Our CHD Improvement Programme team have prepared these answers. They can help you understand the audit process.
We want to answer more of your questions; send them to qis.chdauditprogramme@nhs.net. We will reply and post our answer here.
Click on a Q&A section to find answers to your questions:
- Submitting your audit cases
- The audit and the Standards
- Audit of primary care practice
- Atrial Fibrillation (AF)
- Heart Failure
- Acute Coronary Syndrome (ACS)
- Cardiac Rehabilitation.
- SCI ACS
1. Submitting your audit cases
“We do not have enough cases for the audit.”
Submit those you do have by the agreed deadline.
“We do not have enough submission forms.”
We will supply your Managed Clinical Network (MCN) with more forms. Contact Mel Miller or Christine Hill on 0131 623 4702 or 0131 623 4749.
“What happens if we miss the submission deadline?”
We will accept submissions a day or two past the submission date.
“How do we submit our forms?”
Give your completed forms to your MCN office. They will return your forms to us.
2. The audit and the Standards
“Will the ‘final’ CHD Standards affect the audits?”
It is possible that the second audit may be slightly different to the first. But, we do not expect the Standards to have any major impact on this work.
We will alert your MCN to any major changes to either data items or the audit process before the second audit begins.
“The audit’s ethnicity codes are different to others we have seen.”
Our ethnicity codes meet the standards set by the
National Clinical Dataset Development Programme (NCDDP) . These codes cover our main headings and allow us to analyse the data we collect.
3. Audit of primary care practice
“How did you select which primary care practices to involve?”
A sample size was agreed using Information Services Division’s (ISD’s) data on primary practices by NHS board area.
“Will you ask for a case note review?”
We will not ask you to carry out a case note review for this audit. We will draw all the data we need from your practice’s electronic record.
“Who will extract this data?”
We anticipate a member of your practice team or an MCN representative to run the extract for us.
“Will we be given technical/financial support?”
You can ask your MCN for support if needed. But the process will be straightforward.
“When will we receive the extraction programme?”
We hope to make the extraction programme available as soon as possible. We will give full programme instructions including how to submit the results.
“Should our audit data be submitted on one form or split by CHP? Some NHS boards will have more than one CHP and this would allow CHPs to report back to Boards?”
We will ask MCNs to submit the data for your NHS board. This includes any CHP split and helps us to analyse the data at the correct level.
“Will there be a search for VISION practices?”
We will be commissioning a similar search/extraction for VISION practices.
4. Atrial Fibrillation (AF)
“Why is the primary care the focus?”
The audit looks at primary care because:
- there is a need to highlight the level of care currently available in the primary care setting
- hospital based systems are not able to support AF data collection
- the majority of AF cases are managed in primary care.
5. Heart Failure
“When will the first audit results be available?”
MCNs will get the results from the first round of data collection in July.
“What will the second data collection period be?”
The data collection period is yet to be confirmed.
“Will the second round of data be collected in the same way?”
We are working with Professor Dargie and his team to confirm the method of data collection. The team will keep you informed and confirm arrangements before the second round starts.
6. Acute Coronary Syndrome (ACS)
“How will we receive our forms?”
MCN will give out forms in sites who receive ACS patients.
“Why not separate ACS forms?”
We are using one form, which reflects our standards to:
- reduce the amount of paperwork used
- make it easier for those completing the forms.
“Why are we all not using an electronic submission system?”
Not all NHS boards have access to the electronic system. We cannot guarantee that the system will be in place for everyone by the July start date. We have issued paper forms to avoid delaying data collection.
“Our electronic system is in place, which system do we use?”
For boards with paper forms and an electronic system in place, your MCN will tell you what system to use.
“Will we use the electronic system for the second audit?”
We hope that the system will be fully operational for the second audit. We are working closely with the Scottish Government and the system developers to test its data sharing abilities. We will keep you informed of developments.
“What is the difference between the paper and electronic systems?”
