❓ Mr. Kirkup questions the South Metropolitan Health Service (SMHS) regarding readmission rates for tonsillectomies/adenoidectomies and hysterectomies. The Minister provides data, explanations for readmissions, associated costs, and ongoing review processes.
AnsweredQoN 5654Legislative Assembly
Asked
15 October 2019
Member
Portfolio
Deputy Premier; Minister for Health; Mental Health
QuestionView source ↗
I refer to page 54 of the South Metropolitan Health Service 2018-19 Annual Report, and ask: (a) Why is there such a significant re-admission rate of patients receiving: (i) Tonsillectomy and adenoidectomy surgery; and (ii) Hysterectomy; (b) For (a)(i)-(ii) what are the overall numbers of patients who received this surgery; (c) What is the estimated cost associated with patient re-admission; and (d) What work is being undertaken to reduce re-admission rates for patients?
AnswerView source ↗
Answered
10 December 2019
Response time
15 days
I am advised:
(a)(i) Clinical review of tonsillectomy and adenoidectomy cases identified the majority were due to small post-operative bleeds requiring conservative treatment and a single overnight stay. A number of cases were adult patients readmitted for post-operative bleeding. This cohort of patients is considered to be at higher risk of bleeding due to the severity, frequency and duration of their pre-operative symptoms, which contribute to their complexity of care.
(ii) Review of the hysterectomy cases identified that a number of these patients had undergone hysterectomy as a secondary procedure to other complex surgery, with the subsequent readmission not directly related to the hysterectomy. Clinical review of the remaining cases identified the majority of the readmissions were as a result of minor bleeding and wound infections, which were treated appropriately with the patient discharged the following day. A small number of patients also had multiple co-morbidities including a raised body mass index and multiple previous surgeries with related associated complications. There was no indication of any system or clinical care issues.
(b)(i) 329 surgeries.
(ii) 203 surgeries.
(c) The average readmission cost is $6,863 per patient.
(d) A quarterly review is undertaken of unplanned readmissions for tonsillectomy and adenoidectomy and for hysterectomy at departmental Clinical Review or Morbidity and Mortality Committees. In addition, these indicators are monitored at the highest level of SMHS governance being presented and discussed at the Area Executive Group and SMHS Board Safety and Quality meetings. Where concerns are identified, external reviews will be commissioned along with benchmarking of SMHS rates with other relevant state and national health services.
Review of the above readmissions for tonsillectomy and adenoidectomy and for hysterectomy identified that there were no trends or issues with clinical care such as surgeon, surgical technique or medication to indicate any systemic issues.
(a)(i) Clinical review of tonsillectomy and adenoidectomy cases identified the majority were due to small post-operative bleeds requiring conservative treatment and a single overnight stay. A number of cases were adult patients readmitted for post-operative bleeding. This cohort of patients is considered to be at higher risk of bleeding due to the severity, frequency and duration of their pre-operative symptoms, which contribute to their complexity of care.
(ii) Review of the hysterectomy cases identified that a number of these patients had undergone hysterectomy as a secondary procedure to other complex surgery, with the subsequent readmission not directly related to the hysterectomy. Clinical review of the remaining cases identified the majority of the readmissions were as a result of minor bleeding and wound infections, which were treated appropriately with the patient discharged the following day. A small number of patients also had multiple co-morbidities including a raised body mass index and multiple previous surgeries with related associated complications. There was no indication of any system or clinical care issues.
(b)(i) 329 surgeries.
(ii) 203 surgeries.
(c) The average readmission cost is $6,863 per patient.
(d) A quarterly review is undertaken of unplanned readmissions for tonsillectomy and adenoidectomy and for hysterectomy at departmental Clinical Review or Morbidity and Mortality Committees. In addition, these indicators are monitored at the highest level of SMHS governance being presented and discussed at the Area Executive Group and SMHS Board Safety and Quality meetings. Where concerns are identified, external reviews will be commissioned along with benchmarking of SMHS rates with other relevant state and national health services.
Review of the above readmissions for tonsillectomy and adenoidectomy and for hysterectomy identified that there were no trends or issues with clinical care such as surgeon, surgical technique or medication to indicate any systemic issues.
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