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

Capturing turn down rates What this reveals about overall vascular practice


Aaa turn down rates

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

May-Dec 2011 BCH


Turn down group n 23

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

May-Dec 2010 BCH

  • 1 ruptured AAA

  • 1 CVA

  • 2 Unknown cause


May dec 2010 bch1

May-Dec 2010 BCH


Summary

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

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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