Volume 194 - Issue 1
Mandatory performance reporting as part of health care reform: but where are the clinical data?
Author: Peter L Field
Med J Aust 2011; 194 (1): 48. || doi: 10.5694/j.1326-5377.2011.tb04149.x
Published online: 3 January 2011
Published online: 3 January 2011
To the Editor: Readers of the Journal’s editorial on the importance of clinical patient-outcome monitoring asking “Where are the clinical data?”1 will be pleased to know that the state of Victoria collects considerable data on surgical outcomes.
Since 2001, the Department of Health’s Victorian Surgical Consultative Council (VSCC; http://www.health.vic.gov.au/vscc/) has monitored surgical outcomes in the state’s public hospitals. Monitoring of both morbidity and mortality outcomes is combined with voluntary and mandatory case reporting and a high level of participation of hospitals and surgeons. It is compulsory for hospitals to report a range of sentinel adverse events and undertake corrective strategies.
Data about surgical inpatients are obtained from discharge coding in medical records statewide, and the chief executive officers and directors of surgery of health services with “outlying performance” are invited to analyse the case records and provide their findings to the VSCC. A VSCC subcommittee, the Surgical Outcomes Information Initiative, promulgates the conclusions in a de-identified manner to hospitals, surgeons and trainees, with a view to improving safety, systems and surgical outcomes.
Since 2008, deaths of public hospital patients that occur under surgical care are monitored by the Victorian Audit of Surgical Mortality (VASM, derived from the VSCC), which covers most surgical specialties, and is soon to embrace private hospitals and, hopefully, gynaecological surgery as well. De-identified educative information from autopsies and case analyses is offered to surgeons and trainees, whose participation in case reporting and assessing is now a professional requirement of the Royal Australasian College of Surgeons (RACS).
Surgical mortality as monitored by the VASM is now bi-nationally compared through the RACS’s overarching Australian and New Zealand Audit of Surgical Mortality. Victoria’s Department of Health has longstanding collections of data for anaesthetic, obstetric and perinatal outcomes, with similar consultative councils. Several surgical specialties have for over a decade collected and promulgated their morbidity and mortality information. The Melbourne Vascular Surgical Association requires its members to participate in clinical outcome audits, as does the Australian and New Zealand Society for Vascular Surgery. Other specialties that audit outcomes are orthopaedic surgery (the bone and joint registry), transplantation surgery and cardiac surgery.
Surgeons’ general experience of clinical patient-outcome monitoring is that of enthusiasm for its professional and community benefits, including the benefit of knowing that Australia’s overall surgical standards are comparable with the world’s best. The incentive remains to improve data capture, patient safety and eternal clinical vigilance, and these endeavours deserve support.
References
- Watterson LM, Holland RB, Davies JM, Hughes CF. Mandatory performance reporting as part of health care reform: but where are the clinical data? [editorial]. Med J Aust 2010; 193: 253-254.