We have tried wherever possible to make the systems compatible. The data items and their descriptions may differ slightly.
“Do I record the patient’s log number at the beginning or end of a patient’s journey? What if the patient comes into contact with more than one NHS Board?”
At the beginning. The first point of contact records a log number for that patient. This is the responsibility of the staff making first contact with the patient regardless of NHS Board.
7. Cardiac Rehabilitation
"I am unsure of what I am being asked to complete for this part of the audit."
Get our
cardiac rehabilitation reference sheet . This gives advice on completing each field.
"My patient had a STEMI then a PCI. Do I record the PCI under treatments? The section of the form is called 'previous treatment', is this where I record this information?"
Yes. The STEMI is the initiating event and the PCI is recorded under previous treatment.
“Our patients are assessed at every phase of their programme, how do we record their needs assessment?”
The needs assessment field relates to Phase III.
“How do we record home based programmes on the form?”
Use the individual exercise field in the ’rehabilitation programme details’ section to record home and disease management advice.
“Should we collect community based rehab programme data?”
Yes. Group or community based exercise, for example, held in a sports complex as part of Phase III should be collected and recorded at Phase III.
“How long will the audit take?”
The audit starts on June 22nd. Data collection will be on-going with data for the audit submitted toward the end of September.
“What are ‘initiating events’? As part of the patient’s significant medical history we are asked ‘For most recent/initiating event tick only one and record the date’”.
Use this date box to record the first event. For example, if MI leads to CABG then the initiating event would be the date of MI.
“For all other sub sections is it ok to record more than one event?”
Yes.
“’Phase I - referral to out patient programme.’ Does this relate Phase III?”
Yes.
“’Reason for no referral to out patient programme.’ Is this Phase II or Phase III?”
Phase III.
“'Reason for no referral to out patient programme.’ Should we record barriers to attendance here?”
Yes. We understand that barriers could have been included at a number of points on the form and will review this before the second audit.
“’Cardiac Rehab Needs Assessment.’ What does this mean?”
This is a pre- entry to Phase III assessment. A functional assessment not a professional judgement regarding a patient’s exercise needs. The next question asks at what stage the assessment was undertaken and the final question asks for the detail.
We are not looking for information on who carried out the assessment. We want to know if the assessment took place.
“Why are there boxes for all 4 phases of rehab next to the date for starting the out-patient programme?”
Sections should be completed up to the point where the patient leaves the programme.
“What is the ‘maximum tolerated dose’?”
It is the best dose the patient can tolerate and if it matches the optimum dose then that’s even better.
“Drug information is extremely difficult to supply i.e. dosage of drug / contraindications / not tolerated / etc. Can basic drug information be submitted without all the requested detail?”
Yes. We are happy to take whatever information you can supply, the more detail the better.
“How do we classify re-admissions?”
ISD adopt the 120 day rule. For example, if a patient has a MI on 1st of January and another on 2nd of May, capture both events.
"There have been a couple of patients referred to Cardiac Rehab but not seen as the diagnosis has changed between referral and first visit. e.g ischaemic probable ACS to VT induced ischaemia. There is no option to record referred but not seen. What is the best way to record the information?"
"VT induced ischaemia could be recorded as an arrhythmia under significant medical history. If an in-patient and not seen then record as either contraindicated/not available. If an outpatient then under date of referral to out-patient record as contraindicated or similar."
“When will we have access to an electronic data collection form/system?”
A system has been developed in the West of Scotland that will be available for other Boards to make use of later in the year.
NHS boards will be responsible for supporting systems locally.
We recognise that other systems may also meet national criteria and will be available in the future. We will not be promoting any one system but will back systems that support data collection and audit.
"Please confirm if the Immediate discharge summary, refers to: the summary sent from Cardiac Rehab to Practice/District Nurse using the letter from SCIACS, or if the discharge summary from the ward has been given to patient to hand into GP - do both of these count or are we looking for a consultant letter to GP?"
