Page 141 - Hospital Authority Convention 2018

Service Enhancement Presentations

F4.7 Clinical Safety and Quality Services II 16:15 Room 421

Clinical Use of DAGDA Score and Pneumonia Prevention Programme
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Wong KKF , Wong OW , Yiu CW , Yam PC , Fung TK , Leung SK , Lee MY , Law YP , Ho HS , Lau SW , Har KH , Li SM , Choi
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TY , Leung LBO , Chung CM , Mang FW , Lau KW , Leung MN , Chun WK , Lo S , Kwok CL , Lee JS , Sin KM , Kwan A , Auw
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A , Leung S , Chau S , Ma B , Poon YH Poon3 HOSPITAL AUTHORITY CONVENTION 2018
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Department of Surgery, Medicine Department, Physiotherapy Department, Tuen Mun Hospital, Hong Kong
Introduction
Post-operative pneumonia is significantly related with mortality (P-value <0.01). In 2014, we formulated DAGDA score to
predict high risk patients. Pneumonia prevention programme is started.
Objectives
Results of using DAGDA score and pneumonia prevention programme are reviewed and analysed.
Methodology
In 2014, by using SOMIP 2012-2013 database (1742 patients), we identified five (out of 38) significant variables (p-value
< 0.05) associated with postoperative pneumonia; including activities of daily living (ADL) dependence, ascites, General
Aanaesthesia, pre-operative dyspnea and ASA score >= 3. They are weighed according to their respective proportion (B-value)
to form the DAGDA score to predict high risk patients in developing postoperative pneumonia.
Maximum DAGDA score is 18 with area under ROC curve 0.776 (95% CI: 0.716 – 0.837). Sensitivity and specificity of DAGDA
score with cut-off point of 8 are 73.6 % and 72.8 % respectively. External validation is examined by using another group of
4,484 patients with similar results achieved. Monday, 7 May 2018
Since 2/2016, a multidisciplinary team (MDT), including surgeons, respiratory physicians, surgical nursing staffs and
physiotherapists, was formed. In May 2016, pneumonia prevention programme was started in one surgical team. High risk
patients (DAGDA score >= 8) were identified and preventive measures were applied as follows, including:
(1) warning sign over patients’ bed and bed stat
(2) perform CXR and bronchoscopy if needed
(3) early post-operative mobilisation with good pain control
(4) vigorous chest physiotherapy and breathing exercise with incentive spirometer
(5) nursing care, including head-of-bed elevation and sit up at all meal, twice daily oral hygiene swabs
(6) consult respiratory physician
Results
Within 9 May 2017 to 30 November 2017, 435 patients received major/ultra-major operations. Post-operative pneumonia rate
was decreased from 3.2% (14/435) to 4.1% (p-value: 0.56)
Besides, there is a statistically significant decrease in the pneumonia-related mortality rate, after adopting the pneumonia
prevention programme, only one (over 14 patients) succumbed (7.14%, p-value: 0.048*) when compared with the July 2012 to
June 2013 (24/72, 33.3%).
DAGDA score is useful in predicting high-risk patients in developing post-operative pneumonia. A MDT approach in
formulating pneumonia preventive measures can significantly prevent postoperative pneumonia-related death.

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