“Flash-Mob” Audit 2019
Watch Dr Rory McCulloch Presents the Preliminary Results
"Flash-Mob" TTP Audit 2019
Nationwide audit of treatment delays in patients presenting with acute Thrombotic Thrombocytopenic Pupura (TTP) to UK hospitals
The 2019 HaemSTAR national Flash-Mob audit evaluated the extent of recurrent barriers to early treatment initiation for patients presenting with acute TTP.
Thrombotic Thrombocytopenic Purpura (TTP) is a very rare, life-threatening condition. It is a recognised medical emergency requiring prompt diagnosis and initiation of therapy of therapy. Plasma exchange remains the only treatment shown to impact significantly on acute mortality and early treatment is critical with up to 50% mortality of TTP deaths occurring within 24 hours of presentation.
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Prompt initiation of plasma exchange (PEX) faces many logisitcal challenges. The average UK NHS Trust may diagnose only one case of TTP per year, presenting symptoms are often non-specific and first point of contact is normally with non-haematologists in the primary or secondary care settings making timely diagnostic challenging.
Once TTP is recognised arrangements for PEX, including central line insertion, must be made. Most centres do not have the provision for a 24-hour PEX service meaning either local ad hoc arrangements are made, or transfer to a regional tertiary centre must be co-cordinated, which can be a complex and time-consuming task.
Although these challenges are recognised there is currently no comprehensive record of treatment delays experienced by patients presenting with acute TTP in UK hospitals. A collaborative national audit has potential to highlight important recurring issues. This audit will, for the first time, evaluate the extent of recurrent barriers to early treatment initiation and will provide valuable information to inform and shape the design of future national care provision.
Initial data collection took place between October and December 2019. After data clearing through the first half of 2020 complete data on 148 patients, treated at 80 UK centres, was available for analysis.
Publications
The final results were published in the Journal of thrombosis and haemostasis in February 2022. The paper was published under a collaborative authorship model listed simply as The HaemSTAR Collaborators. An appendix details all contributors to this project and each is pubmed-citable.
Full List of Contributors
Large scale nationwide projects such as this are not possible without a huge collaborative effort. We wish to thank and acknowledge every one of the following individuals for their contributions to the 2019 Flashmob Audit:
Adam Bloomfield, Adam Cole, Alexander Bashford, Alexander Langridge, Alexander Sternberg, Alexandra Pike, Alexandros Rampotas, Amanda Clark, Amir Shenouda, Amit Sud, Amy Gudger, Amy Knott, Anand Lokare, Andrew Doyle, Andrew Nicholds, Andrew Stewart, Anna Austin, Arvind Pillai, Asmaa Abdussalam, Astrid Etherington, Azza Almaremi, Basabi Chatterjee, Beena Salhan, Benjamin Bailiff, Benjamin Gray, Beverley Hunt, Bhuvan Kishore, Brigit Greystoke, Catherine Page, Catherine Prodger, Cecilia Gyansah, Chris Bailey, Chris Bailey, Christopher Dean, Claire Corrigan, Claire Horgan, Claire Mapplebeck, Clare Kane, Corinne De Lord, Daniel Castle, Daniel Kajita, David Davies, David Dutton, David McLaughlin, David McLaughlin, David Tucker, Diana Triantafyllopoulou, Edward Belsham, Eleana Loizou, Elissa Dhillon, Elizabeth Jones, Elvis Aduwa, Eman al-Rawi, Emily Booth, Emily Finan, Emily Hughes, Francesca Leonforte, Gary Benson, Gavinda Sangha, Harshita Goradia, Indrani Venkatadasari,
Ioana Whalley, Isabel Farmer, Israa Kaddam, Izabela James, Jagdish Adiyodi, Jahanzeb Dr Khawaja, James Clark, Jamie Maddox, Jayne Parkes, Jayne Peters, Jennifer
Ross, Jennifer Young, Jeremy Schofield, Jessica Griffin, Joannes Hermans, Joost van Veen, Josephine Crowe, Josephine Crowe, Julia Wolf, Jun Yong, Kanchana De
Abrew, Katharine Rothwell, Katherine Wickenden, Kathryn Thornton, Katie Randall, Keir Pickard, Kenneth Douglas, Kiri Dixon, Lara Roberts, Laura Munro, Li Chan, Louise
