Capturing Turn Down Rates

1. Capturing Turn Down Rates Mr Greg McMahon Specialty Trainee Registrar in Vascular Surgery University Hospitals of Leicester NHS Trust

2. Comparisons of Outcomes

3. Gathering the Data • Ongoing prospective collection • Snap-shot analysis of a 7 month period

4. Measuring Turn Down Rates ( ) number of patients turned down 100 total number of patients considered patients offered surgery % turn down rate patients turned down

5. Collecting the Data • Every patient undergoing AAA surgery appears in the theatre diary • No central record of turned down patients • Clinic letters • MDT minutes patients offered surgery patients turned down

6. Additional Factors for Consideration • Referrals from elsewhere • Diameter thresholds set higher • Assessments in progress

7. Local Methods • All elective patients with a AAA ≥ 5.5cm in whom a decision to operate was made • All patients with a AAA ≥ 5.5cm who were turned down for surgery • 1st March to 30th September 2011

8. Results • Total of 84 patients

9. Results • Total of 84 patients • 20 outside referrals

10. Results • Total of 84 patients • 20 outside referrals • 25/64 turned down • 39% turn down rate

11. Results

12. Results – Reasons for Not Operating • Age cited in 14 (median age 84) • Also cited: 5 patient choice 2 dementia • 4 respiratory disease 1 malignancy • 3 cardiac disease 1 renal disease

13. Results – Reasons for Not Operating • Age not cited in 11 (median age 77) • Reasons cited: 7 cardiac disease 2 renal disease • 5 respiratory disease 1 malignancy • 5 patient choice • Age cited in 14 (median age 84) • Also cited: 5 patient choice 2 dementia • 4 respiratory disease 1 malignancy • 3 cardiac disease 1 renal disease

14. Moving Forward • Discuss all AAA patients at the MDT • Cultivate and standardize the collection of turn down data • Evaluate the outcomes of those turned down • Retrospectively re-assess the turned down patients • Focus group

15. University Hospitals of Leicester NHS Trust