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Non-melanoma skin cancer (NMSC) excision national audit 2014


Interim report

BAD national audit on non-melanoma skin cancer excision 2014 - interim report (June 2015)

Graphs and summaries (PowerPoint file)

Email invitation to all UK working members (this audit is now closed)

Dear member,

This is the first official BAD national audit on non-melanoma skin cancer excision, designed and piloted jointly by BAD and BSDS representatives to provide a snapshot of Dermatology (non-Mohs) excision practice for non-melanoma skin cancer in the UK, and we would like to invite you to participate as your contributions will be invaluable.

Unlike recent national audits we are using an Excel-based proforma to collect all the data instead of Survey Monkey; we would like to request that you enter data for 10 patients per clinician.

All instructions, including data collection methodology and how to save and submit your file, are provided in the spreadsheet.

Ideally, we would like to receive data that are collected prospectively to reduce the chance of bias through case selection and to provide an indication of the specificity of the triage to excision, but there is a column in the spreadsheet to indicate if it was not the case for each patient entry.

Collecting data prospectively means that you would need to be vigilant with the arrival of histology reports.

However, if collecting data retrospectively, please identify 10 consecutive surgical cases from 1st January 2014.

The Excel audit data collection proforma can also be a used as a continuous tool for data collection, with the aim of maintaining a record of clinical activity and outcome. Many Dermatologists already do this using their own tool, or the one linked to at the top of the page in the proforma.

Please complete your details in the designated areas in the proforma to validate your submission, so we can subsequently email you an acknowledgement, as well as a copy of the results which can be used as evidence to support revalidation.

You may be able to register this with your hospital or Trust to satisfy their requirements, and also enable you to provide benchmarked results for discussion with your clinical and management team.

The audit data collection will close on Friday 23rd May 2014.

The deadline has been extended in light of requests from members who wish to collect their personal surgical data prospectively and having to factor in the time it takes to receive histology reports.

Please consider these actions before proceeding to begin to enter the audit data:

  1. Register the audit with your hospital or Trust.
  2. Decide early on whether or not collecting all the data prospectively would be achievable at your hospital.

Please forward any queries to Dr M. Firouz Mohd Mustapa (clinicalaudit@bad.org.uk).

Frequently Asked Questions

Q1: I have submitted my completed proforma - when will I receive my acknowledgment letter?
A1: You will receive an acknowledgment letter after the deadline, and once we have checked and verified your data and personal details.

Q2: Why is the data collection method different from previous BAD national audits?
A2: Previous national audits involved retrospective data collection for just 3 patients and Survey Monkey is a convenient web-based platform for such data entry. However, members are encouraged to collect their data prospectively for this audit, and for 10 patients. Therefore, a downloadable Excel-based proforma was felt to be a more appropriate tool.

Q3: Can I use the proforma as a continuous data collection tool for my personal, surgical practice?
A3: Members are encouraged to use the proforma to actively collect their data and maintain a record of surgical activity and outcome.

Q4: Does the pre-operative clinical diagnosis determine eligibility for inclusion in this audit, or subsequent histologically confirmed diagnosis?
A4: Eligibility for inclusion is determined by pre-operative clinical diagnosis; there should then be no incomplete excisions based on mistaken clinical diagnosis.

Q5: In the proforma, the options for the histology column include "melanoma" and "benign lesions" - are patients with suspected NMSC pre-operatively but with confirmed melanoma (or benign) histologically to be included?
A5: Yes.

Q6: In the proforma, the margins for clearance were very specific; at my hospital they are only specified as being ">1 mm" if clear and no more - what do I do?
A6: Please use the comments column to indicate this.

Q7: What does non-melanoma skin cancer refer to for this audit?
A7: Non-melanoma skin cancer refers to invasive tumours only, e.g. BCC and SCC, and excludes Bowen’s disease and actinic keratosis.

Q8: The clinician carrying out the surgery is not necessarily the clinician who made the initial pre-operative diagnosis - who should fill in the proforma?
A8: This audit is for 10 sequential lesions personally excised and can be used as a record for personal excision quality. This may limit uptake amongst consultants, but will increase uptake from non-consultants, skin surgery nurses and trainees who we hope to get involved as they are a big part of service delivery especially so in larger centres.

Q9: What are the audit standards on which this national audit is based?
A9: The audit standards are an amalgamation of BAD quantitative (auditable) standards for both major kinds of NMSC and are derived from BAD clinical guidelines for the management of BCC and SCC.

Q10: What is this audit for and what does the BAD hope to achieve with this national audit?
A10: Firstly, this audit is to enable members to participate in a national audit with BAD assistance. Secondly, it is to determine the appetite amongst the membership for collecting their own skin cancer data. Thirdly, we hope to provide a snapshot of the complexity of surgery and case mix of patients operated upon by BAD members. In the longer term, the BAD will be considering on providing a portal for members to undertake data collection with a view to establishing a personal log to contribute to appraisals.

Q11: Can I enter my 10 sets of patient data as a mix of prospective and retrospective cases?
A11: Yes you can - please indicate this in the appropriate column.

Q12: I wanted to enter free texts in relevant fields but an error message came up - what do I do?
A12: MANY of the columns in the spreadsheet proforma have pre-loaded dropdown options for you to choose from - please use these instead of entering free texts.

Q13. Can plastic surgeons contribute to this audit as the excisions are also done by them at my hospital?
A13. Yes they can - please select the appropriate clinician grade from the dropdown options.

Q14: Is it necessary to enter in patients' initials or unit numbers?
A14: Columns C and D with patient initials and unit number are optional for ease of local collation. Before submitting the completed proforma, they should be deleted from the spread sheet.

BAD Clinical Standards Unit
BAD Health Informatics sub-committee

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