Quality improvement, benchmarking and reporting

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Embed measurement and data collection in the perioperative process to support benchmarking, performance reporting and quality improvement.

Role of the perioperative service

  • Ensure each patient’s health and social status is documented and accessible (including self-reported outcomes and experiences).
  • Collect, manage and review data to ensure quality.
  • Use key metrics  to empower changes and track improvements to patient care.
  • Create reporting schedules and provide regular reports (at least quarterly) to clinicians and managers to support continuous quality improvement.
  • Implement quality improvement initiatives where performance, trends or outcomes are unsatisfactory.

        Resources

        Enhanced Recovery After Surgery: Key Principles for Implementation of Models
        Perioperative care pathways to achieve early recovery after surgical procedures.
        Source: Agency for Clinical Innovation

        Model for Improvement and Plan, Do, Study, Act (PDSA) cycle
        Improvement methodology to address identified problems in the clinical area.
        Source: Clinical Excellence Commission

        National Surgical Quality Improvement Program (NSQIP)
        NSQIP assess a hospital’s surgical outcomes against local and international peers.
        Source: Agency for Clinical Innovation

        Perioperative Quality Improvement Programme (PQIP)
        A program to reduce variation in care and support implementation of best practice.
        Source: Perioperative Quality Improvement Programme

        Measurement, indicators and outcomes

        Measurement, indicators and outcomes will be specific to the location and/or site. Where possible, align measures with the Operating Theatre Efficiency: Clinical Practice Guide.

        Collect indicators and outcomes and review regularly, e.g. monthly, as part of a process of continuous quality improvement. For example, the Ministry of Health Surgical Dashboard.

        Suggested measures

        Clinical outcomes

        • Mortality and survival1-3
        • Complications or adverse events, e.g. unplanned reoperation, infections1-5
        • Unplanned readmission rates1, 2, 4-7
        • Unplanned admission to intensive care unit within 14 days of surgery5, 8
        • Unplanned reoperation within 30 days4

        Process outcomes

        • Pre-admission preparation,8, 9 e.g. percentage of patients assessed in pre-admission clinic, percentage of patients receiving medication instructions, percentage of pre-admission clinic visits using virtual care, time of pre-admission clinic before surgery, duration of pre-admission clinic appointment, waiting times for physical clinic
        • Percentage of patients not ready for care
        • Operative time5, 8
        • Length of stay in hospital1, 2, 4, 5, 7
        • Procedure non-attendance or cancellation on day of surgery8, 9
        • Discharge, e.g. within 24 hours5 or unplanned delayed discharge9
        • Short-term recovery or discharge destination, e.g. own home, rehabilitation facility or care home, level of dependence, need for carers2
        • Post-discharge follow-up9

        Patient-reported measures (PRMs)

        Patient-reported measures and HOPE platform

        Patient-reported measures (PRMs) give patients the opportunity to provide direct, timely feedback about their health-related experiences and outcomes at the point of care. This feedback helps drive improvements in care across the NSW health system

        Health Outcomes and Patient Experience (HOPE) is a purpose-built IT platform to capture PRMs. It was co-designed with consumers, clinicians and managers across NSW in partnership with the ACI, eHealth NSW and the NSW Ministry of Health. HOPE digitally enables consumers and clinicians to access real-time information and report on healthcare experiences and outcomes at the point of care.10

        The HOPE Platform is a secure website which requires a password. Patients receive access when a clinician invites them to participate in the Patient Reported Measures Program. They receive a secure code via email or text message to a mobile phone.10

        References

        1. Boney O, Moonesinghe SR, Myles PS, et al. Core Outcome Measures for Perioperative and Anaesthetic Care (COMPAC): a modified Delphi process to develop a core outcome set for trials in perioperative care and anaesthesia. Br J Anaesth. Jan 2022;128(1):174-85. DOI: 10.1016/j.bja.2021.09.027
        2. Haller G, Bampoe S, Cook T, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: clinical indicators. Br J Anaesth. Aug 2019;123(2):228-37. DOI: 10.1016/j.bja.2019.04.041
        3. Abbott TEF, Ahmad T, Phull MK, et al. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. Br J Anaesth. Jan 2018;120(1):146-55. DOI: 10.1016/j.bja.2017.08.002
        4. Tan YY, Liaw F, Warner R, et al. Enhanced Recovery Pathways for Flap-Based Reconstruction: Systematic Review and Meta-Analysis. Aesthetic Plast Surg. Oct 2021;45(5):2096-115. DOI: 10.1007/s00266-021-02233-3
        5. Zacharakis D, Diakosavvas M, Prodromidou A, et al. Enhanced Recovery Protocols in Urogynecologic and Pelvic Floor Reconstructive Surgery: A Systematic Review and Meta-Analysis. Urogynecology (Phila). 1 Jan 2023;29(1):21-32. DOI: 10.1097/spv.0000000000001261
        6. Centre for Clinical Effectiveness. Key performance indicators for hospital reporting: a rapid review. Melbourne, Australia: Monash Health; 2016 [cited 28 Mar 2024].
        7. Cline KM, Clement V, Rock-Klotz J, et al. Improving the cost, quality, and safety of perioperative care: A systematic review of the literature on implementation of the perioperative surgical home. J Clin Anesth. Aug 2020;63:109760. DOI: 10.1016/j.jclinane.2020.109760
        8. Queensland Health Clinical Excellence Division. Operating theatre efficiency guideline. Brisbane, Queensland: Queensland Health; Jan 2017 [cited 28 Mar 2024].
        9. The Australian Council of Healthcare Standards. Australasian clinical indicator report: 2015-2022: 24th edition. Ultimo, Australia: ACHS; 2023 [cited 8 May 2024].
        10. NSW Ministry of Health. Engage Health Patient Reported Measures: HOPE Platform. NSW, Australia: NSW Ministry of Health; 2024 [cited 28 Mar 2024].
         
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