Guidance

Protocol for reporting deaths: process for AAA screening programmes

Updated 9 December 2019

This document outlines the process for reporting deaths within the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme.

Mortality rates in men with AAAs are monitored as part of the quality assurance process within the NHS AAA Screening Programme. In addition, the national programme may be able to learn from deaths of screened individuals, to inform changes in future practice and improve outcomes.

1. Death data

Data on the number of deaths of men, identified through the screening programme, is recorded via the national Screening Management and Referral Tracking (SMaRT) IT system.

Data should only be entered by the manager/co-ordinator or administrator of the local AAA screening service (sometimes referred to as ‘local programme’) if they have system permissions to record deaths. Clinicians and hospital staff should liaise with the programme manager/co-ordinator or administrator to record deaths following referral for treatment.

The data set has been expanded to capture additional information on the circumstances of the death. The national programme requires the support of providers to supply information on men who have died, including the registered cause of death.

It is a mandatory requirement that any man who dies while in the screening programme should be recorded on SMaRT if they:

• are under surveillance with an AAA <5.5cm
• have an AAA ≥ 5.5cm and are waiting for treatment after referral

Providers should also record on SMaRT any man, who has been part of the screening programme, who dies:

• within 30 days of surgery for AAA
• with an AAA ≥ 5.5cm where a joint decision between the man and his consultant surgeon has been made not to intervene
• of ruptured AAA having had a negative scan and thought not to have an AAA

2. Timeframes for reporting

When a man dies within the screening programme, he should be marked as deceased on SMaRT. A new tab will be presented showing the required fields. The fields displayed depends on the status of the man at the time he is marked as deceased.

2.1 Deaths during surveillance

It is the local AAA screening service manager/co-ordinator’s responsibility to ascertain when the man died, together with the cause of death. The mandatory information should be completed within 6 weeks of the provider being notified of the death (see flowchart). The man remains on the ‘death proforma required’ alert until all the mandatory information is submitted.

Mandatory information is:

• date of death
• category of death
• cause of death
• where the man died

2.2 Deaths following referral, but before planned treatment

These are men referred to a vascular unit who died before planned surgery. The mandatory information should be completed by the local AAA screening service manager/co-ordinator within 6 weeks (see flowchart).

Mandatory information is:

• date of death
• category of death
• cause of death
• which hospital was dealing with the man when he died

2.3 Deaths following treatment

These men may have died in hospital, at home or in another institution after treatment or they may have died in the same hospital after readmission.

If the death was within 30 days of the date of treatment, the mandatory information should be completed by the local AAA screening service manager/co-ordinator, in liaison with the consultant surgeon responsible for the rationale for the care. The screening subject population index (SSPI) log will be active for up to 3 months following surgery to allow for a delay in registering any deaths.

Mandatory information is:

• date of death
• category of death
• cause of death
• which hospital was dealing with the man when he died

2.4 Deaths following a decision not to operate

These include men who are not suitable for, or decline, intervention and who subsequently die. The local AAA screening service manager/co-ordinator should liaise with an identified person to help complete the mandatory information. This will usually be the consultant surgeon to whom the man was originally referred, although information may be required from the man’s GP or other medical professionals. The mandatory information should be completed within 6 weeks (see flowchart).

Mandatory information is:

• date of death
• category of death
• cause of death
• which vascular service was dealing with the man when he died
• the reason not to operate
• where the man died

2.5 Deaths from rupture in men screened negative

These men will have been screened and are likely to have had an aortic diameter between 2.0cm and 2.9cm at initial screening. It will be the responsibility of the local AAA screening service manager/co-ordinator to ascertain when and where the man died.

Providers should contact the national programme and regional screening quality assurance service (SQAS) team by telephone or email if they are notified of a screen negative man who has survived a rupture. The mandatory information should be completed within 6 weeks (see flowchart ).

Mandatory information is:

• date of death
• category of death
• where the man died

3. Timescales

Details of any avoidable deaths (including inappropriate delay in referral or surgical treatment) must be completed within 48 hours. Potentially avoidable deaths should also be reported to SQAS and the local screening and immunisation team in accordance with managing safety incidents in NHS screening programmes.

4. Post mortems

It is very important that information from post mortems is provided in the additional information section of the Death Proforma tab. Providers should try to find this information. It is acknowledged that there will be a delay in response when post mortems are required. It is the responsibility of the provider director to inform the national programme’s clinical lead.

5. Reporting

A weekly report will be extracted from SMaRT and made available to the national programme’s clinical lead and SQAS regional teams. This will include information on records with missing information. SQAS will follow up on the deaths on a case-by-case basis. A quarterly summary report will be made available to the AAA joint action meeting.