Final Report > Chapter 7: The Audit and Monitoring of the Paediatric Cardiac Surgical Service in Bristol > How the clinicians in Bristol reviewed paediatric cardiac surgery > The sources of data
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The sources of data
14 The surgeons, anaesthetists and perfusionists kept separate logs of their clinical activity, and the paediatric cardiologists maintained their own computerised information system known as the South West Congenital Heart Register. Basic demographic data and data on diagnoses, procedures and outcomes were recorded for each child seen or operated on.
15 Mr Wisheart stated that he kept a log of his open-heart operations from 1975 until the end of his career. The log contained information about each patient and in particular about the outcome of the procedure(s) carried out. Mr Wisheart stated that he used his logbook to monitor his own performance: `It had the advantages of being within my possession (i.e. in my hospital office), accessible, highly reliable and because of the way that it was set up it was both functional and effective. [9] ... I believe that the quality of the data in the log is high but I would never claim that it is perfect. ... I would regard entries concerning death and autopsies as extremely reliable.' [10] Mr Dhasmana described his surgeon's log: `The main purpose of the logbook was to provide a quick reference for the personal audit of the open-heart procedures carried out by me in the Hospital, as an ongoing process. This helped in recognition of problems at an early stage. The logbook provided figures, which helped with preparation of various audits, reports including compilation of data in the U.K. Cardiac Surgical Register.' [11]
16 The cardiac surgeons used their logs and the South West Congenital Heart Register as their chief sources of statistical data. A variety of statistics were produced, including annual statistical summaries, annual reports on paediatric cardiology and cardiac surgery, figures for audit and other meetings, and the annual returns made to the UKCSR.
17 From 1990 the cardiac surgeons introduced their own computerised information systems, the METASA system and later the Patient Analysis and Tracing System (PATS), for the purpose of local audit and research, although these never functioned effectively during the period of the Inquiry's Terms of Reference.
18 The paediatric cardiologists kept records of all children seen by them with a congenital heart defect. Dr Jordan stated that the recording system had a long history. Records had progressed from books to various early computer systems, until the Bristol and South West Children's Heart Circle purchased a computer which was capable of holding a database of information. Dr Jordan engaged his son to write a software application to make the system more `user friendly'. [12] A small research grant from the Regional Health Authority paid for a part-time secretary to put in the data. Some 96 items were recorded for each patient. Dr Jordan explained: `In general, while the system probably sounds amateurish and was by no means perfect, it was better than most units had in place. Clearly it would have been better if we had had more clerical and computer staff, but we had no finances to pay for this [13] ... Even with the system as it was, I could have made much more use of it if I had had more time.' [14]
19 As regards the anaesthetists, they each kept personal logs. Professor Prys-Roberts told the Inquiry that he regarded the keeping of such a log as `proper medical practice.' [15] Referring to the data in her log, Dr Sally Masey, consultant anaesthetist UBH/T stated: `... The data are, as far as I am aware, complete for my practice except for 1988 ... The record of in-hospital deaths may not be complete, as some deaths may have occurred about which I was unaware.' [16]
20 The perfusionists also kept logbooks. Mr Richard Downes, a clinical perfusionist at the BRI from 1992, stated that: `The function of the Perfusionist's log was to provide a record in the form of lists of the type and number of open-heart surgery cases the perfusionists had carried out over the years. That information was limited to the cumulative number of patients operated on, surgeon's initials, patient name, age, operation type and date of operation ...' [17] Additional sources which contained data about heart operations on children included: the Post-Mortem log kept by Professor Berry, consultant paediatric pathologist, BRHSC; the Operating Theatre Register; Helen Stratton's (Cardiac Liaison Nurse, UBHT) register of the cases that she dealt with; and the Ward Admission Books kept by the ward nurses.
21 Apart from all the sources of information kept by healthcare professionals, administrative staff in the UBH/T also collected and kept data on patients: the UBH/T's Patient Administration System (PAS). This was a computerised system maintained for administrative purposes. It included demographic data (such as name, address and date of birth), administrative data (such as dates of hospital appointments and dates of admission), and clinical data (diagnoses and procedures) for all patients treated by the UBH/T. This information formed the basis of returns to the national Hospital Episode Statistics (HES) database, held by the Department of Health (DoH). From the early 1990s the UBHT also sent PAS data for analysis to a private consultancy called CHKS Limited. This company provided reports on the Trust's performance in selected specialties, comparing UBHT with a group of similar hospitals. CHKS Limited produced a report on the cardiology and cardiac surgery services dated 1992. PCS was not separately identified in the report. Given that it was regarded as a distinct, administrative system, there is no evidence to suggest that the clinicians providing the PCS service would have referred to or taken account of the data on the UBHT's PAS system.
22 Referring to PAS systems in general, Ms Ann Harding, then Acting Director of the NHS Information Authority, told the Inquiry: `... I think this is one of the problems that we have, the data is collected for the purposes which clinicians believe is managerial and therefore is not relevant to them. ... the level of detail at which a clinician would want the information for the purposes of audit is not readily encompassed within the levels of diagnosis and operative coding that we currently have.' [18]
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Footnotes
[9] WIT 0120 0255 Mr Wisheart
[10] WIT 0120 0259 Mr Wisheart
[11] WIT 0084 0001 Mr Dhasmana
[12] WIT 0099 0002 Dr Jordan
[13] WIT 0099 0003 Dr Jordan
[14] WIT 0099 0004 Dr Jordan
[15] T94 p.5 Professor Prys-Roberts
[16] WIT 0270 0001 Dr Masey
[17] WIT 0169 0015 Mr Downs