regional collaborative south central regional collaborative data 13 th november 2014 wokefield park
TRANSCRIPT
Regional Collaborative
South Central Regional Collaborative Data
13th November 2014
Wokefield park
Regional Collaborative
Regional Collaborative
Actual deceased donors- South Central team
DBD DCD
48
16
40
13
44
25
57
23
60
20
54
28
48
29
62
39
60
47
29
10
58
20
Nu
mb
er
0
10
20
30
40
50
60
70
80
90
100
110
Year
05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 Apr-Sep
14/15 projected
1 April 2005 to 30 September 2014, data as at 14 October 2014Hospitals are allocated to teams using the current team allocations, not the allocation at the time of donation
Regional Collaborative
Actual deceased donors
DBD DCD
36
26
51
21
46
25
41
25 25
19
21
3
38
22
29
10
40
17
10
16
29
20
26
33
Nu
mb
er
0
10
20
30
40
50
60
Eastern London Midlands North West
Northern Northern Ireland
Scotland South Central
South East
South Wales
South West
Yorkshire
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Plan
• DCD• DBD• Our possible DBD not tested• DBD case presentations (Roger)
Regional Collaborative
DONATION AFTER CIRCULATORY DEATH
Regional Collaborative
Why less DCD?
• Chance• Not being referred? Referral % still increasing• Fewer people dying in ICU• Less withdrawal of treatment (LCP effect)• Surgeons becoming more risk averse• Informal triage filtering out patients who
previously might have become donors
Regional Collaborative
Regional Collaborative
Regional Collaborative
Regional Collaborative
Regional Collaborative
South Central DCD referral rate
Ref
erra
l rat
e (%
)
0
20
40
60
80
100
Number of imminent death anticipated patients
0 10 20 30 40 50 60
1
1011
12
13
14
15
16
17
18
2
3 4
5
67
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD referral rate
-------- National rate
8580
6972
86
7674
71 72
78 7679
Re
ferr
al r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD SN-OD involved
-------- National rate
79
84
58
86
6870
45
75
8783
59
86
% a
pp
roa
ch
es
wh
ere
SN
-OD
invo
lve
d
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD consent rate
-------- National rate
54
4945
53
59
4952
40
63
43
5153
Co
ns
en
t/a
uth
ori
sa
tio
n r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD conversion rate
-------- National rate
1410
7 7
12
5
19
6
1114 14
17
Co
nve
rsio
n r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Trends in national DCD rates%
0
20
40
60
80
100
Period
Apr 10 - Sep 10
Oct 10 - Mar 11
Apr 11 - Sep 11
Oct 11 - Mar 12
Apr 12 - Sep 12
Oct 12 - Mar 13
Apr 13 - Sep 13
Oct 13 - Mar 14
Apr 14 - Sep 14
Referral rate Approach rateSN-OD involved rate Consent/authorisation rate
4247
5055
62 63
70 7276
56
54
5760
49 48 46
53 54
61
6770
73 73
49 51 49
53
50
55 53 51
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Trends in South Central DCD rates
%
0
20
40
60
80
100
Period
Apr 10 - Sep 10
Oct 10 - Mar 11
Apr 11 - Sep 11
Oct 11 - Mar 12
Apr 12 - Sep 12
Oct 12 - Mar 13
Apr 13 - Sep 13
Oct 13 - Mar 14
Apr 14 - Sep 14
Referral rate Approach rateSN-OD involved rate Consent/authorisation rate
30
3943
60
53 5561
64
71
42
50
66
55 54
4247
41
41
46
63
67
74 74
88
75 75
5047 45
46
5754
40
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DCD consent/authorisation rate by ethnic group
1 April 2014 to 30 September 2014, data as at 14 October 2014
ODS team White patients BAME patients
Family
approachedConsent/ authorisation
rate*Family
approachedConsent/ authorisation
rate*Eastern 95 58 7 -London 62 50 22 45Midlands 125 50 12 25North West 96 56 4 -Northern 61 64 2 -Northern Ireland 33 48 - -Scotland 62 55 4 -South Central 56 43 6 -South East 71 62 3 -South Wales 57 44 2 -South West 64 56 2 -Yorkshire 79 54 2 -Total 861 54 66 35 * Consent/authorisation rates are not shown where the number of families approached is less than 10
Regional Collaborative
DCD Summary
• Fewer people dying on ICU• Fewer families approached• More age 70 to 79 declined by
transplant surgeons• Consent rate dropped to 40%• South Central SNOD involvement
slipping?
