The Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) Cardiac Surgery Database is a clinical quality registry. Established in Victoria in 2001, the binational program captures data from 56 participating private and public hospitals in Australia and New Zealand. The registry aims to maintain a high standard of care for cardiac surgery patients by collecting data about the treatment and outcomes of surgery and using this information to monitor hospital performance and provide feedback. The key outcomes the database focuses on include post-operative infection, stroke, post-operative renal impairment, the requirement for re-operation due to bleeding, and death within 30 days of the operation.
VAHI has worked with clinical quality registries that receive Victorian funding to ensure there is an outlier policy in place. This is consistent with the recommendations in the 2016 Targeting zero review for clinical quality registries. Each outlier policy outlines which measures will be tracked for outlier identification, and what thresholds will apply to trigger remedial action to improve any identified safety and quality issues.
By way of example, the ANZSCTS registry provides feedback to contributing hospitals on their performance on a quarterly basis, allowing for early detection of any issues or hazards. If a hospital is found to satisfy the agreed thresholds for unexpected variation for any outcomes, the registry enacts a constructive and supportive outlier process guided by a specialised committee comprising cardiac surgeons and health data analysts.
The process begins with a data audit to confirm the findings, followed by the hospital conducting a review of potential causes or reasons for the variation, with the assistance of tailored summary data provided by the registry. The aim of this collaborative process is to understand the source of variation, identify areas for improvement and create positive changes in outcomes.
Recently, a Victorian public hospital was found to have a high number of post-operative deep sternal wound infections (infections in the tissues of the chest) over a six-month period in coronary artery bypass surgery patients. The hospital was notified by the registry, and after reviewing the relevant cases, investigated further to identify how and why a high number of infections were occurring.
As part of this thorough investigation, the hospital took many proactive measures including observation of work patterns in operating theatres, and reviewing procedures relating to skin preparation and treatment, wound dressings and wound care. The hospital also checked the water supply to operating theatres, ward showers and wash basins for bacteria, and examined the way surgical imaging probes were handled.
Following the investigation, the hospital made a number of changes, including adjustments to the washing and disinfection practices for imaging probes, annual replacement of the water fittings on the ward, and stricter pre-emptive antibiotic use.
As a result, the hospital’s rate of deep sternal wound infections markedly decreased over the following year and was lower than the average rate for all the hospitals contributing to the database.
This is but one example of how the ANZSCTS registry works with participating sites to identify any unexpected changes in outcomes for patients undergoing cardiac surgery and to investigate the underlying courses of variation in order to improve outcomes. The database provides near real-time monitoring of performance and prompts direct and timely benefits for patients and hospitals.
For more information about VAHI’s clinical quality registries program, please contact Louise Kelly, Acting Manager of Clinical Quality Registries and Patient Reported Outcomes via firstname.lastname@example.org.