Clinical Quality Registries have become an accepted and important aspect of safe and affordable healthcare. Implementation of clinical registries across all areas has been strongly advocated by the Australian Commission on Safety and Quality in Health Care (ACSQHC). Registries efficiently provide data for monitoring quality of care, benchmarking hospital outcomes, and supporting the implementation of ‘best’ evidence-based practice. The ability to provide timely, relevant and reliable information on patient care to individual clinicians has been shown to reduce variations in practice and improve quality of care, health care outcomes and patient satisfaction. More so, in an era where data is increasingly collected electronically (and often semi-automatically in perioperative and critical care environments) there is an even greater opportunity for perioperative clinical registries to be implemented in a cost-effective way.
The Perioperative Clinical Outcomes Registry (PCORE) initiative of the Australian and New Zealand College of Anaesthetists (ANZCA) is a national clinical quality registry in perioperative medicine. The target population is comprised of adults undergoing inpatient non-cardiac surgery in public and private hospitals in Australia. ANZCA PCORE collects a core set of perioperative data including baseline and intraoperative risk factors, process of care data, in-hospital complications and post-discharge mortality. The registry has been established in accordance with the Framework for Australian Clinical Quality Registries developed by the ACSQHC.
In this project, the investigators aimed to establish an evaluation environment to support the development of a national infrastructure for registry-based clinical trials. The multicenter registry environment was based on PCORE and comprised of additional high-quality routine perioperative care data and commonly accepted clinical outcomes from adults undergoing non-cardiac surgery. The expanded registry (‘PCOREx’) was intended to provide a high-quality and efficient data resource for current and future clinical research projects. It was designed to provide a data collection infrastructure for large-scale registry-based randomised clinical trials (RCTs). It is also an efficient way to provide data for ‘classic’ RCTs and cohort studies, and to collect specific population-level pilot data for the design of definitive studies. Furthermore, by providing credible risk adjusted clinical data and patient-centred outcomes, the additional PCORE research components can also be used to monitor variation in perioperative practice against health outcomes and for centre-level benchmarking.
Associate Professor Stefan Dieleman, Westmead Hospital, NSW
Dr Jennifer Reilly, Alfred Hospital, Melbourne
The project was awarded $A90,148 through the ANZCA research grants program for 2022.
We planned to set up a method that would help us to efficiently collect data about patients before, during and after an anaesthetic for a surgical procedure (the perioperative period). This would create a large database that would help to perform quality improvement and research projects in the perioperative period in a time- and cost-efficient way. Once set up, we planned to test this method in a number of large research projects that are already ongoing.
We had significant difficulties to develop the actual methods of ata collection. These included problems with getting the correct information from the electronic health records in the various hospitals, but also trouble in getting patients to respond to text messages sent out to them to request completion of questionnaires after their anaesthetic. As a result, we had to make the decision to stop the project early, since many of the issues could not be resolved in the time period that this project had been funded for.
The main thing that we have learned from this project is that, with the current electronic health record infrastructure in New South Wales, it will be very difficult to collect reliable and timely large-scale data from the perioperative period in a low-cost and time-efficient manner. Also, we cannot rely on just text messaging to get in contact with patients after their anaesthetic.
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