There are relatively few admissions per hospital per year of new cases of heart failure or COPD and much of the diagnostic work-up is undertaken in the primary care or outpatient setting. We therefore chose to study cases of admission for an exacerbation of either of these two tracer conditions and excluded admissions for diagnostic workup. These working definitions for data collection were: Definition of an exacerbation of COPD: exacerbation is a sustained worsening of the symptoms from their usual “An patient’s stable state which is beyond normal day-to-day variations, and is acute in onset. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour.”[31] Definition of an exacerbation of heart failure: "An exacerbation of heart failure is a sustained worsening of the patient's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset. Commonly reported symptoms are worsening breathlessness, tiredness and swelling of the feet and/or ankles."[23] Choosing the number of case notes for review In choosing the number of case notes for review we were unable to use prior hypotheses to assist in determining how many case notes would be required for the reliability studies. We considered using van of calculating the Belle’s method[32] number of events (e.g. identified opportunities for error as being event = 20 times the number of parameters) from which to assist with this calculation, but subsequently found that it was practically impossible to model the range of opportunities for error presenting in these complex care pathways. In addition it was decided that the study was more likely to find variations in care rather than identifiable adverse events and that in health care there could be very large opportunities for error. We therefore took a pragmatic decision to select approximately 50 case notes per condition per hospital. This number also fitted with the custom and practice of the Royal College of Physicians CEEu in which about 60 case notes per hospital form the basis for review in national clinical audits and this number of case notes had previously provided sufficient data for studies of inter-rater reliability.[24]
There are relatively few admissions per hospital per year of new cases of heart failure or COPD and much of the diagnostic work-up is undertaken in the primary care or outpatient setting. We therefore chose to study cases of admission for an exacerbation of either of these two tracer conditions and excluded admissions for diagnostic workup. These working definitions for data collection were: Definition of an exacerbation of COPD: “An exacerbation is a sustained worsening of the patient’s symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour.”[31] Definition of an exacerbation of heart failure: "An exacerbation of heart failure is a sustained worsening of the patient's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset. Commonly reported symptoms are worsening breathlessness, tiredness and swelling of the feet and/or ankles."[23] Choosing the number of case notes for review In choosing the number of case notes for review we were unable to use prior hypotheses to assist in determining how many case notes would be required for the reliability studies. We considered using van Belle’s method[32] of calculating the number of events (e.g. identified opportunities for error as being event = 20 times the number of parameters) from which to assist with this calculation, but subsequently found that it was practically impossible to model the range of opportunities for error presenting in these complex care pathways. In addition it was decided that the study was more likely to find variations in care rather than identifiable adverse events and that in health care there could be very large opportunities for error. We therefore took a pragmatic decision to select approximately 50 case notes per condition per hospital. This number also fitted with the custom and practice of the Royal College of Physicians CEEu in which about 60 case notes per hospital form the basis for review in national clinical audits and this number of case notes had previously provided sufficient data for studies of inter-rater reliability.[24]
eThesis.docx