Page 84 - HA Convention 2015

Masterclasses

MC5.3 Advances in Medical Technology 14:30 Convention Hall C

Monday, 18 May Surgical Outcomes Monitoring and Improvement Programme and Quality Improvement in Surgery
Lai PBS
Department of Surgery, Prince of Wales Hospital, Hong Kong

Surgical audit or monitoring of surgical outcome is an essential component of good clinical governance in surgical service
provision. This is particularly important for public healthcare provider like the Hospital Authority to maintain good quality
surgical care throughout its hospitals.

Since 2009, the annual report on the risk-adjusted performance data on post-operative morbidity and mortality for elective
and emergency surgical procedures conducted by 17 surgical departments of the Hospital Authority has been published
under the Surgical Outcomes Monitoring and Improvement Programme (SOMIP). The pre-operative, operative and post-
operative data are collected by a team of independent nurse reviewers. The level of performance is reflected by the
observed/expected ratio (O/E ratio) of morbidity and mortality in sub-groups of patients after risk adjustments and statistical
modeling.

It is well-known that surgical outcome is not just dependent on the operating surgeons but the overall care received by
patients throughout their journey in the hospitals. With the provision of risk-adjusted outcome data, surgical teams can take
prompt actions on improvement programmes. Frequently, sub-optimal performances are results of a range of systemic
factors rather than purely surgeon factors. Thus, we have to perform multi-level analyses to identify significantly contributing
systemic factors, of which could only be solved at a corporate level. For example, the support from intensive care units and
interventional radiology could have a significant impact in the overall surgical outcomes, it could not be solved only by the
surgical department.

SOMIP is certainly not some kind of “Your Big Brother is Watching” programmes which watch over surgeons’ back and
punish or weed out bad apples. Through collection of accurate data, rigorous risk-adjustments and sophisticated statistical
analysis; SOMIP can provide surgeons and hospitals with actionable data to achieve continuous quality improvement of
surgical care.

HOSPITAL AUTHORITY CONVENTION 2015

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