Regional Collaborative
DONATION AFTER BRAIN DEATH
Regional Collaborative
Trends in national DBD rates%
0
20
40
60
80
100
Period
Apr 10 - Sep 10
Oct 10 - Mar 11
Apr 11 - Sep 11
Oct 11 - Mar 12
Apr 12 - Sep 12
Oct 12 - Mar 13
Apr 13 - Sep 13
Oct 13 - Mar 14
Apr 14 - Sep 14
Testing rate Referral rateApproach rate SN-OD involved rateConsent/authorisation rate
7173 76
7376
79 7882 80
8386
9092
91
92 9396 9592 94
9393 94
92
6669 70
7275
65
64 6364
6966 67
70 67
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
Trends in South Central DBD rates
%
0
20
40
60
80
100
Period
Apr 10 - Sep 10
Oct 10 - Mar 11
Apr 11 - Sep 11
Oct 11 - Mar 12
Apr 12 - Sep 12
Oct 12 - Mar 13
Apr 13 - Sep 13
Oct 13 - Mar 14
Apr 14 - Sep 14
Testing rate Referral rateApproach rate SN-OD involved rateConsent/authorisation rate
7268
76 75
67
7973 76
66
8479
8789 89 89 89 94 9496
83
97
90 89
39
62 61
80 85 86
52
81
55
67
91
7066
76 71
1 April 2010 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD- Neurological death testing rate
-------- National rate
8284
77
86
94
83 84
66
78
60
84
71
ND
te
ste
d (
%)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD- South Central Neurological death testing rate
-------- National rate
0 0
50
65
100
67
100 100
50
100 100
33
100
6567
100
ND
te
ste
d (
%)
0
20
40
60
80
100
Hospital
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD- South Central Neurological death testing rate
ND
test
ed (%
)
0
20
40
60
80
100
Number of neurological death suspected patients
0 5 10 15 20 25 30
1
10
11
12
13
14
15
1617
18
2
3
4
5 6
7
8
9
Hospital National rate 95% Lower CL95% Upper CL 99.8% Lower CL 99.8% Upper CL
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD referral rate
-------- National rate
9395 97 96 98
90
9794 95
87
98 98
Re
ferr
al r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD approach rate
-------- National rate
92 9296
9389
94
100
9397
94
88 90
Ap
pro
ac
h r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD SN-OD involved
-------- National rate
93 91
73
94 9387
55
86
95
82 84
97
% a
pp
roa
ch
es
wh
ere
SN
-OD
inv
olv
ed
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD consent rate
-------- National rate
67
55
68
5964
77
71 71 73
59
89
74
Co
ns
en
t/a
uth
ori
sa
tio
n r
ate
(%
)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD conversion rate
-------- National rate
58
46
59
5055
67 6762 62
56
6964
Co
nv
ers
ion
ra
te (
%)
0
20
40
60
80
100
Team
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD consent/authorisation rate by ethnic group
1 April 2014 to 30 September 2014, data as at 14 October 2014
ODS team White patients BAME patients
Family
approachedConsent/ authorisation
rate*Family
approachedConsent/ authorisation
rate*Eastern 50 72 7 -London 54 72 45 33Midlands 67 70 10 50North West 70 61 7 -Northern 41 66 1 -Northern Ireland 31 77 - -Scotland 55 69 1 -South Central 36 78 4 -South East 55 75 7 -South Wales 16 56 - -South West 30 90 2 -Yorkshire 32 78 1 -Total 537 72 85 36 * Consent/authorisation rates are not shown where the number of families approached is less than 10
Regional Collaborative
Coroner permission requested
Permission given None Partial Full
7.14%
90.82%
5.19%
16.88%
77.92%
10.20%
85.71%
5.68%
14.77%
79.55%
12.50%
16.07%
71.43%
22.73%
77.27%
10.91%
85.45%
7.55%
28.30%
64.15%
6.45%
90.32%
8.06%
88.71%
10.64%
14.89%
74.47%
%
0
10
20
30
40
50
60
70
80
90
100
Eastern London Midlands North West
Northern Northern Ireland
South Central
South East
South Wales
South West
Yorkshire
1 April 2014 to 30 September 2014, data as at 14 October 2014
Regional Collaborative
DBD summary
• 5% increase in DBD nationally but not in South Central
• Brain stem death testing rates remain red on dashboard at 66%. Blip or trend?
• Other areas of pathway remain ok
Regional Collaborative
South Central Brain Stem Death Testing
• Jan to Oct 2014• 21 cases BSD? Not tested• 4/21 not referred• 3/21 never planned to test• We think 7 could/should have been
tested
Regional Collaborative
Reasons
• Delay in testing due to sedation• Patient not for donation (malignancy,
advanced directive, refusal after 1st set)• Miscellaneous (individual consultant
behaviour)
Regional Collaborative
BRAIN STEM DEATH? PRESENTATIONS
Dr Roger Lightfoot
Regional Collaborative
Questions, discussion
1. Compared to other regions our BSD testing is lower. Problem or statistical blip?
2. Is brain stem death testing whenever possible still our aim? If not why not?