Using registry data to improve surgical outcome
Download as PPTX, PDF1 like68 views
This document discusses using registry data to improve surgical outcomes. It notes that while 310 million surgeries are performed worldwide each year, the true mortality rate is unknown. Failure to rescue, where a patient dies after a treatable complication, is presented as a measure of surgical quality that can identify variations not found in other metrics. The document outlines a stepped wedge randomized cluster trial testing an enhanced peri-operative care pathway for high-risk patients across 93 UK hospitals and 20,000 patients, with results expected in autumn 2017. National registry data through the HQIP-NELA program is being used to capture outcomes data for the study.
Using registry data to improve surgical outcome
- 1. Using registry data to improve surgical outcome Rupert Pearse Professor of Intensive Care Medicine Queen Mary University of London
- 2. Disclosures Research Grants • Nestle Health Sciences • Edwards Lifesciences • Intersurgical • Medtronic Honoraria • Nestle Health Sciences • Edwards Lifesciences • Medtronic • Glaxo Smithkline
- 5. Isoflurane and the trial of n=1
- 7. Not every treatment should be tested in a randomised trial…
- 8. • 310 million surgical procedures worldwide • True mortality rate is not known • 3 million deaths each year
- 9. 0.00 2.50 5.00 7.50 10.00 0.00 1.00 2.00 3.00 4.00 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Numberofprocedures(millions) 90-daymortality(%) Mortality (inclusive) Mortality (intermediate) Mortality (restrictive) Frequency (inclusive) How much surgery do we do? Abbott & Fowler Brit J Anaesth 2017 in press
- 10. ‘Unexplained variation is the enemy of quality’ W. Edwards Deming
- 11. ‘Failure to rescue’ • Death after a ‘treatable’ complication • A measure of quality of healthcare • Meant to avoid flaws in other quality metrics • Has flaws just like other quality metrics
- 12. Ghaferi et al. Ann Surg 2009; 250: 1029–34. Mortality rates vary but complication rates don’t….?
- 13. An assessment of “failure to rescue” derived from routine NHS data. Jones, Bottle & Griffiths; 2011 NHS data: Failure to rescue outliers
- 14. Surgical death rates vary in US hospitals Ghaferi A. N Engl J Med 2009; 361: 1368-75.
- 15. Failure to Rescue Hospitals ranked in quintiles by activity volume Complications Mortality FtR International Surgical Outcomes Study Br J Anaesth 2016; 117: 601-609.
- 16. Mortality following cardiac surgery in the UK
- 17. 30-day survival following STEMI
- 18. NHS publishes surgical mortality data
- 19. Planned ICU admission and mortality Kahan B et al. Intensive Care Med. 2017; 43: 971-79.
- 20. Kahan B et al. Intensive Care Med. 2017; 43: 971-79. ICU bed provision and mortality
- 21. ICU admission for complications Kahan B et al. Intensive Care Med. 2017; 43: 971-79.
- 23. Enhanced Peri-Operative Care for High-risk patients
- 24. Integrated Care Pathway adapted from: Higher Risk Surgical Patient; RCS 2011
- 25. Trial design • Stepped wedge randomised cluster trial – Hospitals randomised in geographical clusters – Integrated ethnographic & economics analyses – Data capture via HQIP-NELA • Intervention – Integrated Care Pathway – Local leadership by ‘champions’ – QI training, cluster meetings, web-based resources
- 26. Stepped wedge randomised cluster trial
- 28. • Trial completed • 20,000 patients in 93 hospitals • National audit data • Data governance regulations • Results expected autumn 2017
- 29. Change invisible to the naked eye