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Table 3 Summary of NCA data completion approaches in the study sites

From: Hidden labour: the skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT

Hospital Service Data collection processes Extent to which shared data are used
Teaching hospital 1
(TH1)
Cardiology ‘Jim’, a cardiology nurse specialist, works full-time on NCA data returns. He completes a hard-copy data form for each eligible patient, using information from paper medical notes and the Trust’s HIT, and keys the data into a departmental database. The data are then uploaded by the hospital’s IT department to MINAP. MINAP and PICANet data returns are separately generated rather than being auto-populated from within hospital HIT systems. NCA data are, however, checked or cross-referenced against these systems: for example, to ensure that all eligible patients are included within the audit return, and that dates/interventions within hospital HIT match those separately generated for the NCA.
PICU ‘Anne’, a full-time non-clinical audit co-ordinator, collates data collected by nurses and registrars on the ward on paper data collection forms, provided by the audit supplier. She checks this information by comparing it with the ward admissions book, handover sheets, patient notes, the PAS and EPR, and then keys the data into a local Access database, before uploading the data to PICANet’s web portal. She also enters some additional data, not stored in her database, separately into the portal.
Teaching hospital 2
(TH2)
Cardiology ‘Neil’, a full-time, non-clinical member of staff, is responsible for several NCA data returns. His attempts to involve staff on the wards in MINAP data collection via a paper data collection form have met with limited success, and he tends to collect the data himself without recourse to a form, storing them in an Access database before uploading to the supplier. He obtains some information in bulk by querying the hospital’s data warehouse, exporting it to an Excel spreadsheet and then importing it into his Access database. He also obtains information from paper patient notes and digitally-stored discharge letters and ambulance systems. The MINAP data return is separately generated rather than being auto-populated from within hospital HIT systems,
although Neil minimises re-keying of data by importing data from other systems where possible.
PICU ‘Grace’, a part-time audit clerk, is responsible for the PICANet return for this small PICU. She does not have a dedicated database or spreadsheet, but transfers data direct into PICANet’s web portal from four or five different systems, including the Trust’s PAS and EPR; an electronic system that contains appointments and transport data; and paper patient notes. The PICANet data return is separately generated rather than being auto-populated from within hospital HIT systems, although data are copied between systems whenever possible, rather than re-keyed.
Teaching hospital 3
(TH3)
Cardiology MINAP data are stored in an in-house database. NSTEMI data (Non-ST-elevation myocardial infarction: a milder type of heart attack) are collected via a paper data collection sheet by two cardiology nurse specialists, ‘Molly’ and ‘Louise’, alongside their clinical duties, when they see patients. For patients they don’t see themselves, they obtain data from a range of sources, including the PAS and EPR, ambulance service records and paper notes. STEMI data (ST-elevation myocardial infarction: a serious type of heart attack) are collected by a full-time non-clinical assistant, ‘Amy’, who inputs them directly into the database from sources such as paper notes; an electronic system that stores patient letters; and bulk reports of patients’ blood results. When MINAP data are complete, the department’s IT team runs a report and uploads the data to the supplier. MINAP and PICANet data returns are separately generated rather than being auto-populated from within hospital HIT systems, although data are checked or cross-referenced against these systems.
PICU PICANet data are recorded by nurses and doctors on paper data collection forms, after which they are input to a specially designed Excel spreadsheet and direct to PICANet’s web portal. This was done by a full-time database manager, ‘Adam’, until his recent departure to a new job, and is now done by another non-clinical staff member, ‘Sara’, supported by a research nurse.
District General Hospital 1
(DGH 1)
Cardiology Data are collected directly from paper patient notes by cardiology nurses, who enter them to a departmental database. The return is co-ordinated and uploaded to the supplier by ‘Sue’, a nursing team leader, who runs reports to check and clean the data and uploads them to MINAP. Sue took on the role recently from another experienced nurse. In both hospitals, the MINAP data return is separately generated rather than being auto-populated from within hospital HIT systems, although data are cross-referenced.
District General Hospital 2 (DGH 2) Cardiology ‘Linda’, an experienced cardiac assessment nurse, works with two other nurses on MINAP data collection alongside clinical duties. Where eligible patients are admitted directly to the Coronary Care Unit, nurses there begin completing paper data collection forms, which are collected daily by the MINAP team, who add discharge data and then key the results direct to the MINAP web portal (there is no in-house database). For other patients, MINAP team members complete the forms themselves, consulting a range of different systems, such as the PAS and paper notes.