Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (51)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by SPIEGELHALTER, D.
Right arrow Articles by TREASURE, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by SPIEGELHALTER, D.
Right arrow Articles by TREASURE, T.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

International Journal for Quality in Health Care 15:7-13 (2003)
© 2003 International Society for Quality in Health Care

Paper

Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery

DAVID SPIEGELHALTER1, OLIVIA GRIGG1, ROBIN KINSMAN2 and TOM TREASURE3

1MRC Biostatistics Unit, Institute of Public Health, Cambridge
2Dendrite Clinical Systems, Henley-on-Thames, Oxfordshire
3Thoracic Surgery, Guy’s and St Thomas Hospitals, London, UK

Objective. To investigate the use of the risk-adjusted sequential probability ratio test in monitoring the cumulative occurrence of adverse clinical outcomes.

Design. Retrospective analysis of three longitudinal datasets.

Subjects. Patients aged 65 years and over under the care of Harold Shipman between 1979 and 1997, patients under 1 year of age undergoing paediatric heart surgery in Bristol Royal Infirmary between 1984 and 1995, adult patients receiving cardiac surgery from a team of cardiac surgeons in London, UK.

Main outcome measure. Annual and 30-day mortality rates.

Results. Using reasonable boundaries, the procedure could have indicated an ‘alarm’ in Bristol after publication of the 1991 Cardiac Surgical Register, and in 1985 or 1997 for Harold Shipman depending on the data source and the comparator. The cardiac surgeons showed no significant deviation from expected performance.

Conclusions. The risk-adjusted sequential probability test is simple to implement, can be applied in a variety of contexts, and might have been useful to detect specific instances of past divergent performance. The use of this and related techniques deserves further attention in the context of prospectively monitoring adverse clinical outcomes.

Keywords: adverse clinical outcomes, general practitioners, monitoring, mortality, paediatric and adult cardiac surgery, risk-adjustment, sequential probability ratio tests


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 ICVTSHome page
L. Noyez
Control charts, Cusum techniques and funnel plots. A review of methods for monitoring performance in healthcare
Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 494 - 499.
[Abstract] [Full Text] [PDF]

Home page
 Med Decis MakingHome page
M. E. Matheny, D. A. Morrow, L. Ohno-Machado, C. P. Cannon, M. S. Sabatine, and F. S. Resnic
Validation of an Automated Safety Surveillance System with Prospective, Randomized Trial Data
Med Decis Making, March 1, 2009; 29(2): 247 - 256.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
J. M. Ansermino, J. P. Daniels, R. T. Hewgill, J. Lim, P. Yang, C. J. Brouse, G. A. Dumont, and J. B. Bowering
An Evaluation of a Novel Software Tool for Detecting Changes in Physiological Monitoring
Anesth. Analg., March 1, 2009; 108(3): 873 - 880.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. L. Grunkemeier, R. Jin, and Y. Wu
Cumulative sum curves and their prediction limits.
Ann. Thorac. Surg., February 1, 2009; 87(2): 361 - 364.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
V. T. Tsang, K. L. Brown, M. J. Synnergren, N. Kang, M. R. de Leval, S. Gallivan, and M. Utley
Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?
Ann. Thorac. Surg., February 1, 2009; 87(2): 584 - 587.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
B. Kunadian, J. Dunning, A. P Roberts, R. Morley, D. Twomey, J. A Hall, A. G C Sutton, R. A Wright, D. F Muir, and M. A d. Belder
Cumulative funnel plots for the early detection of interoperator variation: retrospective database analysis of observed versus predicted results of percutaneous coronary intervention
BMJ, April 26, 2008; 336(7650): 931 - 934.
[Abstract] [Full Text] [PDF]

Home page
 Int J Qual Health CareHome page
M. Coory, S. Duckett, and K. Sketcher-Baker
Using control charts to monitor quality of hospital care with administrative data
Int. J. Qual. Health Care, February 1, 2008; 20(1): 31 - 39.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
V. A. Ferraris, F. H. Edwards, D. M. Shahian, and S. P. Ferraris
Risk Stratification and Comorbidity
Card. Surg. Adult, January 1, 2008; 3(2008): 199 - 246.
[Full Text]

Home page
 Journal of Health ManagementHome page
A. Patwardhan and D. Patwardhan
How Transferable is Deming's Approach to a Health and Social Care Setting?
Journal of Health Management, December 1, 2007; 9(3): 443 - 457.
[Abstract] [PDF]

