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Using CRAB to provide assurance to County Durham and Darlington NHS Foundation Trust and to determine whether it is a true outlier


County Durham and Darlington NHS Foundation Trust wanted a better insight into surgeon and unit mortality and morbidity to help it make comparisons throughout the organisation. Jeremy Cundall has been a consultant colorectal and general surgeon at the trust since 2008. He says the main reason for turning to CRAB was because the organisation wanted a system that was simple to use and well validated.

Using CRAB to identify whether the organisation is a true outlier

According to one national mortality indicator (Summary Hospital Mortality Indicator) the organisation appeared to have higher than expected mortality at one of its sites. Dr Cundall says the starting point for a deeper investigation was a CRAB analysis. “We looked at the data and using CRAB established that patients at the site were generally sicker, which effectively meant we were not an outlier. For me, as head of surgery, it is really important to be able to have this more detailed insight. In fact, it is the only system that we can trust because we know that surgeons accept the data.”

A tool trusted by clinicians and recognised by experts

Dr Cundall says the fact that CRAB has been used by the Department of Health for national mortality reviews to get a true picture of outliers is very reassuring. He also points out that CRAB is trusted by clinicians. One of the most significant benefits is the ability to carry out longitudinal analysis. “Many consultants will experience different volumes of work every month. There could be a month when you only do 15 cases and there are two deaths. If you looked at the data in isolation, you would then be an outlier, but clearly that is not the case,” he says.

Using CRAB for consultant appraisal and assurance for the organisation

Going forward Dr Cundall says he expects consultants to start using CRAB as part of appraisal process. From a trust assurance point of view a three monthly reporting cycle will be established with reports for each unit being sent to clinical directors and medical directors, although Dr Cundall points out that the intention is not to act on a single three-month block of data.


County Durham and Darlington NHS Foundation Trust is using CRAB to identify outliers at consultant and unit level

CRAB is trusted by clinicians and will be used as part of the appraisal process to improve their own practice

Longitudinal analysis allows for a more complete understanding of variations in individual performance

CRAB is providing the organisation with a level of assurance on morbidity and mortality that it didn’t have before

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