Important: Demonstration Site

This PEUGIC project portal is a mock-up for demonstration purposes. It only contains made-up patient data; you MUST NOT enter real data here.

User guide

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Background

The PEUGIC project is funded by the NIHR (National institute of Health Research) and managed by the PEUGIC project team. This is a collaboration between the National Cancer Registration and Analysis Service (NCRAS), which is part of NHS England; Health Data Insight (HDI); Sandwell & West Birmingham NHS Trust and Heartburn Cancer UK.

The project has developed a method of identifying PEUGIC cases from routinely collected national data and has developed a root cause analysis form for a structured review of each case. This allows the tool users to determine the most plausible explanation for the case and identify areas for quality improvement.

To provide a national perspective, the PEUGIC project team will collate pseudonymised data centrally. This can then be compared against local results upon request.

Contacting the PEUGIC project team

Please use the Contact us form on the portal or email england.peugic.project@nhs.net.

Root cause analysis portal registration

To register for an account:

  1. Access the portal on an N3/HSCN connection and press the ‘sign up’ button. The portal runs on Microsoft Edge, Internet Explorer version 11, Firefox and Chrome.
  2. Select PEUGIC (Post-Endoscopy Upper Gastrointestinal Cancer) Root Cause Analysis.
  3. Provide your details: Name; nhs.net or NSH accredited email address - if you do not have an nhs.net account and your hospital/trust email address in not on the list of NHS accredited email addresses, please ask your IT team to create an nhs.net account for you as you will not be able to create an account on the Clinical Audit System otherwise; Mobile number - we will send you a one-time verifcation code when you attempt to log into the portal; GMC/NMC number - only mandatory for doctors and nurses; Organisation - please select which of the participating organisations you would like to be registered with. There is an option to ‘Add another organisation’ if you would like to join the portal under multiple organisations. Please note that some trusts have been split into their hospitals;
  4. Consent to the 3 options regarding storage and use of your details. If you need to withdraw your consent and user account at any point, please email nhsdigital.clinicalaudit@nhs.net.
  5. Submit your application
  6. Follow the link provided in the email sent to the email address you provided to verify your email address. If you do not receive an email within 24 hours, please contact nhsdigital.clinicalaudit@nhs.net.

Once you have followed the above, your details will be verified by the PEUGIC project admin team and an account will be set up for the organisations you have requested within 5 working days. Organisation lead accounts will be created for the organisation leads of each of the participting orgnisations which have been previously agreed on.

Once your account has been set up, you will receive an email with the portal website, your username and your password. Each time you log in, a one-time verification code will be texted to the mobile number you provided. Depending on your local network, subsequent logins from the same organisation and/or computer will sometimes not require a one-time verification code.

Home (landing page)

You will be presented with a dashboard in the landing page with information of the number of cases for each trust that you are registered with. From the actions panel you can navigate to the following pages:

  • Manage portal users (if you are the organisation lead)
  • Manage cases

From the top panel you can navigate to the following pages:

  • Home (landing page)
  • About
  • Documentation
  • Contact us

About

This page contains information about the PEUGIC project

Documentation

On the documentation page you can find the following documentation:

PEUGIC project information

Guidance documentation

Contact us

Please use the contact us form to ask any questions regarding the project, the portal or the root cause analysis form. You can also email us on england.peugic.project@nhs.net.

Manage portal users (organisation leads only)

If you are the organisation lead you will be able to manage the users from that organisation on the portal. From the home page, select ‘Manage portal users’ on the ‘Actions’ tab for the relevant organisation.

On the manage users page there is a dashboard with 3 different tabs:

  1. ‘Active’ has the current active users for your organisation. You are able to remove them from the portal under your organisation here.
  2. ‘Action required’ includes new users that you requested have access to the portal and that have had accounts created for them by the PEUGIC project admin team. As a final step organisation leads are required to accept or reject their accounts.
  3. ‘Rejected’ includes previously active users that you removed. You are able to reactivate their account here.

