Surgery registries crucial to improving patient care, researchers say

by Anne Crawford

Monash University Central Clinical School (CCS) clinician-researchers are behind a push for the Federal Government to urgently implement strategies to overcome barriers to clinical quality registries for surgery.

Registries systematically collect data on markers of quality of care for a given procedure across multiple sites, identifying times where the outcomes for patients are outside the normal range (good or bad) by risk adjusting and then benchmarking performance.  That information is then used to inform quality improvement initiatives for patients.

Professor Wendy Brown, Head of the Department of Surgery and an upper GI and bariatric surgeon at The Alfred hospital, and anaesthetist Dr Jennifer Reilly, have had two research papers on the issue published recently, on which they were both authors. Professor Brown led a review that appeared in the ‘ANZ Journal of Surgery’ while Dr Reilly led a paper published in ‘Anaesthesia and Intensive Care’. 

 More than 2.7 million surgeries are performed in Australia each year. 

“Registries have the potential to do an enormous amount of good in the community,” Professor Brown said. “We set up clinical quality registries to track and monitor best practice by collecting and monitoring quality indicators thought to be important by the profession. By keeping sight of these we can make sure patients are getting good care,” she said.

Registries offered reassurance to the community that practitioners are keeping an eye on how they are collectively performing, could potentially provide data for research, and ultimately saved public funds, she said.

Professor Brown is Clinical Lead of the Bariatric Surgery Registry – one of a few surgical registries along with a cardiac registry. She pointed to some local examples where clinical care registries have led to 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 Orthopaedic Association identified a higher-than-expected re-operation rate for a particular hip joint surgeons were using. This was reported to the TGA and a recall was issued.

However, the current constructs under which registries function were set up to support clinical trials and research rather than quality and safety initiatives such as registries, she said. Privacy laws hampered the amount of health-care data that can be used for a secondary purpose such as inclusion in a registry, and the short-term grants funding that clinical trials are run on is not suited to ongoing registries, she said. 

 Professor Brown said that while the Australian Government has released a 10-year strategy for clinical quality registries reform, the need was urgent.

“We need to focus registries on high-risk surgical procedures or surgery that’s at an early stage of its evolution so that outcomes can be checked to ensure patients are getting best care. To do this you do need to capture as many patients’ information into the registry as you can.”

Dr Reilly’s study surveyed hospitals in the Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network to find out the proportion of anaesthesiology departments in Australian hospitals able to access routinely collected electronic data for research and quality assurance. The paper, titled ‘Towards a national perioperative outcomes registry’, is part of Dr Reilly’s PhD studies.

The study looked at data across six different domains of patient care in anaesthesia. In five of six domains where electronic data are routinely collected, it found that only about half of anaesthesiology departments could access data exports. In four of those domains, only half of departments that could export the data were doing so regularly for quality assurance or research.

“At the moment, data on risk factors and outcomes are collected in every hospital, mostly in electronic format, but they’re largely not extractable to doctors to analyse in order to assess and improve patient care,” Dr Reilly said. “I think of this as ‘lazy data’. It’s already been collected, sitting in computers around every hospital across Australia, but we’re not harnessing it for good,” she said.

Economic evaluation has shown that Australian registries provide a return on investment of between two and seven dollars for every dollar spent due to improvements in patient care they bring, she said. “We’re missing a huge opportunity to improve value in the healthcare system at absolutely no cost.”