Data quality audit: What's going on?
NJR’s data quality project manager Carol Harrison has been leading the NJR’s mandatory national programme aimed at assessing data completeness and quality within the registry for Trusts and Health Boards.
The NJR's quarterly magazine, Joint Approach, caught up with Carol recently to ask her how the programme is going since its launch last summer and what has come out of the early engagement.
The National Joint Registry has been collecting data since 2002, so what is the data completeness and quality audit programme and how does it enhance the way in which the registry has previously operated?
Last summer, the NJR launched an ambitious programme of local data completeness and accuracy audits, following the development of an audit toolkit during a six-hospital pilot phase early last year.
The process starts with a patient administration system (PAS) data extract for the financial year 14/15, for hip and knee, primary and revision procedures, after which the NJR works to identify sets of ‘matched’ and ‘unmatched’ records against the NJR database. The data is then returned back to the hospital unit and the unmatched records are further investigated by the unit.
The NJR has eight Regional Coordinators covering all regions in England, Wales and Northern Ireland who have been working with a nominated clinical lead, audit lead or hospital data managers at each hospital, in order to facilitate and support the audit process. This has helped identify what data is missing from the registry over the audit period. Any records that need amending can be put back into the NJR’s edit stack for correction and resubmission into the system.
On the whole, this has seen the NJR enhance the level of engagement with hospitals and staff, and has encouraged a local review in hospital units of the end to end NJR process which over time will offer even more robust data collection and submission.
How has the programme been received and how has engagement with Trusts and Health Boards has developed since last summer?
On the whole it’s been an incredibly successful and encouraging process. Perhaps most fundamentally, it has been a great exercise for the NJR to identify who within the Trust is the best person to work with us on audits and take the lead. This may seem like an obvious thing but it’s not always very clear who the best person is.
The audit has been well received by those who have engaged with it at a local level. Hospital data managers and NJR Regional Coordinators have forged very valuable relationships. With the assistance of our hospital-based peers, this process has benefited hospitals, surgeons and the registry alike and these relationships will go a long way in supporting the continued strength and accuracy of our data and future audits.
That is certainly very promising. This is a mandatory audit: what plans or additional measures are being taken to ensure organisations who have not submitted data engage with the programme?
Only 26 Trusts out of 150 have not currently engaged with the audit – which encouragingly is less than 20 per cent. So we are currently identifying where the gap in the communication between the NJR and the Trust or Health Board has occurred in these small number of cases and identifying the best contact at each hospital to help with this. Additionally, NJR Regional Clinical Coordinators have also been working hard to identify key individuals at each Trust to resolve any ongoing issues.
How does the NJR plan to engage and include independent hospitals as part of this programme?
The next exciting step for the programme is to include independent hospitals. We will be writing to CEOs of independent groups after Easter to begin the process of involving and including the independent sector.
We have learnt lots of lessons during this first pilot year, allowing us to make sure that the process is as smooth and successful as possible for independent hospitals, which in turn will offer greater provision of robust evidence and patient safety across the whole joint replacement sector. Independent hospitals should watch this space and contact their regional coordinator once they receive further details late-spring.
From the early engagement, what positive developments have come out of the programme?
From the fully completed audits we have to date, on average the matched data against NJR data is 95 per cent. Put another way, the process has ensured that for those Trusts who have fully completed the audit the NJR has the most complete and strongest data since the registry was created. This is fantastic and really sets the bar in terms of where we want to be with our data completeness.
Another interesting development has been Trusts seeing an additional financial benefit to the process too. Whilst going through the process several Trusts have uncovered a small number of NJR records which have not been entered into Trust’s patient administration system (PAS) and would have otherwise resulted in the potential loss of income.
Now that you are in a position to reflect on nearly 12 months since the launch of the programme, what are the key learning points for the NJR and what are the next steps to further enhance the programme?
Going forward, we will be ensuring that we make our instructions clearer on what information we require as part of the audit and how Trusts might obtain this via their Information Departments. This should reduce any difficulties Trusts have experienced in getting PAS extracts to us.
Carol Harrison is the NJR’s Data quality project manager and is contactable on email@example.com
On completion of each Trust audit, an Audit Compliance Report is created and sent to the CEO of the Trust which contains the key findings, recommendations and additional learning points from the audit process. This report provides each Trust with their own key learning points to act on.
We hope to continue to build on the existing long-term relationships between hospital data managers and NJR regional coordinators. This has been highlighted by the excellent attendance at the two most recent NJR regional conferences (see page 7). The feedback collected at our regional conferences has been very useful in also identifying ways we can improve the programme too.
Ultimately, we need to do more to enhance this programme and ensure that every Trust and Health Board is engaged with the audit and understands the importance of it. We need to particularly raise the NJR as a priority for those Trusts who are not yet engaged. Whilst we know there is more to do to achieve this, we look forward to the programme becoming a fixed process with the NJR collecting and reporting upon the most complete, accurate data possible.