Page 59 - ANZCP Gazette May 2023

ETHNICITY BASED OUTCOMES DIFFERENCES FOLLOWING CARDIAC SURGERY IN AUSTRALIA AND AOTEAROA NEW ZEALAND
Tim Willcox, Richard Newland AND Robert Baker
Flinders Medical Centre, SA
PURPOSE: Aboriginal and Torres Strait Islanders in Australia, and Maori and Pacific Islanders in Aotearoa New Zealand experience worse outcomes in cardiovascular health compared to non-Indigenous people. Flinders Medical Centre (FMC) and Auckland City Hospital (ACH) provide cardiothoracic services to the Northern territory and South Australia and Northern region of NZ respectively. Both countries have implemented policy to achieve health equality for indigenous peoples. We aimed to compare practices and outcomes for Aboriginal and Torres Strait Islanders, Maori and Pacific Islanders with non-indigenous patients receiving cardiac surgery requiring cardiopulmonary bypass.
METHODOLOGY: Adult patients undergoing cardiac surgery between 2008 -2021 at FMC and ACH identified as Caucasian (FMC 3521, ACH 6971), Aboriginal and / or Torres Strait Islanders (871), Maori (1248) or Pacific Islanders (1919) were included. Odds ratios for 30-day mortality at each hospital were calculated using logistic regression, adjusting for preoperative variables included in the AusScore.
RESULT: Aboriginal and Torres Strait Islanders had higher adjusted odds for 30-day mortality (AOR 1.95 [CI 1.03-3.73] p=0.042) than non-Indigenous Australians. Similarly, inequity was found for Maori (AOR 1.48 [CI 1.02-2.14] p=0.039) and Pacific Islanders (AOR 2.14 [CI 1.57-2.91] p<0.001. There was no difference between hospitals for non-indigenous patients.
CONCLUSION: Aboriginals, Torres Strait Islanders, Maori and Pacific Islanders have a different risk profile and greater likelihood of 30-day mortality following cardiac surgery in Australia and Aotearoa New Zealand. Further study is required to identify if primary healthcare factors contribute to these inequalities.
‘GOOD CATCH’ REPORTING AS A FOUNDATION FOR SAFETY IMPROVEMENT IN CARDIOPULMONARY BYPASS
Jessica Betts AND Richard Newland
Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, South Australia
BACKGROUND: Historically, improvement in safety focuses on incident related data. Collecting data concerning variation from routine cardiopulmonary bypass (CPB) practice may provide a better foundation
for development of safety improvement initiatives. This project aims to: identify if education on the importance of collecting ‘Good Catch’ data including variations in practice during CPB increases safety reporting and the opportunity to guide safety improvement initiatives.
METHODS: The project used a pre-post intervention approach, using data collected from the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) in adults undergoing CPB at Flinders Medical Centre from December 2021 - June 2022 (Pre-intervention, n=114) and July - August 2022 (post-intervention, n=21). Changes to routine practice included education on the clinical relevance of a ‘Good Catch’ and modification of the definition of a ‘Good Catch’ to include variation from standard practice. Data Collection was updated to include description of events and actions taken.
RESULTS: ‘Good Catch’ data was reported in 14% in pre-group CPB cases and 81% in post-group cases. 35% of post-intervention data showed a consistent theme of hyper-focusing on initial variations in practice, which resulted in secondary oversights. Timing of incident occurred largely during CPB tepid/hypothermic conditions (56%), followed by normothermic conditions (31%). Increased communication (88%) and increased awareness (76%) were common adaptions in practice to maintain safety following an event.
CONCLUSION: Collection of data that identifies variation from standard CPB practice increases safety reporting and the opportunity to guide improvement initiatives.
QUALITY IMPROVEMENT TO SUPPORT BLOODMANAGEMENT:THEAUSTRALIAN NEW ZEALAND COLLABORATIVE PERFUSION REGISTRY (ANZCPR)
Rona Steel, Richard Newland, David Roxby AND Robert Baker
Westmead Hospital, NSW
PURPOSE: Compliance to the National Safety and Quality Health Service (NSQHS) Standard 7: Blood and Blood Products is mandatory for all Australian hospitals and protects the public from harm and improves quality in healthcare. Measuring compliance can be challenging for a cardiac unit. The ANZCPR aims to support contributing sites monitor their compliance to Standard 7 through their use of blood management strategies.
METHODOLOGY: Data from the ANZCPR registry from 2007–2021 (>46,000 cases) was used to assess compliance to Standards 7.1, 7.3, 7.4, 7.5 and 7.8 by recording the use of perioperative blood management strategies. Registry data was also used to show compliance over time and to report the effectiveness of these strategies.
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