Page 13 - ANZCP Gazette May 2023

• Best of all, DAH30, is a very highly sensitive quality measure. It’s so sensitive it can detect:
– a small change in a given population.
– a change within a smaller patient cohort or sample size. This is particularly useful for minority populations or units/ projects with small case numbers or short study periods.
– a change within a patient sub-population with small variances- eg between grades of pre-op kidney disease or NYHA class or for continuous variables like age or pre-op haemoglobin.
• Also, DAH30 has great statistical power as all patients receive a meaningful number. It’s not a random nor rare event like other quality measures we use, like mortality or a particular complication. This means one can effectively measure improvements or changes in practise more quickly and accurately, than with conventional outcome measures. Bell’s 2019 paper (2) reported DAH30 could detect a difference in their audit program six times quicker than a composite of mortality and complications, and 28 times faster than 30-day mortality alone.
• Furthermore, DAH30 is again superior to composite outcome measures as they are often flawed or skewed in their design to generate a large enough sample size for analysis.
• DAH30 allows for benchmarking within centres and between centres due to its sensitive and definitive nature.
• DAH30 is a better outcome measure than the traditional post operative length of stay (poLOS) which fails to capture the real discharge date for patients with non- home discharges, any early discharges or any readmissions. It also fails to capture early deaths. Non-home discharges include those to rehab facilities, referring/ secondary
hospitals and other cardiac centres. Thus, DAH30 better represents the impact of the patient’s post-op experience and costs of care than poLOS.
How feasible is it to collect DAH30?
This study concluded DAH30 was feasible to collect. Westmead, like almost all Australian centres, already collects most of the information required to calculate it. All we needed in addition was any final discharge dates from secondary facilities and any readmission dates. As these rates are quite small, it wasn’t such an onerous task.
For our centre, only 9% of patients had a non-home discharge, and 8% required readmission. So, sourcing these extra dates took less than two minutes per patient for these few patients. These dates were available from the usual sources – hospital eMR or routine 30-day phone call. I sourced these additional dates in monthly batches using routinely collected data to identify patients with readmissions and patients discharged to non-home locations.
There was a chance, however, the hospital eMR may not include readmission or discharge data from health facilities outside the local health district. This is where the NSW HealtheNet proved invaluable. HealtheNet is a NSW state-wide application that records, among other things, a patient’s hospital stay, including admission and discharge dates, across all public hospitals in the state. HealtheNet is linked to the hospital eMR and is easy to use, making it easy to record public admissions outside your local health district. For other Australian states, an application like Healthenet will be available in the near future. HealtheNet does have one limitation in respect to this project, it does not record admissions to non- public hospitals i.e. private hospitals or private rehabs. This had a minor impact on our study, as we only had two such patients during our 31-month project period. One patient was discharged to a private rehab and the other returned to a correctional facility. This limitation can be overcome by sourcing such information from a 30-day follow-up phone call.
MAY 2023 | www.anzcp.org 10