PD Audit

Masterclass 10

Medhat Zaiada

Associate Specialist

Victoria Hospital

Kirkcaldy, Fife

PD Audit

Analysis of Data Collected INumber of patients: 30

Male : female: 18 :12, 60% : 40%, ratio 1.5 :1.0

Average age: 74.5 y, youngest 45 y, oldest 88 y

Referral source: 26/30 GP

03/30 consultants

01/30 clinical assistant

6 weeks target met: yes 25/30 (83.3%) - no 5/30 (16.7%)

Average delay: 12.6 days, shortest 5, longest 24

Reasons for delay: 2 were initially referred to neuro

1 no clinic for 2 weeks (festive season)

2 no reason identified

Referred untreated: yes 26/30 (86.7%)

no 04/30 (13.3% all on levodopa)

PD Audit – Masterclass 10

Analysis of Data Collected IIOutcome:1= not PD, discharged 15/30 (50%)

mix of ET, hydrocephalus, tremors ? Cause, dementia, stop R/ and discharge X2

2= IPD 03/30 (10%)

3= other parkinsonism 4/30 (13.3%)

drug induced parkinsonism x 1

vascular parkinsonism x 3

4= unclear, tests, stop R/, monitor 8/30 (26.7%)

?PD, ? Vascular x 2

?PD, ? Neuropathy x 1

?PD, ?PD plus x1

?PD, ?drug induced x 1

?early PD, monitor x 2 (1 referred on R/)

withdrawal of R/ but needs monitoring x 1

Have we achieved audit standards?

PD Audit Standards-Part IS1 access to PD specialist neuro/ger = yes

S2 access to PDNS at all stages = yes

S3 access to PT at all stages = yes

S4 access to OT at all stages = yes

S5 access to SALT at all stages = yes

S6 access to PD medications = no (doudopa)

S7 access to neurosurgery = yes

S8 regular reviews by PD specialist = yes

PD Audit Standard-Part IIS1 Patients with ?PD referred untreated = no

S2 Patients with ?PD seen within 6 weeks = no

S3 complex cases seen within 2 weeks = not included in audit

PD Audit – Masterclass 10

Result

PD services at Victoria Hospital have met all audit

standards part I with the exception of duodopa due to

SMC restriction.

Audit standards part II were not fully met.

Majority of patients referred did not have PD approx

63%.

Approx 27% of cases referred were unclear & needed

monitoring.

Only 10% of referrals were confirmed as IPD.

IPD is difficult to diagnose even in specialist clinics

and some cases needs close monitoring.

PD Audit – Masterclass 10

what to do next?

Educating GPs & other doctors to refer

patients untreated (letters sent to GPS &

hospital doctors).

Improving referral system so that patients

can be seen quicker.

Repeat audit at local level and aim for

better results to meet all audit standards

Dear colleagues

We recently conducted Parkinson’s disease audit at Victoria hospital PD clinic. This is a multi-centre audit conducted under the supervision of the Parkinson’s Disease Academy as part of PD masterclass 10. The aim of the audit is to assess patient access to services and NICE recommended treatments. The local audit at VHK has shown that some patients (16.7%) were not seen within 6 weeks (42 days) of referral (as recommended by NICE), mainly due to the fact that patients are not directly referred to the PD clinic which causes some delay. The audit also shown that some patients (13.3 %) were referred to PD clinic already treated. The guidelines recommend that such patients must be referred untreated.

As a result of this audit I should be most grateful if you could use the following guidelines:-

1. Please refer patients with suspected Parkinson's disease directly to PD clinic at Victoria Hospital ( to Dr John Cordina for those over the age of 65 and to Dr Martin Ziedler for those under the age of 65).

2. Please refer Patients with suspected Parkinson’s disease to PD clinic untreated.

We are aiming to conduct the second audit cycle locally in the very near future. Thank you very much for your co-operation. Please let me know if you would like a copy of the audit. Kind regards.

Your faithfully

Medhat Zaiada

Associate Specialist