MINAP Newsletter. Key Messages. Training and Support. Issue 16 February Inside this issue: A look back at 2013

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1 MINAP Newsletter Inside this issue: Issue 16 February 2014 Key Messages A look back at Looking ahead... 2 Information Governance Public and Patient Involvement 3 3 Data Entry 4 The data validation deadline is fast approaching (4 March 2014). 158 out of 220 hospitals have either completed or started completing the study. If you are one of the ones that are yet to start the study you will be hearing from Ronald shortly. If you are having any difficulties in completing the study, accessing the tool or any other problems relating to this activity please contact us as soon as possible so that we can help or help to facilitate the necessary support. The MINAP Public Report submission deadline remains the same as every year and that is 31 May Please ensure that all your data are as complete as possible by this date covering specifically the last financial year, including all heart attack patients admitted between 1 April 2013 and 31 March 2014 (inclusive). Data Quality 5 Timely data entry see page 7 on the importance of timely data entry and how it affects ambulance services reporting. MINAP Applications Ambulance Services & MINAP 6 7 If the name of your hospital has changed please let us know as soon as possible; this is to ensure that we publish your hospital s results by the name that your hospital is known by. If unsure, please contact your local media department for guidance. MINAP webpages 8 Any changes to the staff involved in MINAP for your hospital must be notified to the MINAP team as soon as possible to ensure the information and updates are communicated effectively. Helpdesks 8 Training and Support We recommend that colleagues take an introductory course in excel it is needed to maximise the usefulness of their data and to keep on top of data completeness, accuracy, and performing local analysis. It is very likely that your trust provides an introductory course to excel. Alternatively, if you prefer self-paced learning, UCL Information Services Division for example offers manuals for some courses, Excel 2010 is one of them: common/resources/excel. The Healthcare Quality Improvement Partnership (HQIP) the organisation that holds commissioning responsibility for MINAP and over 40 other national clinical audits provides training and other educational support for clinical audit staff. More information on the available resources can be found at: Peer support one might argue is probably one of the best ways to learning as it offers an opportunity to share practice and you learn from someone who is in the same boat. The MINAP team will be happy to put you in touch with colleagues from a hospital/ambulance service that provides similar services and/or faces similar challenges.

2 Page 2 MINAP Newsletter A look back at 2013 Page Since 2009 three hospitals from the Belfast Trust have been participating in MINAP, and more hospitals in Northern Ireland started submitting data to MINAP last spring. This is great news, as the more coverage MINAP has, the greater understanding will be gained about the incidence of ACS in the UK, the process of care and patient outcomes. There are a couple more hospitals yet to recruit ACS nurses who will be responsible for data collection and data submission. Inclusion of transferred nstemi patients in MIN- AP was introduced in April 2013 see newsletter Issue 15, April 2013 for rationale for this change. This change is understood to pose a significant resource issue for some hospitals whilst others remain unaffected (this relates particularly to interventional hospitals). Just a reminder that day-case transfers (those transferred for angiography +/- intervention and then transported back to the referring hospital that day) do not need to be recorded in MINAP by the interventional hospital as the referring hospital will take care of the record. If yours is an interventional hospital discharging a transferred patient home/to the community you only need to complete a skeleton record, paying particular attention to secondary prevention medication at discharge and any management that was introduced/took place at your hospital. We are doing further work on developing a methodology to link the records where more than one admission is involved. Revision of MINAP dataset: A revised dataset was implemented on 3 June 2013 with many 3rd party software users following shortly after. It is expected that by now all hospitals are up to date with the changes. Later on this year we will be considering the current dataset again; please let Lucia know of any dataset changes that you believe would assist in capturing the service/care that is provided by your hospital. Updated application notes v8 were published in December Among other changes it now also contains different patient pathways broken down by type of admitting hospital and identifies which fields are required to be completed. There are also data collection forms on the MINAP webpages developed by Sarah Cawkwell from North Tees and Hartlepool NHS Foundation Trust. These are broken down by type of heart attack (STEMI and nstemi) and patient pathway and can be tailored to your needs. Thank you to everyone who completed the additional Takotsubo dataset for patients with a discharge diagnosis of Takotsubo Cardiomyopathy. There is a section in the application notes about this condition, with links to more information for clinicians and general public and the reasons why we are collecting this data. Since the dataset v was introduced, >135 patients have been recorded to have been discharged with TC diagnosis. The MINAP 2013 Annual Public Report was published on 16 October 2013 and can be found on the MINAP webpages: audits/minap/publicreports. Data from the public report are also available on the data.gov.uk website as per the Government s Transparency Agenda. Last year MINAP data were the most sought after and downloaded dataset of all HQIP national clinical audits. In 2013, the MINAP project team held two roadshows in Birmingham in April and in Taunton in October. The day consisted of presentations from colleagues from both interventional and non-interventional hospitals, ambulance services, presentations on research findings using MINAP data and a workshop/discussion with the MINAP team to discuss the challenges, things that work well and what can be done to overcome the challenges. We hope that colleagues found the meetings useful and we look forward to meeting you all again soon. Looking ahead As announced in the last MINAP report, in the late spring/early summer of 2014 we intend to publish a Patient Outcomes Report as an addendum to the 2013 annual report. The report will focus on 30-day mortality rates at the provider (hospital) level and in the first instance will look at STEMI patients. This initial report will be a relatively simple analysis and will form part of the ground work necessary for more complex analyses related to reporting of mortality and other outcomes (such as length of stay or readmission). More information will follow as the work progresses. As part of NICOR standardisation processes, it has been agreed that each national audit within NICOR should develop a Minimum Data Standard which has to be met by each participating hospital for the results to be published in the public domain. It is anticipated that hospitals that fail to meet the standards will not have their results published and will be named as such. MINAP is in the final process of defining this minimum data standard and we hope to share it with you for consultation in the next few days. There are plans for it to be rolled out on 1 April There will be a staged approach to the standard being met similar to that of the quality standards for care management defined in the National Service Framework back in During this period we hope to provide you with the tools to monitor the adherence to the standard in order to put the appropriate measures in place. The reason behind the introduction of the minimum data standard is to prevent publication of unreliable or misleading information due to missing or poor quality of data. Working towards the standard will be of benefit to all. For this year the MINAP team is planning to visit three regions in England via roadshows: East Midlands (May/ June), South-East Coast (23 September), North-East (3 December). If you know of any regional meetings that could affect attendance, please let Ronald know.

