medhat zaiada associate specialist victoria hospital ... · medhat zaiada associate specialist...
Post on 19-Jul-2020
16 Views
Preview:
TRANSCRIPT
PD Audit
Masterclass 10
Medhat Zaiada
Associate Specialist
Victoria Hospital
Kirkcaldy, Fife
PD Audit
Analysis of Data Collected INumber of patients: 30
Male : female: 18 :12, 60% : 40%, ratio 1.5 :1.0
Average age: 74.5 y, youngest 45 y, oldest 88 y
Referral source: 26/30 GP
03/30 consultants
01/30 clinical assistant
6 weeks target met: yes 25/30 (83.3%) - no 5/30 (16.7%)
Average delay: 12.6 days, shortest 5, longest 24
Reasons for delay: 2 were initially referred to neuro
1 no clinic for 2 weeks (festive season)
2 no reason identified
Referred untreated: yes 26/30 (86.7%)
no 04/30 (13.3% all on levodopa)
PD Audit – Masterclass 10
Analysis of Data Collected IIOutcome:1= not PD, discharged 15/30 (50%)
mix of ET, hydrocephalus, tremors ? Cause, dementia, stop R/ and discharge X2
2= IPD 03/30 (10%)
3= other parkinsonism 4/30 (13.3%)
drug induced parkinsonism x 1
vascular parkinsonism x 3
4= unclear, tests, stop R/, monitor 8/30 (26.7%)
?PD, ? Vascular x 2
?PD, ? Neuropathy x 1
?PD, ?PD plus x1
?PD, ?drug induced x 1
?early PD, monitor x 2 (1 referred on R/)
withdrawal of R/ but needs monitoring x 1
Have we achieved audit standards?
PD Audit Standards-Part IS1 access to PD specialist neuro/ger = yes
S2 access to PDNS at all stages = yes
S3 access to PT at all stages = yes
S4 access to OT at all stages = yes
S5 access to SALT at all stages = yes
S6 access to PD medications = no (doudopa)
S7 access to neurosurgery = yes
S8 regular reviews by PD specialist = yes
PD Audit Standard-Part IIS1 Patients with ?PD referred untreated = no
S2 Patients with ?PD seen within 6 weeks = no
S3 complex cases seen within 2 weeks = not included in audit
PD Audit – Masterclass 10
Result
PD services at Victoria Hospital have met all audit
standards part I with the exception of duodopa due to
SMC restriction.
Audit standards part II were not fully met.
Majority of patients referred did not have PD approx
63%.
Approx 27% of cases referred were unclear & needed
monitoring.
Only 10% of referrals were confirmed as IPD.
IPD is difficult to diagnose even in specialist clinics
and some cases needs close monitoring.
PD Audit – Masterclass 10
what to do next?
Educating GPs & other doctors to refer
patients untreated (letters sent to GPS &
hospital doctors).
Improving referral system so that patients
can be seen quicker.
Repeat audit at local level and aim for
better results to meet all audit standards
Dear colleagues
We recently conducted Parkinson’s disease audit at Victoria hospital PD clinic. This is a multi-centre audit conducted under the supervision of the Parkinson’s Disease Academy as part of PD masterclass 10. The aim of the audit is to assess patient access to services and NICE recommended treatments. The local audit at VHK has shown that some patients (16.7%) were not seen within 6 weeks (42 days) of referral (as recommended by NICE), mainly due to the fact that patients are not directly referred to the PD clinic which causes some delay. The audit also shown that some patients (13.3 %) were referred to PD clinic already treated. The guidelines recommend that such patients must be referred untreated.
As a result of this audit I should be most grateful if you could use the following guidelines:-
1. Please refer patients with suspected Parkinson's disease directly to PD clinic at Victoria Hospital ( to Dr John Cordina for those over the age of 65 and to Dr Martin Ziedler for those under the age of 65).
2. Please refer Patients with suspected Parkinson’s disease to PD clinic untreated.
We are aiming to conduct the second audit cycle locally in the very near future. Thank you very much for your co-operation. Please let me know if you would like a copy of the audit. Kind regards.
Your faithfully
Medhat Zaiada
Associate Specialist
top related