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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 . 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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  1. Capturing turn down rates What this reveals about overall vascular practice

  2. 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

  3. May-Dec 2011 BCH

  4. 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)

  5. May-Dec 2010 BCH • 1 ruptured AAA • 1 CVA • 2 Unknown cause

  6. May-Dec 2010 BCH

  7. 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

  8. 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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