What does a Clinical Director look for in the Annual Registry Report ? D Eadington Hull Royal Infirmary June 2008

1. What does a Clinical Director look for in the Annual Registry Report ? D Eadington Hull Royal Infirmary June 2008 Conflict of Interest; no longer a Clinical Director

2. The problem with the post-prandial talk …. PRIMACY RECENCY

3. What do I look for ? • Feedback – confirm what we know already • - discover what we don’t • - comparison; neighbours, peers • Stimulus - set priority areas • - educate or re-educate staff • Things that inform the commissioning process

4. Who do we compare ourselves with ? • What do I look at (or not) ? • What does the data mean ? • What else do we do with it ? • What would I like more of ?

5. Luton • Windsor • Sunderland • 19th Hull 1st HULL

8. Population 1.04 million, ~3000 sq m • 3 peripheral DGHs (~540k) • Satellites; 1992 Brigg • 1998 Scarborough • 2002 Grimsby • 2007 Scunthorpe (Brigg closed) • 2008 Bridlington • 2008 Fresenius partnership (first central unit) York 40 miles Leeds 65 miles Sheffield 65 miles Middlesborough 80 miles

9. Who are our comparator units ? • Colleagues; Leeds, Bradford, York • Neighbours ; Sheffield, Middlesborough • Peer hospitals; Preston, Newcastle • “How are they doing that better than us ?”

10. What do I do with the report ? • Some; look at quickly – less interest • Some; look at longer - wonder what it means • Rest; look at longest - compare with other units, discuss • - where is the widest range ? • Reflection; What are we not doing well enough ? • - outcomes, data inputs • What is not there at all ?

11. What else do we do with the reports ? • Service planning (less than in past) • Training – junior staff • - nurses • - medical students • Nursing governance – ‘every data point counts’ • Patients – dietitians, information posters

12. 1. Look at quickly • Demographics – are take on rates stabilising ? • - more palliation as part of LCC ? • Items where new action is not a high priority • - Adequacy/URR • - Ferritin • Not yet a strong evidence base to change practice • - Cholesterol

13. Be clear what take on rates mean

14. Be clear what take on rates mean 1.62m 1.27m 0.47m 1.61m 4.97 m Which one is right ?

15. 2. Look at longer; what does it mean ? • Anaemia • PTH

16. Adequate

17. Is it any better ? • (CHOIR/CREATE)

20. 3. Look at longest – comparisons matter • Phosphate • Blood pressure • Survival

23. Reviewing serial data would be welcome

24. Blood pressure – a very wide range Is data collection standardised ?

25. Survival is the main outcome

30. Does deprivation affect ESRD survival ?

32. Does the disadvantage of deprivation on health continue into ESRD ? OR Is it neutralised by the severity of other risk factors ? OR Something else ?

34. What do I look for ? • Feedback – confirm what we know already • - discover what we don’t • - comparison; neighbours, peers • Stimulus - set priority areas • - educate or re-educate staff • Things that inform the commissioning process

35. Stimulus - what are we not recording well enough ? • Hull • Transplant blood pressures • Comorbidity data • Referral patterns

36. Crash landers remain too common

37. What do we have to do for ourself ? • More interactivity with own data possible ? • Time - IMPROVEMENT • Relative position – RATE OF CHANGE

38. Cause of death ; how many withdrawals ? • Low Clearance Care; how many for palliation ? • evidence for slower progression ? • (CKD5 pilot) What else is missing ?

39. How is your commissioning process ? Save 1 kg paper / copy online

40. “Wake up, he’s finishing …” • stimulus to service improvement • pride in a communal effort • content far outweighs any shortcomings