3 Issue 16 Page Page Information Governance Sending PIDs to MINAP and NICOR helpdesk Occasionally the MINAP project team or NICOR helpdesk team receives patient identifiable information such as name, date of birth and/or NHS number, without prior warning, via . There are two problems with this: 1. Only a small number of individuals within NICOR are authorised to receive, handle or process any patient identifiable information and neither the MINAP team nor NICOR Helpdesk are part of that small group. There are instances when you need to provide this information, for example to delete specific records or when there are other technical issues that need resolving. However in the first instance please us regarding the problem and should the need for PIDs arise, you will be directed to whom and how the information is to be sent. 2. The second issue relates to the transmission of the patient identifiers. Under no circumstances should PIDs or patient sensitive data be ed to us. NICOR has a secure facility for transmission of information the NICOR Dropbox and everyone with a user ID has access to this facility via the MINAP application on Lotus Notes and the webportal. Therefore it is very important that no patient identifiable information is sent to us without prior warning. We have been requested to report any such instances to the Trust s Caldecott Guardian as unauthorised sharing of patient information is a breach of the Data Protection Act. Importing your data to NICOR servers Recently it was noted that due to misaligned import files, NHS numbers were imported into fields that are un-encrypted e.g. one of the secondary prevention fields. There exist a number of automatic checks that result in a warning or rejection of a record, but these are kept to a minimum. Adding additional checks would only make the import log even less user friendly. Therefore please check that your import routines are aligned with the MINAP import file which can be found on our website: minap/dataset Public and Patient Engagement Back in September 2013 you would have been invited to take part in the survey monkey survey where we wished to gauge any interest in the distribution of hard copies of Patient Friendly Reports. First of all thank you very much to everyone who responded and for the enthusiasm expressed in your responses and willingness to share the information about your hospital services. This is indeed commendable and demonstrates your organisation s commitment to ensuring that your patients get the best care possible. Receiving such encouraging results, and to ensure that the data are presented in an understandable manner to the general public, we at NICOR decided to take it one step further and have organised a patient/carer workshop where we hope to gauge the public s interest in clinical audit data, its presentation and means of reaching out to the wider community affected by cardiovascular disease. Information about our event can be found on our website: The printable information is available in Appendix 1 for distribution to patients via clinics, cardiac rehab sessions, waiting rooms or however you feel it appropriate. Unfortunately the small grant we received for this event doesn t cover the printing and distribution costs. The workshop will be held on 8 May Thank you in advance for your support.

