Our NJR Data Quality Audit programme has been devised to assess the completeness and quality of the data submitted to the registry. This enables us to compare patient records for procedures recorded in local hospitals’ databases (e.g. Patient Administration Systems (PAS)) to that in the registry, with the aim of investigating the accuracy of the number of arthroplasty procedures submitted to the registry, compared to the number carried out.
The importance of the Data Quality Audit is clear when considered in the context of our primary aims. To achieve those aims, there are two principal outcomes of interest to the NJR: revision surgery and mortality volumes.
Revision surgery is an indicator of implant failure or surgical performance. This is determined by linking a primary arthroplasty procedure to a subsequent procedure which typically occurs a number of years after the primary procedure. Therefore, compliance with reporting revision surgical procedures is essential to estimate implant failure rates and surgical performance more accurately.
Mortality data is collected from Civil Registration Data which is obtained from NHS Digital and linked to individuals within the registry. However, it is important to remember that joint replacement is a very successful operation with a very low mortality rate and all surgeons and hospitals have outcomes in line with the expected range.
In 2020/21 we began a national roll out of a semi-automated audit process which enables units to check their data quality on a monthly or quarterly basis. This has greatly reduced the number of mismatches that have to be checked each time the audit is run, and the pre-rollout pilot suggested that this rapidly becomes part of the normal workflow. This subsequent roll out is underway for hip, knee, elbow, ankle and shoulder data and 314 hospitals have now completed an audit of their 2018/19 data, with 199 hospitals having completed an audit of 2019/20 data and 46 hospitals having started auditing their 2020/21 data. If you yourself work for a hospital that has not yet signed up for the audit programme, please contact email@example.com or via the NJR website.
For the previous five years a manual NJR audit had been undertaken each year to achieve exactly the same checking of anomalies and update of missing data by reconciling the PAS and the NJR sources with each other. This semi-automation of the old audit process is therefore a most beneficial development as it has enabled a less cumbersome process for hospitals, thus making the process easier to engage with to continue to ensure the high quality, validity and accuracy of data entered into the registry.
In order to ensure that more historic data anomalies are able to be addressed in elbow surgery, we are working with the British Elbow and Shoulder Society (BESS) to carry out a national manual audit of elbow arthroplasty data. This involves surgical trainees reviewing patient records and identifying missing cases. For more information, please contact BESS on firstname.lastname@example.org.
Similar spotlight data quality exercises involving dual mobility hip replacements, reverse shoulder replacements and multi-compartmental knee replacements are being developed in consultation with the relevant specialist societies.