The NJR is conducting an audit to retrospectively check and improve the volume and quality of the registry shoulder joint replacement data.

We are asking selected hospital units to help us with the review of shoulder procedure data that have been flagged as missing from the registry from a comparison with data in the registry to that for Hospital Episode Statistics (HES) records. The time period of shoulder data to be audited is from the start of April 2012 to the end of September 2020 (data for procedures performed after September 2020 are already being reviewed as part of the standard automated NJR data quality audit and so are not included in this audit dataset).

The purpose of the audit is to identify from hospital records (HES data) any eligible shoulder joint replacement procedures that have not been entered into the registry and to ask hospitals to obtain the clinical data required to enter these missing procedures into the registry retrospectively. It is possible that some of these procedures may have been incorrectly coded initially and may not be eligible for registry submission (for example a procedure may have been coded as shoulder joint replacement but in fact was a proximal humerus fixation). It is helpful that this is identified, and the case then discounted as a missing joint replacement procedure.

Click here to view a video overview of the audit (6 mins), and below you can view our audit instructions (22 mins).

Audit process

Audit process

Many hospital data managers have already been involved with our recent NJR elbow audit and we are very grateful for their efforts which resulted in a significant increase in the volume and quality of elbow procedures in the registry. This new shoulder audit will also add procedure records previously missed to greatly improve our data analysis and thereby help us in the achievement of our aims of enabling greater future patient safety and improving surgery outcomes. The shoulder audit will be structured similarly to the elbow audit, and we are aiming to again capture as many missing procedures as possible.

As with the elbow audit, we hope the team for each hospital site will be comprised of the following members:

  • Hospital data manager
  • Clinical lead (consultant)
  • Orthopaedic trainees – we are working with a number of orthopaedic trainee networks (including the British Orthopaedic Trainee Association (BOTA), the British Elbow & Shoulder Society Trainees (BESS-T) and other regional orthopaedic trainee collaboratives) to identify orthopaedic trainees in each trust who may be available to provide clinical support for the audit.

The typical process is as follows:

  • The local audit team opens the data file received to identify the relevant patients and their procedures to confirm eligibility for inclusion in the registry.
  • The local audit team will request the relevant clinical information is made available (this may include case notes, electronic records and radiology records).
  • The trainee will assist or lead on extracting the data required as per the NJR MDSv8 form.
  • The HDM will input the procedures into the registry.
  • The trainee will complete the data file and return to the shoulder Audit Data Analyst –

The role of the audit data analyst is to compare HES data to what is currently in the registry and to extract the shoulder replacement procedures from the HES data that have not been submitted to the registry. These records will form the data that is provided by the analyst to each unit.

When the procedures have been input into the registry, the data analyst will run checks on new numbers in the registry.

There will also be analysis performed on the data to look for patterns that might indicate why procedures are being missed from being input into the registry.

The data analyst will manage the data in accordance with Data Protection regulations and thus should be the only audit team member that patient-sensitive data should be shared with.

As this file will contain patient-sensitive data, it should be returned using an email address, which has built-in encryption. If you need to return it to us using a email account, then the email/file will need to be returned to us securely, using encryption in line with your local – information governance policies.

For more information, please refer to the NHS email encryption guide

Audit rules of engagement

All audit contributors will be included in the shoulder section of the NJR Annual Report that will be published in the September following the audit closure – and will also receive a letter to acknowledge the skills they have demonstrated in this study including understanding the importance of routine data collection and understanding the principles of research governance. This acknowledgement letter can be used as evidence of research skills for the Certificate of Completion of Training (CCT) requirements.

More than one collaborator from a given trust can submit data. Having multiple contributors within a trust is encouraged to make data collection easier. It is preferable to work closely together with any colleague who is also signed up from your trust, to avoid duplication.

Contributors who fail to submit data by 31 October 2024 will not be deemed as having successfully participated in the audit, so will not receive an acknowledgement letter. If there are any problems of any kind with your data collection, please email so that we can help you resolve any problems early on

Please note: do not include any sensitive data when emailing this inbox as this is not an NHS-encrypted email address.

All collaborators are expected to register the NJR shoulder audit with their hospital audit department and identify a consultant to supervise the work.

All contributors will be sent information from the analysis of the data collected so that the success of the work can be presented locally – which is encouraged.

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