Home page
 Qual Saf Health CareHome page
R. Wolfe, S. Bolsin, M. Colson, and P. Stow
Monitoring the rate of re-exploration for excessive bleeding after cardiac surgery in adults
Qual. Saf. Health Care, June 1, 2007; 16(3): 192 - 196.
[Abstract] [Full Text] [PDF]

Home page
 Qual Saf Health CareHome page
D. J Biau, M. Resche-Rigon, G. Godiris-Petit, R. S Nizard, and R. Porcher
Quality control of surgical and interventional procedures: a review of the CUSUM
Qual. Saf. Health Care, June 1, 2007; 16(3): 203 - 207.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
S. P. McGuirk, J. Stickley, M. Griselli, O. F. Stumper, S. J. Laker, D. J. Barron, and W. J. Brawn
Risk assessment and early outcome following the Norwood procedure for hypoplastic left heart syndrome
Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 675 - 681.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
N. Kang, V. T. Tsang, S. Gallivan, C. Sherlaw-Johnson, T. J. Cole, M. J. Elliott, and M. R. de Leval
Quality assurance in congenital heart surgery.
Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 693 - 697.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. J. Murphy, C. A. Rogers, M. Caputo, and G. D. Angelini
Acquiring Proficiency in Off-Pump Surgery: Traversing the Learning Curve, Reproducibility, and Quality Control
Ann. Thorac. Surg., November 1, 2005; 80(5): 1965 - 1970.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
G Leandro, N Rolando, G Gallus, K Rolles, and A K Burroughs
Monitoring surgical and medical outcomes: the Bernoulli cumulative SUM chart. A novel application to assess clinical interventions
Postgrad. Med. J., October 1, 2005; 81(960): 647 - 652.
[Abstract] [Full Text] [PDF]

Home page
 J Public Health (Oxf)Home page
J. Billett, N. Kendall, and P. Old
An investigation into GPs with high patient mortality rates: a retrospective study
J. Public Health Med., September 1, 2005; 27(3): 270 - 275.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
C. A. Rogers, J. S. Ganesh, N. R. Banner, R. S. Bonser, and On behalf of the steering Group
Cumulative risk adjusted monitoring of 30-day mortality after cardiothoracic transplantation: UK experience
Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1022 - 1029.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
C. A. Rogers, B. C. Reeves, M. Caputo, J. S. Ganesh, R. S. Bonser, and G. D. Angelini
Control chart methods for monitoring cardiac surgical performance and their interpretation
J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 811 - 819.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D.J. Spiegelhalter
Monitoring clinical performance: A commentary
J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 820 - 822.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Caputo, B. C. Reeves, C. A. Rogers, R. Ascione, and G. D. Angelini
Monitoring the performance of residents during training in off-pump coronary surgery
J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 907 - 915.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
C. Sherlaw-Johnson, S. Gallivan, T. Treasure, and S.A.M. Nashef
Computer tools to assist the monitoring of outcomes in surgery
Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 1032 - 1036.
[Abstract] [Full Text] [PDF]

Home page
 Qual Saf Health CareHome page
M A Mohammed
Using statistical process control to improve the quality of health care
Qual. Saf. Health Care, August 1, 2004; 13(4): 243 - 245.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
N. Kang, T. Cole, V. Tsang, M. Elliott, and M. de Leval
Risk stratification in paediatric open-heart surgery
Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 3 - 11.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
M. A Mohammed, A. Rathbone, P. Myers, D. Patel, H. Onions, and A. Stevens
An investigation into general practitioners associated with high patient mortality flagged up through the Shipman inquiry: retrospective analysis of routine data
BMJ, June 19, 2004; 328(7454): 1474 - 1477.
[Abstract] [Full Text] [PDF]

Home page
 Int J Qual Health CareHome page
A. P. Morton
The use of statistical process control methods in monitoring clinical performance
Int. J. Qual. Health Care, August 1, 2003; 15(4): 361 - 362.
[Full Text] [PDF]

Home page
 Int J Qual Health CareHome page
S. Bolsin and M. Colson
Making the case for personal professional monitoring in health care
Int. J. Qual. Health Care, February 1, 2003; 15(1): 1 - 2.
[Full Text] [PDF]

Home page
 Int J Qual Health CareHome page
T. O. Lim
Statistical process control tools for monitoring clinical performance
Int. J. Qual. Health Care, February 1, 2003; 15(1): 3 - 4.
[Full Text] [PDF]

Home page
 Int J Qual Health CareHome page
J. C. Benneyan and A. D. Borgman
Risk-adjusted sequential probability ratio tests and longitudinal surveillance methods
Int. J. Qual. Health Care, February 1, 2003; 15(1): 5 - 6.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.