To add a new user:

  1. Click ‘Add a new user’.
  2. Provide the email address of the new user and which organisation(s) (that you are lead for) you would like them to be added to.
  3. The requested user will receive an email from the clinical audit team to sign up to the Clinical Audit System.
  4. Once they have signed up and an account has been created for them, you will receive an email prompting you to ‘Approve’ their account from within the ‘Action required’ tab

Manage cases

From the home page you will be able to go to the ‘Manage cases’ page for each of the organisations you are signed up with.

The ‘Manage cases’ page contains a dashboard with 4 tabs:

  1. ‘My cases in progress’ contains all the cases you are currently reviewing. If you would like to stop reviewing a case so that another user can continue, select ‘Unassign’ from the ‘Action’ column. This case will then be added to the ‘Available cases’ tab. To continue reviewing a case, click ‘Continue reviewing’.
  2. ‘All cases in progress’ contains all the cases being reviewed by your organisation. If you are the organisation lead you will also be able to unassign users from cases they are reviewing.
  3. ‘Available cases’ contains cases that haven’t started their review process yet and cases that have started to be reviewed and have been unassigned. To start reviewing a case that is new click ‘Start eligibility review’. As soon as you click on a new case it will become assigned to you regardless if you input any data. To return it to the list of available cases click ‘Unassign’ from the dashboard under ‘My cases in progress’ or ‘All cases in progress’. To continue reviewing a case that has been unassigned click ‘Continue review’.
  4. ‘Complete cases’ contains all the cases that have been completed and submitted by your organisation. Click ‘View complete summary’ if you would like to see the completed form for that case. Click ‘View duty of candour summary’ for a subset of data items selected to help with a duty of candour meeting.

Each tab contains 4 or 5 columns:

  1. ‘Case Id’ is the unique identifier for that case
  2. ‘Patient name’ contains the patient names which are offuscated to protect patient identity. To reveal patient names for 30 seconds, click ‘Reveal names’ at the top of the page.
  3. ‘Event(s)’ indicates which events occured at your organisation i.e whether the cancer was diagnosed and/or the index endoscopy was performed at your organisation.
  4. ‘User’ (oragnisation leads only) contains the name of the portal user that a case is assigned to.
  5. ‘Action’ allows you to work on, view or unassign yourself from cases (more detail in the list above).

PEUGIC cases are identified using a selection process. If the cancer diagnosis and the index endoscopy occur at different organisations, the case is initially allocated to the cancer diagnosis trust to review the cancer details. Once this is complete the case is re-allocated to the organisation where the index endoscopy occurred. We will add up to 25 new most recent PEUGIC cases every four months where the index endoscopy was performed at your organisation (regardless of the location of the cancer diagnosis).

Root cause analysis form

Case eligibility

The first step in reviewing a case is confirming the case is eligible for the PEUGIC project. You will be presented with patient data, details about the cancer, the cancer diagnosis date and location and the index endoscopy (non diagnostic endoscopy performed 3-36 months prior to cancer diagnosis date) date and location. If the cancer diagnosis and index endoscopy occurred at different organisations, you are only expected to confirm details regarding the event that happened at your trust.

To enable us to identify the most recent PEUGICs we are identifying cancers before the cancer registry has completed all their data quality checks and ‘signed’ them off. The data item ‘Case registration status’ will indicate if the case is provisional (not signed off) or final (signed off) in the cancer registry. Coding issues in the Hospital Episode Statistics (HES) dataset might be another reason for incorrect data. Data quality issues can result in patients being incorrectly included during the data cohort selection process.

If all the patient data presented is correct, the case is eligible. Please select ‘Patient data are correct’ and submit to move onto completing the root cause analysis form.

If patient details are incorrect or you have no record of this patient or event, please select ‘Patient data are NOT correct or unavailable’. Follow up questions will appear to provide more details. There are several situations where incorrect patient data does not necessarily mean the case is not eligible for the PEUGIC project. For example, date of birth might be incorrect but if the patient was still over 18 at the cancer diagnosis, the case is still eligibile for the PEUGIC project.

