Tag FAQ

Entries 51 Total

How to use the ICNARC coding method?

Jul 8, ’11 3:04 PM

Clear instructions and an online tool to generate the diagnostic code when patients are admitted with a diagnosis other than pneumonia (or) when you are reporting a major physiogical event during follow-up.

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Does a patient on noradrenaline score a point in CURB-65?

Jul 8, ’11 3:02 PM

Yes.

Patients with a systolic blood pressure <90, a fall in the systolic of >40 mmHg from baseline or those in receipt of vasopressors should score the “B” point in CURB-65. Similarly if the urea < 7 mmol/l but the patient is receiving renal replacement therapy, or if the patient is ventilated but the respiratory rate is <30 then these would count toward the CURB-65 score.

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Does the patient need to be on antibiotics to be considered eligible?

Jul 8, ’11 2:06 PM

Please only include patients who are on antibiotics and where that is a new or changed prescription within 48 hours of the day of the chest x-ray.

The screening process aims to remove patients from the work list (that is generated from the X-ray system) who are unlikely to have a lower respiratory tract infection. This is the purpose of asking about antibiotics and we would like you to exclude patients who are not on antibiotics as it seems unlikely that their clinical team are working with a possible diagnosis of pneumonia. We also recommend excluding patients where they are on antibiotics but the prescription has not changed in the 48 hours before or after the calendar day of the CXR.

This is intended to stop your needing to continue screening patients who are on antibiotics for other reasons (for example those on long term antibiotics following a splenectomy), and to avoid your screening patients where the antibiotic decision has been reversed by a more senior member of the team.

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How to access the National Outreach Forum’s Monthly Returns page

Jul 6, ’11 12:02 PM

After logging in please look for the NOrF data tab …

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Choose the month for which you wish to enter data … (and watch for the month indicator in the top left to update itself)

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If you cover more than one hospital then make your choice …

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You should now see the following screen …

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All users can view this screen but only authorised users may enter or edit data. If you need to enter data but discover you can’t then please contact the (SPOT)light team (and cc the local Principal Investigator if necessary so we know that it is OK to go ahead and grant you this privilege).

Please note that any questions about this are being handled by the NOrF team who you can email here or visit their webpage.

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Can you explain how we are able to collect patient details without their consent (and why this is necessary)?

May 26, ’11 8:44 AM

We collect the patient identifiers for only one reason and that is so we can link your patients to the NHS Medical Research Information Service (MRIS). This is so we can determine 90 day survival which is a big improvement in quality on hospital mortality. MRIS can only match using name, dob, postcode and NHS number is used by them to confirm the match (but by itself will not do).

To use this information in most instances requires patient consent, and to do so without consent requires an application to the Ethics and Confidentiality Committee (ECC) at the National Information Governance Board (NIGB). This body is authorised under the NHS Act 2006 (Section 251) to grant permission to use this data when seeking consent would be impracticable. Because the deteriorating ward patients are frequently confused and therefore lack capacity; because the population has a high mortality and seeking retrospective consent would be very difficult; and, because only using data from patients who can consent would exclude the sickest patients from the study and therefore introduce bias we have been granted time limited access to this data without consent.

Once we have completed the matching and ascertained 90 day survival then we destroy all identifiers.

We also have to pass a very extensive security check to ensure that the data is held securely.

All these documents and procedures have been reviewed by R&D and the ethics committee.

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(SPOT)light: All patients not just septic patients

May 17, ’11 3:30 PM

A data collection problem has recently come to our attention at one of the (SPOT)light sites.

  • Sites should be submitting data on ALL ‘deteriorating’ ward patients (i.e. those that are assessed by critical care/outreach) not just those with suspected sepsis. Sepsis is a planned subgroup analysis but the protocol requires data for all patients regardless of diagnosis.

Please do let us know as soon as possible if this affects your data.

Steve (on behalf of the (SPOT)light team)

 

 

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Do we include re-admissions to critical care?

Mar 21, ’11 8:10 AM

 

Re-admissions should not need to be routinely included – this applies when the re-admission is for the same diagnosis as the initial admission.

The only circumstance where a re-admission would be included is when a patient who is discharged after one episode of illness develops a new condition that warrants ward evaluation.

 

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Minimum dataset for a (SPOT)light visit

Mar 17, ’11 1:44 PM

We are uploading accrual data for each hospital at the beginning of each month. There is a minimum required dataset for (SPOT)light, and if the data is not present on the record, the accrual will not count towards your monthly figures. The minimum information we require are:

Demographics

  • First name
  • Last name
  • Date of birth
  • Hospital number
  • Postcode (or confirmation that postcode is unknown)

Visit details and outcome

  • Level of care on arrival
  • Level of care on departure
  • Visit outcome (regarding further review)

Vitals (either a value or confirmation that the measurement was not made)

  • Systolic blood pressure
  • Heart rate
  • Oxygen saturations and FiO2
  • Arterial blood gas PaO2
  • GCS or AVPU
  • Platelets
  • Bilirubin
  • Creatinine

 

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Patient lists explained again (sorry!)

Mar 15, ’11 6:14 AM

The concept of the patient list has not been helpful, and we are sorry it has caused so many of you trouble.  The default list you see was from the days when people would have been entering follow-up visits which would also mean all patients would at some point be discharged.  However, now we only accept first visits this is not the case.  We will change this (soon) so that the list shows the last months patients.

In the mean time your other ‘discharged’ patients are still visible.

Click on ‘All hospitals’ and you will see your hospital followed by numbers for “Total – Empty – Open – Closed – Multiple”.  Clicking on these numbers will take you to

  • Empty patients – i.e. patients with no visit attached to their demographic details
  • Open – the default list of undischarged patients
  • Closed – the list of discharged patients
  • Multiple – patients with more than one visit

 

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ICU admissions from theatre

Feb 9, ’11 5:38 AM

Q: I need some clarification re criteria for Spot. Do I enclude patients who have been planned and emergency operations but have not been planned admissions to HDU/ITU but during the operation the patient,s condition has deteriorated and the outcome is to be admitted to critical care.

A:  Probably not – they would still need a ward visit (we are not considering evaluation or assessment in theatre to be considered a visit as there are too many differences).  If they had a ward visit by critical care before hand then yes … or if critical care are asked to see the patient in recovery because they don’t look well enough to return to the ward then this would also be yes.

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