Fraser, Louise Garth, Lucia Chen, Luke Attwell, Luke Carter-Brzezinski, Lyndsay McLeod-Kennedy, Lynn Manson, Mamatha Karanth, Marie Scully, Mark Vickers, Mary
Subhan, Mathew Sheridan, Matthew Fowler, Matthew Horan, Maya Raj, Michael Joffe, Molham Tahhan, Murugaiyan Thanigaikumar, Nadreen Mustafa, Naomi Cornish,
Narind Sharma, Natalie Heeney, Neelakshi De Silva, Nichola Coooper, Nicholas Denny, Nicholas Lafferty, Nicholas Pemberton, Paolo Polzella, Paul Cahalin, Paul
Kerr, Paul Kerr, Philip Robson, Phillip Nicolson, Quentin Hill, Rachel Hall, Rachel Peck, Rachel Rayment, Rajani Chengal, Rebecca Shaw, Rhys Williams, Richard Buka,
Richard Calvert, Richard Gooding, Richard Karim , Richard Murrin, Rory McCulloch, Rosina Shujaat, Rui Zhao, Sajir Mohamedbhai, Salena Chauhan, Sam
Ackroyd, Samah Babiker, Samuel Burrows, Sandhya Munireddy, Sara Boyce, Sarah Alford, Sarah Barsam, Sarah Beverstock, Sarah Challenor, Sarah Jaafar, Sarah
Mangles, Sarah Wheeldon, Sarah Wheeldon, Sean McGoldrick, Shalal Sadullah, Sonia Garcia, Sophie Otton, Sophie Smith, Sophie Todd, Sudhir Tauro, Sue Pavord, Suzanna
Docherty, Swathy Srinath, Talat Khan, Thomas Fail, Thomas Seddon, Thomas Skinner, Tina Dutt, Tom Bull, Udaya Reddy, Vickie McDonald, Victoria Ware, Vinayak
Tandon, Will Lester, William Thomas, Yishi Tan, Zar Ni Soe, Zara Sayar, Zeeshan Khan, Zunera Anwar.
And the hospital sites and Trusts at which the project was registered:
Arrowe Park Hospital, Barking Havering and Redbridge (Queen's Hospital), Barts Health NHS Trust, Belfast Health and Social Care Trust, Blackpool Victoria, Bradford Royal Infirmary, Buckinghamshire Healthcare, Calderdale and Huddersfield NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, Central Manchester University Hospitals Foundation Trust, Central Manchester University Hospitals Foundation Trust, Chelsea and Westminster Hospital NHS Foundation Trust, Dorset County Hospital , Dudley group NHs foundation trust, Epsom and St Helier, Gateshead NHS Foundation Trust, Gloucestershire NHS Hospitals , Great Western Hospitals, Guy's & St Thomas NHS Trust, Hampshire Hospitals NHS Foundation trust, Heartlands Hospital, Homerton University Hospitals NHS Foundation Trust, Imperial College Healthcare NHS Trust, Ipswich NHS Trust, James Paget Hospital , King's College Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, Lewisham and Greenwich NHS Trust, London North West University Healthcare NHS Trust, Maidstone Tunbridge Wells NHS Trust, Mid Yorkshire Hospitals NHS Trust, Milton Keynes University Hospital NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, NHS Fife, NHS Gampian (Aberdeen Royal Infirmary), NHS Greater Glasgow and Clyde, NHS Lothian, NHS Tayside (Perth Royal Infirmary), Norfolk and Norwich University Hospital NHS Foundation Trust, North Bristol Trust, North Devon District Hospital, North Middlesex University Hospital NHS Trust, North West Anglia NHS Foundation Trust, Northampton general Hospital, Nottingham University Hospital NHS Foundation trust, Oxford University Hospitals NHS Foundation Trust, Poole General Hospital, Queen Alexandra Hospital, Royal Berkshire Hospital, Royal Blackburn Hospital, Royal Bournemouth Hospital, Royal Cornwall Hospital NHS Trust, Royal Devon and Exeter NHS Foundation Trust, Royal United Hospitals Bath NHSFT, Sandwell and West Birmingham Hospitals NHS Trust, Sheffield Teaching Hospitals, South Tees Hospital Trust, South Tyneside and Sunderland NHS Foundation Trust, South Warwickshire NHS Foundation Trust, Southampton General Hospital, St Helens and Knowsley, Swansea Bay University Health Board, Taunton and Somerset NHS Foundation Trust, The Countess of Chester Hospital NHS Foundation Trust, The Royal Liverpool University Hospital, The Royal, Wolverhampton NHS Trust (New Cross Hospital), Torbay and South Devon, UH Bristol NHS Foundation Trust, University College Hospital, London, University Hospital Lewisham, University Hospitals Birmingham (QE), University Hospitals Coventry and Warwickshire, University Hospitals of Leicester , University Hospitals Plymouth NHS Trust, Walsall Healthcare NHS Trust, Warrington and Halton teaching NHS trust, West Suffolk Hospital NHS Foundation Trust, Weston Area Health Trust, Wexham Park Hospital, Worcestershire acute hospitals NHS trust, York Teaching Hospital NHS Trust.