The scenarios (options) presented in the form and their associated eligibility consequences are:

  • No record of patient - Case not eligible.
  • Patient name is incorrect - Case still eligibile.
  • NHS number is incorrect - Case still eligibile.
  • Date of birth is incorrect - If age >18 at cancer diagnosis, case still eligible. If age <18 at cancer diagnosis, case not eligible.
  • Sex is incorrect - Case still eligibile.
  • No record of diagnosed cancer - Case not eligible.
  • Cancer site is incorrect - If correct cancer site is oesophagus, stomach, D1 or D2, case still eligible. If other, case not eligible.
  • Cancer histology is incorrect - If correct cancer histology is from the PEUGIC cohort selection criteria, case still eligible. If other, case not eligible.
  • Cancer diagnosis trust is incorrect - Case not eligibile.
  • Cancer diagnosis hospital is incorrect - If correct cancer diagnosis hospital is from the same trust, case still eligible. If not, case not eligible.
  • Cancer diagnosis date is incorrect - If correct diagnosis date does not affect the 3-36 months interval between the cancer diagnosis and the index endoscopy, case still eligible. If not, case not eligible. Please see this explanation on how the cancer diagnosis date is calculated for the Cancer Registry. Please only select incorrect cancer diagnosis date if you feel it is significantly different.
  • No record of endoscopy performed - Case not eligible.
  • Index endoscopy trust is incorrect - Case not eligible.
  • Index endoscopy hospital is incorrect - If correct index endoscopy hospital is from the same trust, case still eligible. If not, case not eligible.
  • Index endoscopy date is incorrect - If correct index endoscopy date does not affect the 3-36 months interval between the cancer diagnosis and the index endoscopy, case still eligible. If not, case not eligible.

If you feel there is an option or scenario not covered by the above, please contact us.

Answers given to the subquestions in ‘Patient data are NOT correct or unavailable’ will be checked when the user clicks ‘Submit’. If the incorrect patient details mean the patient is not eligible for the PEUGIC project, ‘Submit’ will result in the removal of the case and take the user back to the ‘Manage cases’ page. If the incorrect patient details do not affect the case eligibility, ‘Submit’ will take the user onto the root cause analysis form.

D1, D2, D3 and D4 cancers are all coded under the Topology code 17.0. However, only D1 and D2 cancers are eligible for the PEUGIC project. If the cancer is Ampular, D3 or D4, please select ‘Cancer site is Ampular, D3 or D4 and therefore case should be excluded’. Clicking ‘Submit’ will take the user back to the ‘Manage cases’ page.

If you still feel the case is not eligible for the PEUGIC project, please select ‘Patient data are correct but case should be excluded’. Please do not exclude a case if it was unavoidable - it is still definitely a PEUGIC. A hugely important output from the project is the proportion of PEUGICs that are unavoidable.

Please do not include any patient identifiable data in the free text fields.

Case review

When the cancer diagnosis and index endoscopy occur at different organisations, you will only see the section of the form which is relevant to the event that happened at your organisation. If the cancer was diagnosed at your oragnisation, completing the form and clicking ‘Submit’ will send the case to the index endoscopy organisation to complete the second half of the form. When the cancer diagnosis and index endoscopy occur at the same organisation the full form is presented.

Please do not include any patient identifiable data in the free text fields.

Duty of candour

In a small number of cases, the PEUGIC will have been avoidable and the patient harmed which might trigger the disclosure of duty of candour. We estimate that around 5% of cases will trigger duty of candour. We find it extremely constructive working with the risk management and clinical governance teams, who have a wealth of experience of these issues from different clinical areas. We advise that you make contact with these teams at the outset to plan for how to deal with these issues. A duty of candour guide has been created with several PEUGIC case examples with how to apply duty of candour.

Saving and submitting data

You can save answers at any point during data entry by pressing the ‘Save’ button at the bottom of the form. We recommend you save your data periodically in case there are any issues with your browser or secure connection.

When you have completed reviewing a case, click ‘Submit’.

Making changes to data

If you need to change any of the answers given in the eligibility review section, click ‘Review eligibility’ at the top of the Case review page.

If you need to make changes to the form after completing a case click ‘Re-review’ at the top of the Complete case page.