Sir, – In their rebuttal of Prof Hardiman (Opinion & Analysis, August 7th), Mr Mealy and Prof Keane highlight the necessity of collecting and applying timely and accurate data to both patient care and case-mix and resource matching in our health service.
Accurate data is a key driver of performance improvement and the efforts of NOCA (National Office of Clinical Audit) is to be applauded and encouraged as it begins the process of collating and auditing this data on a national scale.
We are concerned, however, that the precision and accuracy of “hand-coded” retrospective data such as HIPE (Hospital Inpatient Enquiry), may not allow for meaningful interpretation.
We have interrogated the operating theatre logbooks for the number of common, easily-codeable, general surgical operations (appendicectomy, cholecystectomy, hernia repair) performed in our institution over the past 12 months and we found that the HIPE data under-reported the number of operations to remove an appendix (emergency surgical work) and gallbladder (primarily scheduled elective surgical work) by 21 per cent and 26 per cent respectively, while over-reporting the number of hernia repairs by 27 per cent.
We offer our observations, acknowledging their limitations, to highlight the urgent need for a robust, prospectively-gathered electronic national database of all hospital activity, particularly in the advent of the “money follows the patient” model tying case-mix and activity to hospital reimbursement.
Such a data gathering and interpreting facility has to be properly staffed, resourced and maintained, because the current system cannot hope to achieve these necessary goals.
It seems intuitive, in a 21st-century healthcare system, that we know exactly how we are performing and that we track and improve our performance in our patients’ best interest.
It seems unconscionable that we do not yet seem to have the ability to do so, for even the most commonly performed operative procedures. We would like to join our voices to your correspondents’ appeal for a national office charged with maintenance of an electronic database of patient outcomes that can inform quality improvement measures. – Yours, etc,
GARY BASS
PAUL HEALY
Dr DANIEL DUMBRAVA
DEIRDRE HOGAN-LOWE
Prof TOM WALSH
Connolly Hospital,
Blanchardstown,
Dublin 15.