The discharge letter indicated is the one from the acute receiving team (in-patient stay) to primary care – usually the GP and not the CR discharge to primary care nurses.
8. SCI ACS
Questions and answers relating to electronic data collection
“What is the ‘Patient Code’?”
Patient code is a 3 digit number found on the audit form and recorded on your hospital’s summary sheet. The summary sheet is supplied along with the audit forms. If you do not have one contact us on 0131 623 4702.
“What is the ‘Health Board Code’? Is it the site number for SCI, for example H202H, or the NHS board code used for Minerva collections?”
The Health board code is a single letter; NHS Highland’s is 'H'. We also supplied hospital codes for each participating hospital in each NHS board. If you would like the complete list of hospital codes used contact us on 0131 623 4702.
“How do I complete the ‘QIS Admission Diagnosis’ field for patients admitted with a non-chest pain/MI/ACS diagnosis? For example, the admission diagnosis was heart failure (no chest pain), it then transpired that the patient had had an MI/or developed an MI during the admission. Or, the patient may have had a non-cardiac admission diagnosis, either because the diagnosis was missed on admission or the MI/ACS occurred after admission.”
We only want data on patients with chest pain and a high suspicion of Acute Coronary Syndrome. The CHD resource pack sets out the inclusion criteria as all STEMI patients and the first NSTEMI and Chest Pain cases confirmed daily after 9am daily for the duration of the audit. Get the CHD resource pack for more detail.
“There is no option for patients without Discharge Planning. If the patient died before discharge do I leave this section blank or enter ‘No’?”
Code the 'discharge to' box as 'patient died'.
“Where can I find the system? What is its web address?”
https://scichd.mhs.scot.nhs.uk/SCICHD.Web
“How do I login?”
Enter your username and password.
“Help I have forgotten my username and password”
Contact your local administrator.
“I don’t have a login. How do I get one?”
Contact your local administrator who will set up your account.. If you do not have a local administrator because your hospital is not yet using SCI-CHD ACS, contact your local MCN. Your MCN can contact us and have the system implemented.
“How do I enter a new patient to the system?”
Search for a patient using the “Patient Search” menu option (top right). We recommend you search by CHI number.
You will reach the demographics screen where your patient/episode is registered. Or, you will reach the Patient Summary screen if your hospital has recorded episodes for this patient. Here, create a new episode. This option will not be available if no arrival date has been entered for existing episodes.
“My patient transferred from another centre, how do I enter them?”
You can record information for this patient on the ‘Admissions’ screen in the field ‘Admitted/Transferred From’. This should not be used to record ‘Hospital 1’ from the ACS QIS audit – this should be done through the QIS Data Entry form or the Patient Transfer screen.
“What if the patient dies?”
Record Discharge Destination as “Death” and enter a date of death on the demographics screen.
“Will the audit form be pre-populated with existing data?”
Yes. Our data entry form will display specific patient episode data entered into the SCI-CHD record and vice versa. Demographic patient data will also be pre-populated, use the National CHI search to find it.
We hope to allow data sharing between NHS Boards in time for the second audit. That is, data enter in another hospital in another NHS Board (hospital 1) will contribute to the record of hospital 2.
“Will the system allow 2 screens to be open at the same time?”
No. You can only open one instance of SCI-CHD ACS on the same PC at the same time. You can open more than one internet explorer or internet explorer plus another application at the same time.
“If I only want to fill in your form where do I find it?”
Go to the ‘Letters and Forms’ tab (left hand side) and click QIS Data Entry.
“What if I make a mistake when entering data –can I amend it?”
If you make a mistake just re-type the correct data to fix it.
“How do I move back to the form after calculating GRACE & TIMI Scores?”
Go to the ‘QIS form’ tab and you will return to the QIS form.
“How is my case submitted to NHS QIS?”
Complete all the relevant data fields and exit the form.
The case will be automatically extracted when the regular extract is run for ISD provided you complete the:
- date of admission to hospital
- QIS ID
- and discharge hospital fields.
