Capturing turn down rates what this reveals about overall vascular practice
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Capturing turn down rates What this reveals about overall vascular practice . AAA turn down rates . No historical data Presumed to be low What is the real practice? Over/under treating – resource effectiveness Overall mortality rate of AAA Methods Legacy BCH vascular team

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Capturing turn down rates What this reveals about overall vascular practice

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Capturing turn down rates What this reveals about overall vascular practice


AAA turn down rates

No historical data

Presumed to be low

What is the real practice?

Over/under treating – resource effectiveness

Overall mortality rate of AAA

Methods

Legacy BCH vascular team

Modified data collection tools from QIP Project Team

Prospective data collection, May – Dec 2011


May-Dec 2011 BCH


Turn down group (n=23)

Age: 67-92 yr (mean 80 yr)

AAA max diameter: 55-100 mm (mean 66 mm)

9 (39%) - discussed at MDTs

4 (17%) - patient refusal for intervention

14 (60%) - deemed unfit for any intervention

3 (15%) - patient keen for intervention when symptomatic

8 (35%) - died (as of 02/2012)


May-Dec 2010 BCH

  • 1 ruptured AAA

  • 1 CVA

  • 2 Unknown cause


May-Dec 2010 BCH


Summary

Turn down rate 26%

35% of turned down patients died so far

39% were discussed at MDT meetings

95% decisions involved surgeons

17% patient refusal

60% deemed unfit for intervention due to comorbidities

15% keen for emergency treatment


Discussions

Probable under-recording

Unusually low mortality rates

Useful to capture patient’s choice in case of emergency

Should capture turn down continually

Rollout to the unit

To improve MDT process


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