Bournemouth 2017

Time to closure of diverting ileostomy – data from the National Bowel Cancer Audit – an interview with James Hill

In a series of interviews, we will be previewing this year’s ACPGBI annual meeting in Bournemouth, 3-5 July. We talked to Professor James Hill, Clinical Professor of Colorectal Surgery, Manchester Academic Health Science Centre and Consultant colorectal surgeon at Manchester Royal Infirmary, UK, who outlined how the National Bowel Cancer Audit (NBOCA) is helping to improve clinical practice and the outcomes of patients with colorectal cancer in England and Wales.

“The National Bowel Cancer Audit (NBOCA) was established approximately 15 years ago and its aim is to collect data on all patients having resection for colorectal cancer in England and Wales, and measures the process of care given to patients,” said Professor Hill. “The audit has several aims that include providing feedback for units for benchmarking and identifying any outliers that highlight poor practice, but more than anything the audit is about collecting and sharing information about care outcomes and treatment.”

He explained that participation in the audit is mandatory and the data is collected in-house by individual clinicians and audit co-ordinators. The data is then uploaded via Clinical Audit Platform to HNS Digital who anonymise the data and then send it to the Clinical Effectiveness Unit at the Royal College of Surgeons (England). They then link the data to Hospital Episodes Statistics (HES) data and then they can analyse the risk factors, risk adjusted outcomes etc. The data is then published in an annual report that contains national figures, as well as individual unit data. Individual units are also provided with a pdf of their outcomes compared to both the regional and national standards.

The audit also published ‘funnel plots’, which are risk-adjusted outcomes and this helps units to identify whether they are outliers. In such instances, these individual units can then look at particular aspects of care and target how it can be improved.

Through the audit, the ACPGBI have been able to determine what the standard practice is in relation to the average delay to the closure of stomas, which is of course of significant value to patients. The audit also highlighted those units who had patients whose stoma closure was delayed.

“For example, using the audit data, one unit specifically targeted those patients with a temporary stoma so overtime their average closure time was significantly reduced,” he added. “This demonstrates the impact the audit can have on improving both clinical practice and patient outcomes. In the last couple of years collected data on all patients with colorectal cancer, whether they undergo surgery or not, and we believe this will give us a more complete picture of the management of patients diagnosed with a colorectal malignancy. “

Professor Hill said that data that is effectively 18 months out of date, because of the processes involved in formulating the risk adjusted data, and one of the things the ACPGBI is are trying to do is to get more ‘real time’ data, at least for the data that does not need risk adjusting.

“We are hoping the next report will be published in the Autumn 2017 and for 2018, we are hoping to publish the report in time for the ACPGBI Annual Meeting, so the report will have the greatest impact and allow members to discuss the data with their peers,” he concluded.