4 Page 4 MINAP Newsletter Cardiology Ward Data Entry A Cardiac care unit is, in accordance with current definition, a cardiac facility that may be shared with ITU or HDU or be a part of a cardiac ward or general ward with a higher level of monitoring and cardiac nursing numbers and expertise. Although an AMU is generally not considered to be the ideal place for an MI patient to spend their first 24 Initial Reperfusion hours, where there are additional cardiac facilities available, such units could be classified as CCU (or cardiac ward non-ccu?). The cardiac facilities that would define other wards like AMU or CPAU as CCU would be: daily review by cardiologist, specialist cardiac monitoring, and specialist cardiac nurse review. Currently Initial Reperfusion is defaulted to 0. None whatever initial diagnosis is selected. We are revising the need for this default value but in the meantime please remember that 3.39 Initial Reperfusion Treatment is to be used exclusively for STEMI patients. For nstemi patients please complete angiography/intervention fields (4.13, 4.14, etc.). If a patient develops STEMI after admission, this section should then be used to record what treatment was given even if no reperfusion was given and why. Recording of a referring (field 4.21 Referring hospital code) and referred to hospital (field 4.20 Interventional centre code) information The 4.21 Referring hospital code field is to be completed by the interventional hospitals who receive patients for an angiography/intervention or ppci, and it serves to tell us from which (non-interventional) hospital patients have been referred. If you are a non-interventional hospital referring a patient for a procedure elsewhere there is no need to complete this field, however please remember to tell us where the patient was referred to (4.20 Interventional centre code) Ticagrelor at discharge Data submission deadline for 2014 Public report: 31 May 2014 This field was added as part of the last revision implemented in June last year. It is generally accepted that patients must be started on a new drug before their discharge following an admission with AMI. To prevent the dataset becoming even larger MINAP took the view not to add an additional field recording prescription of ticagrelor during admission and will assume that the patient was started on the medication before discharge.

5 Issue 16 Page 5 Exporting your data As you all know both MINAP portals have the facility to allow export of all your patient level data into a.csv and/or excel file. The export can be defined by the date range, additional variable derived information and the Takotsubo fields. Since excel has some excellent filtering features it allows you to check for missing data for each data field. Each column also contains, in the drop down section, all the entries that are present in the spreadsheet and thus any invalid entries are easily identifiable. Exporting also allows you to store your data on the appropriate drive (please remember the files contain patient identifiable information and so must be stored securely). You can add comments for each cell, for example where an unusual patient pathway has been encountered. Data Quality Manual analysis although there are online views analyses available on both portals, individual patient level data enables you, clinicians or other members of the team, to analyse the data that are relevant to your local needs and generate analyses you are interested in. How to export your data Lotus Notes once in the MINAP database import/export export MINAP data a pop up box is populated select a destination where you want your file saved consider what other additional variable derived information you need, and select if appropriate or leave as it is select the date range and click OK. The more records there are the longer it will take to export your data so please be patient if this is taking a while. Eventually you will be prompted to open the file and you are ready to go! The same process applies to the webportal accessing the export function via Export button on the left hand side (in pink). Timeliness of data entry Timeliness of data entry was discussed in the last issue of the MINAP newsletter. We understand that the resources for data collection are scarce at many hospitals and that leaving members of staff are often not replaced. However, timely and correct data, especially with regard to those STEMI patients brought to you by your local ambulance service(s) are essential. Our ambulance colleagues are judged on their performance through MINAP data data entry for which they have no control. The article on page 7 illustrates the issues that the Yorkshire Ambulance Service (but not exclusively) face when reporting to NHS England on their performance and what the validation of the data entails. Thank you to Ruth Crabtree and Ellis Frampton from Yorkshire Ambulance Service for the article. All hospitals importing data to MINAP please make note of the timeline in Appendix 1 to ensure that you need make no further changes to the data from earlier quarters. The dates in this table apply to all ambulance trusts and hospitals. So far in MINAP we have not locked the database for further data entry or data amendment and we hope this will not be necessary and thus we ask for your cooperation and support for your ambulance colleagues.

