Breast cancer – volume of procedures by consultant team

Metric

This metric measures the proportion of consultant teams at a trust that are performing 30 or more breast cancer operations over 1 year. A review of observational studies provides fairly strong evidence supporting an association between higher case volume and better surgical care.

Numerator

Number of valid consultant teams performing more than 30 breast cancer operations in the year (at any trust) and who do the procedure at the trust

A breast cancer operation is defined as operations:

  • OPCS B27- Total excision of breast (mastectomy)
  • OPCS B28- Other forms of excision of breast

A patient must also have a primary diagnosis of breast cancer:

  • ICD10 C50

A valid consultant team code is one where

  • a. The consultant team code is listed on the GMC specialist register as a surgeon
  • b. The consultant team code has been recorded against at least 6 other breast excision procedures (as defined in the above) in the last three years.

Denominator

Total number of valid consultant teams performing breast cancer operations in the year at the trust.

Data Source

SUS / The Consultant guide questionnaire

Time frame

April 2010 – March 2011

Basis

Acute trust

Statistical methods used

Crude rate

Notes

Following discussions between HES and the BMA as well as other professional bodies, it was agreed that consultant codes in HES records should be referred to as the code of the consultant team leader to make it clear that a team and not just an individual was involved as it will include:

  • all the work carried out by the lead consultant work done by others under the guidance or supervision of the lead consultant, eg junior doctors, nurse practitioners
  • those members of staff for whom the consultant is responsible
  • other staff in other specialties who participate in team activities, eg anaesthetists

More information can be found at HES online

2 Responses to Breast cancer – volume of procedures by consultant team

  1. richard sutton says:
    July 20, 2011 at 11:02 am

    i think that ‘consultant team’ might be just too broad. There may perhaps be some institutions where a significant number of operations are not actually performed by the ‘consultant’ but by a trust grade doctor / associate specialist. Would it not be better to make this measure more specific and look at number of procedures by consultant or surgeon (what ever their grade) rather than by team.?

  2. Angela Ince on behalf of Cancer Department says:
    July 25, 2011 at 3:36 pm

    Comment 1: Mary and I have discussed this and we feel that it is unclear what is meant by consultant team. Also, the metric on Dr Foster is specifying that each TEAM should do 30 cases or more, we are not sure if this is the required activity to maintain skills. We had 147 cases in 09/10 whose primary treatment was surgery, so perhaps Dr Foster is really after the figures per consultant/surgeon and perhaps it should be 30 per consultant rather than per team.

    Comment 2:With regards to team, are the juniors not responsible to the Consultants and under their supervision, in which case the surgeries would be accountable to the team, not the individual consultant?

    Also, by excluding those patients treated for carcinoma-in-situ (ICD 10 Code D05) are we not excluding patients who are treated in the same way as those with ICD Code C50 and, if so, is this not an inaccurate representation, particularly as we have to report the D05 patients in cancer waits?