Medical professionals have called for sustained and increased funding for clinical quality registries after the release of a report which highlights that overall Australia is lagging well behind the UK in the treatment of patients receiving emergency abdominal surgery.
The report is a collaboration between the Royal Australasian College of Surgeons (RACS) and the Australian and New Zealand College of Anaesthetists (ANZCA) as well as associated societies and is based on data from a pilot project known as the Australian and New Zealand Emergency Laparotomy Audit– Quality Improvement (ANZELA-QI) program.
It measures the standard of care for emergency abdominal surgeries (laparotomies). In total, data was collected on 3,178 patients between 1 January 2020 and 31 December 2021. The results found that some hospitals were falling short on 10 key performance indicators.
As an example, 51.2 per cent of patients requiring surgery within eighteen hours arrived in theatre within the appropriate timeframe. Only 24.3 per cent of those needing the most urgent surgery (treatment in less than two hours) achieved the appropriate standard. While these were average figures, there was noticeable variation between different hospitals. It is important to note that time critical management is a key recommendation in the Sepsis Clinical Care Standard published by Australian Commission on Safety and Quality in Health Care in July 2022.
ANZELA-QI Chair, Dr James Aitken, said that the findings highlighted a need for a national clinical quality registry. The support from some states to fund a study so far has highlighted the problems. He contrasted Australia’s situation to the UK where an established system has led to demonstrated improvements and cost savings.
"Emergency laparotomies are surgical procedures that carry high mortality rates, which place significant demands on resources with variable outcomes and standards of care. The findings from this report show that many Australian patients undergoing an emergency laparotomy often do not receive best evidence-based care,” Dr Aitken said.
“We have seen great enthusiasm and support from some state governments across Australia, and participating hospitals. We urge all governments and hospitals to support a national system, as the variation observed not only suggests that clinical care and outcomes could be improved, but that quality improvement will also likely lead to significant cost savings.”
"We have seen in England and Wales that since the National Emergency Laparotomy Audit (NELA) was established, there have already been noticeable gains. For example, since it commenced NELA has reported a four-day reduction in patient length of stay. Each day of reduced stay would save the Australian health system about $40 million each year.
“At the moment Australia is lagging almost a decade behind the UK. Without changes it will remain difficult to catch up. There is an urgent need for a nationally agreed policy to coordinate governance and funding of national clinical quality registries. This will require robust political support, but I am confident that with sustained funding and commitment from all involved that we can achieved similar results.”
“There are now many studies that show clear improvements from audits and clinical qualities registries. We saw this in the recent Western Australian Audit of Surgical Mortality (WAASM), the longest running surgical mortality audit in Australia. After two decades all WA surgeons are participating in this audit and there is significant data available to identify long term trends and make comparisons. In that particular audit we have seen year on year falls in the number of deaths per 100,000 population, which has fallen to the point where the number of deaths is almost half what it was when we first began. This is despite an increase in the state’s ageing population.”
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