Institutional Research Information Service
UCL Logo
Please report any queries concerning the funding data grouped in the sections named "Externally Awarded" or "Internally Disbursed" (shown on the profile page) to your Research Finance Administrator. Your can find your Research Finance Administrator at https://www.ucl.ac.uk/finance/research/rs-contacts.php by entering your department
Please report any queries concerning the student data shown on the profile page to:

Email: portico-services@ucl.ac.uk

Help Desk: http://www.ucl.ac.uk/ras/portico/helpdesk
Publication Detail
Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Comparative Study
  • Authors:
    Spiegelhalter D, Grigg O, Kinsman R, Treasure T
  • Publication date:
  • Pagination:
    7, 13
  • Journal:
    Int J Qual Health Care
  • Volume:
  • Issue:
  • Status:
  • Country:
  • Print ISSN:
  • Language:
  • Keywords:
    Adult, Aged, Cardiovascular Surgical Procedures, Female, Health Services Research, Hospital Mortality, Hospitals, Public, Humans, Iatrogenic Disease, Infant, Male, Medical Audit, Medical Staff, Hospital, Organizational Culture, Probability, Risk Adjustment, Sentinel Surveillance, Treatment Outcome, United Kingdom
OBJECTIVE: To investigate the use of the risk-adjusted sequential probability ratio test in monitoring the cumulative occurrence of adverse clinical outcomes. DESIGN: Retrospective analysis of three longitudinal datasets. SUBJECTS: Patients aged 65 years and over under the care of Harold Shipman between 1979 and 1997, patients under 1 year of age undergoing paediatric heart surgery in Bristol Royal Infirmary between 1984 and 1995, adult patients receiving cardiac surgery from a team of cardiac surgeons in London,UK. MAIN OUTCOME MEASURE: Annual and 30-day mortality rates. RESULTS: Using reasonable boundaries, the procedure could have indicated an 'alarm' in Bristol after publication of the 1991 Cardiac Surgical Register, and in 1985 or 1997 for Harold Shipman depending on the data source and the comparator. The cardiac surgeons showed no significant deviation from expected performance. CONCLUSIONS: The risk-adjusted sequential probability test is simple to implement, can be applied in a variety of contexts, and might have been useful to detect specific instances of past divergent performance. The use of this and related techniques deserves further attention in the context of prospectively monitoring adverse clinical outcomes.
Publication data is maintained in RPS. Visit https://rps.ucl.ac.uk
 More search options
UCL Researchers
Clinical Operational Research Unit
University College London - Gower Street - London - WC1E 6BT Tel:+44 (0)20 7679 2000

© UCL 1999–2011

Search by