1. Cohort review I wouldn’t recommend it to a dog!

2. What are the benefits of cohort review said to be? Accountability – Already accountable for our practice as per NMC Improved management of cases – Those managing cases not always present at CR Improved contact tracing – We can only screen those identified to us Improved outcomes – Our outcomes are already good

3. Origins of cohort review First implemented in Tanzania in 1980s Used in NYC in 1993 London 2010 NW region 2012

4. We have a different starting point We have been doing this for years “The health visitor’s constant, most particular concern is with the contacts of respiratory tuberculosis.” …..”knows the degree of infectivity to which they have been exposed…the conditions under which they live.”

6. We are already too busy Not enough TB Nurses 50% of cases need ECM Many TB Nurses work in isolation It takes too long to fill in the data collection forms Difficulty fitting CR in between clinics and visits, especially DOT

7. Has cohort review improved anything? HIV testing Entry on to ETS Standardised risk assessment

8. Can it really change management? Cases are closed so there is no going back to correct mistakes Some patients have not completed treatment when we present them – we are only guessing at their outcome

9. Is it a true representation of our outcomes? We present our own cases We may embellish the facts Shouldn’t we audit each other’s cases?

10. Can it really improve contact tracing Patients don’t always tell us when we ask who contacts are We might as well just drag passers-by off the street

11. Key people do not attend Nurses are left defending their clinicians’ management Clinicians don’t attend – case managers are left presenting to themselves

12. Summary Do the benefits justify the effort? More colleagues from the TB MDT need to attend Will evidence from cohort review ever translate into more TB nurses? No dogs were harmed in the making of this presentation