Surgical registries are crucial to improving patient care, say researchers
Clinician-scientists at Monash University Central Clinical School (CCS) are leading a push for the federal government to urgently implement strategies to overcome barriers to clinical-grade registries for surgery.
Registries systematically collect data on quality of care markers for a given procedure across multiple sites, identifying when patient outcomes are outside the normal range (good or bad) by adjusting risks, then comparing performance. This information is then used to inform quality improvement initiatives for patients.
Professor Wendy Brown, Chief of Surgery and Upper Gastrointestinal and Bariatric Surgeon at Alfred Hospital, and Anesthesiologist Dr Jennifer Reilly, recently published two research papers on the issue, of which they are both authors. Professor Brown led a review appeared in the “ANZ Journal of Surgery” while Dr. Reilly conducted a paper published in ‘Anesthesia and Intensive Care’.
Over 2.7 million surgeries are performed in Australia each year.
“Registries have the potential to do tremendous good in the community,” Professor Brown said. “We have set up clinical quality registries to track and monitor best practice by collecting and monitoring quality indicators deemed important by the profession. By monitoring them, we can ensure that patients receive good care,” she said.
Registries have reassured the community that practitioners are monitoring their collective performance, could potentially provide data for research and ultimately save public funds, she said.
Professor Brown is Clinical Lead of the Bariatric Surgery Registry – one of the few surgical registries with a cardiac registry. She cited some local examples where clinical care registries have improved care. A breast device registry run by Monash University was one of the first to identify a rare lymphoma associated with breast implants, while the National Joint Replacement Registry run by the Australian Orthopedic Association has identified a reoperation rate higher than expected for a particular hip. joint surgeons used. This was reported to the TGA and a recall was issued.
However, the current constructs in which registries operate were put in place to support clinical trials and research rather than quality and safety initiatives such as registries, she said. Privacy laws have hampered the amount of healthcare data that can be used for secondary purposes such as inclusion in a registry, and the short-term grant funding on which clinical trials are conducted is not not suitable for current records, she said.
Professor Brown said that although the Australian government has published a 10-year strategy for clinical quality register reform, the need is urgent.
“We need to focus registries on high-risk surgeries or surgeries that are at an early stage in their evolution so that outcomes can be audited to ensure patients receive the best care. To do this, you need to enter as much patient information as possible into the registry.
Dr Reilly’s study surveyed hospitals in the Australian and New Zealand College of Anesthetists (ANZCA) Clinical Trials Network to determine the proportion of anesthesiology departments in Australian hospitals able to access collected electronic data routinely for research and quality assurance. The paper, titled “Towards a National Perioperative Outcomes Registry,” is part of Dr. Reilly’s doctoral studies.
The study looked at data from six different areas of anesthesia patient care. In five of the six areas where electronic data is routinely collected, he found that only about half of anesthesiology departments could access data exports. In four of these areas, only half of the departments that could export data did so regularly for quality assurance or research purposes.
“At the moment, risk factor and outcome data is collected from every hospital, mostly in electronic form, but largely not extractable by physicians for analysis to assess and improve outcomes. patient care,” Dr. Reilly said. “I consider this to be ‘lazy data’. It’s already been collected, sitting in computers in every hospital in Australia, but we’re not mining it for good,” she said.
Economic evaluation has shown Australian registries deliver a return on investment of between two and seven dollars for every dollar spent due to the improved patient care they deliver, she said. “We are missing a huge opportunity to improve the value of the healthcare system at no cost.”