Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
KF Wong* (1), HL Yiu (1), Henry Chan (2), HW Yip (2), WM Tang (2), Gerund Cheung (3), CW Lau (3), Benny CP Cheng (3), LM Hau (4), YC Wong (5), Carmen Chan (6)
*corresponding author, e-mail: wkf442@ha.org.hk
Affiliation :
(1) Department of Surgery, Tuen Mun Hospital (2) Department of ICU, Tuen Mun Hospital (3) Department of A&OT, Tuen Mun Hospital (4) Department of Q&S, Tuen Mun Hospital (5) Cluster Chief Executive, NTWC (6) Division of Q&S, HAHO
Introduction :
Routine use of CUHK SOMIP risk calculator (calculator) in the Department of Surgery, TMH, is one of the measures to improve SOMIP results. This calculator was validated by SOMIP team in order to predict emergency operations (EOT) mortality risk. If the calculated mortality risk is >=10%, we will trigger ICU liaison system for conjoint discussion, risk assessment and patient management (among surgeon, intensivist and anaesthetist) before EOT. This is the first time for this calculator being used routinely in Hong Kong.
Objectives :
To investigate the compliance, efficacy, staff satisfaction and clinical outcome after the implementation of this calculator.
Methodology :
Patients received major or ultra-major EOT within 1/10/2023 - 31/12/2023 (2023’) in TMH, under the Department of Surgery, will be recruited. Data, such as patient’s demographic, calculated risks, number of EOT performed, % of major/ ultra-major operations, number of SOMIP risk calculator being used, accuracy of calculator input variables, ICU involvement, 30-day operative mortality, will be included and compared with EOT cases within 10/2022 - 12/2022 (2022’). Staff satisfaction about this programme will also be assessed.
Result & Outcome :
Total 536 EOT were performed (10-12/2023, vs 506 EOT in 10-12/2022). There is no significant difference in EOT magnitude between groups. (P-value: 0.975. 22.0% was major EOT in 2023’ vs 25.7% in 2022’ and 13.8% was ultra-major EOT in 2023’ vs 16.0% in 2022’) Eligible cases to use this calculator was 125 in 2023’ vs 129 in 2022’. 92.8% of used calculator cases had 100% correct in data entry. Total number of risk calculator being used were 11 in 2022’ vs 140 in 2023’. Eligible EOT cases with risk calculated being used were 66.4% in 2023’ vs 3.1% in 2022’. (P-value < 0.001)
ICU involvement in eligible EOT cases increased from 23.3% (2022’) up to 34.4% (2023’). (P-value: 0.049)
There was also a marked decrease in 30-day mortality cases from 15 (2022’, before the use of calculator) to 8 (2023’, after the implementation of calculator).
70.6% (24/34) staff considered this calculator is easy to use and 97.1% (33/34) of them believed this programme can increase their awareness about SOMIP.
This program acts as a pioneer in HK to use this calculator routinely. It gives us the insight on how to improve SOMIP results. Besides, this helps to prioritise and triage cases receiving ICU care, align different parties (Surgery, ICU, A&OT) and increase staff awareness about SOMIP.