6 Page 6 MINAP Newsletter MINAP Applications Web-portal All existing records can be accessed using the MINAP Only button on the navigation section on the left hand corner of the page application. ONLY records created via the webportal are accessible from this application due to a difference in the way that the encryption is set up in Lotus Notes. However if the webportal is used consistently, this issue would be of no relevance. Takotsubo fields are only populated when a discharge diagnosis of Takotsubo Cardiomyopathy is selected. In which case you will be prompted to complete the additional fields. The relevant section is best accessed via the compass icon on the bottom right hand corner. Remember that you are now able to export your data using the webportal. It is worth noting that due to patient identifiable information and other sensitive fields being encrypted in Lotus Notes, any records created using the Lotus Notes application will have patient identifiable fields encrypted in the export. However if you switch to using the webportal to start or edit your existing records, the content of the export will not be limited in any way. The webportal guide is now available on our website: minap/datacollection MINAP database via Lotus Notes NICOR is working towards the use of a webportal for all its national clinical audits. MINAP is ahead of the game (along with TAVI) and the National Heart Failure Audit is rolling out its web app shortly. We strongly recommend that submission and other MINAP data related activities are transferred to the MINAP webportal. Remember that the webportal is accessible from any computer with an internet connection and a browser (Internet Explorer). MINAP Mobile Device Application In November 2013 we ran a survey about the use of smartphones at your workplace. The survey was in relation to a potential for producing a device based MINAP application that would enable a user to collect basic information about the patient prospectively. Such a tool would be more likely useful for the flagging of nstemi patients whose records could subsequently be completed on the webportal. Thank you to everyone who responded the information has been very helpful indeed, as well as your positive response to this new possibility. Three students from the UCL Computer Science Department have developed a shell application as a proof of concept however more work needs to be done to test the connectivity and the data transmission between the device and the NICOR servers in a secure environment. We will keep you posted on progress, and if you wish to get involved in any way or have similar ideas that you would like to share, we would love to hear from you.

7 Issue 16 Page 7 ACQI reporting using MINAP data - the Yorkshire Ambulance Service perspective By Ruth Crabtree and Ellis Frampton Since April 2011, ambulance trusts have been required to report to NHS England, on a monthly basis, on their management of STEMI patients. One of the criteria for this indicator is the STEMI 150 measure for all patients directly transferred to a Primary PCI centre. The data for this is, naturally, taken from the MINAP database. For each ambulance service this data is then made available publicly by NHS England as an Ambulance Clinical Quality Indicator (ACQI) a public measure of the performance of the Ambulance service. To allow some flexibility in the submission of data to MINAP there is a 3 month lag on the data required for NHS England submission. nstemi data collection In 2012 the MINAP Team visited In four order regions to ensure in England that the data submitted is and Wales of the to utmost share accuracy, with our Yorkshire Ambulance colleagues Service how NHS their Trust experience data undertakes is and clinical a process involvement, of used validation and how it on has public the served data report held to and on in MINAP. pages often, 92 teamwork. patients The and improve records services of any and 93. patient If you Some would which hospitals like are some documented to have breached or good advice the systems 150 please minute contact place call-to- have care. We have also help very introduced a topic on nstemi the which data collectionballoon Those of target you MINAP enable helpdesk them not and only we to perform who are reviewed are by the Clinical effective data collection but also involved Audit in department the identification can introduce to confirm you to an experienced that of that the call helps in ensuring nstemi times patients are accurate know that patients and MINAP to determine receive colleague appropriate any in rea- there is no fast and your easy management area way for some during peer support. time and their to do this it takes admission. For one such example please see case study 10 in our latest Month (data) Deadline for acute trust upload to MINAP sons for delay. A good relationship has been developed with the acute trusts in the region and any inaccuracies in the data, valid reasons for delay or clinical learning points are fed back for discussion. Learning points are also cascaded within the ambulance service - this information is invaluable for informing and improving clinical practice. This process of data validation is carried out one month before submission is due to NHS England to ensure that any relevant changes made to the dataset have time to take effect. It is critical that all data is uploaded to MINAP within the time periods indicated in the table. Delays in the uploading of data, or in the amendment of any inaccuracies as a result of data validation, have a significant knock-on effect on the accuracy of data being submitted at a national level. The data validation process is very time and labour intensive and it is not possible to revisit the data after the time windows indicated. January April May 2014 February May June 2014 March June July 2014 April July August 2014 Deadline for acute trust final amendments as a result of YAS data validation May August September 2014 June September October 2014 July October November 2014 August November December 2014 September December January 2015 October January February 2015 November February March 2015 December March April 2015

8 The newsletter for participating MINAP hospitals MINAP and NICOR webpages NATIONAL INSTITUTE FOR CARDIOVASCULAR OUTCOMES AND RESEARCH MINAP and NICOR webpages are available on the following link: Its current content contains information and relevant documentation on the background of MINAP, Data Collection, Dataset, Public Reports & Publications and MINAP Academic Group. We are currently re-developing the structure and the content of our website to make it as informative and relevant as possible to all stakeholders if you have any suggestions on what you would like to see there or have any comments, please us at Feedback/comments We value your feedback on any aspect of the project especially on topics covered in this newsletter. Your feedback informs future developments. For any questions and comments please contact Lucia at Helpdesks For clinical queries, process and general project issues please contact: Tel: or us at For technical issues, access to the MINAP database and similar please contact NICOR Helpdesk on: Tel: or us at NICOR University College London 3rd Floor 170 Tottenham Court Road London, W1T 7NU If you wish to apply for regional or national MINAP data or any other NICOR national datasets, please contact Lucia Gavalova at