units, and when selected will highlight key information about the services provided at the respective centre.
For more information about the Neurosurgical National Audit Programme, please contact: Felicity.Evison@uhb.nhs.uk
22 February 2016
NHS England Neurosurgical Outcome Publication for 2015 may now be accessed on the SBNS-NNAP website www.hed.nhs.uk/sbns and on the My NHS website https://www.nhs.uk/Service-Search/consultants/performanceindicators/1039. I am pleased to confirm that there are no consultants or units with a neurosurgical standardised mortality rate more than 3SD above the national mean mortality rate.
The format of the publication on the SBNS-NNAP website is the same as last year. The risk adjusted mortality rates presented are based on three years’ (April 2012- March 2015) of elective procedural activity for consultants and three years’ of whole practice activity for units. A single outcome report has been issued for consultants with both an adult and paediatric practice, recognising the very low mortality rates in neurosurgical paediatric practice. Separate adult and paediatric reports have been issued at unit level. Please note that the My NHS website is a beta site. This year it is publishing unit level outcomes. Due to an NHS software problem it lists hospitals that are not part of the NNAP and do not provide comprehensive neurosurgical services. This error is being corrected by NHS England.
Please inform Felicity Evison, Felicity.Evison@uhb.nhs.uk of any presentational or factual errors.
The SBNS officers will be meeting with Sir Bruce Keogh early in April to discuss the progress of the NNAP, the challenges we face and the opportunities that it presents. We would welcome your feedback and suggestions. Please reply to firstname.lastname@example.org.
The final draft of detailed 205 Unit Outcome Reports will be circulated to Unit Leads, Clinical Directors and Medical Directors later this week. Please would Unit Leads confirm their email address to Suzanne Murray by return.
NNAP Outlier Policy
NNAP OPCS4 Coding spreadsheet