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    Improving organ donation rates and transplantation in Australia

    Richard DM Allen and Henry CC Pleass
    Med J Aust 2017; 207 (7): . || doi: 10.5694/mja17.00590
    Published online: 2 October 2017

    Broader acceptance of organs from circulatory death donors would increase donor rates significantly

    The initiative funded by the Federal Government in 2009 to improve both the identification of potential deceased organ donors and family consent rates has dramatically changed the prospects for Australians with end-stage organ failure. The subsequent establishment of a coordinated DonateLife network, with more than 150 medical and nursing staff charged with identifying potential organ donors, has led to the donation rate increasing over the past 5 years from 11.4 to 20.9 donors per million population (pmp) in 2016. Record numbers of organ transplants and reduced waiting times for transplantation have resulted.1,2

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      Unravelling the evidence for prescribing medicinal cannabis

      David Allsop
      Med J Aust 2017; 207 (7): . || doi: 10.5694/mja17.00063
      Published online: 2 October 2017

      Handbook of cannabis. Roger G Pertwee, editor. Oxford University Press, 2016 (£40.00; 784 pp). ISBN 9780198792604


      • Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW


      Correspondence: david.allsop@sydney.edu.au
      Competing interests:

      No relevant disclosures.

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        Health care variation: the next challenge for clinical colleges

        Helen Francombe, Heather A Buchan and Anne Duggan
        Med J Aust 2017; 207 (7): . || doi: 10.5694/mja17.00676
        Published online: 2 October 2017

        Unwarranted variation in health care requires action from all players in health — including clinical colleges

        Marked variations in the use of 18 health care services, such as hospitalisations for chronic diseases and surgical procedures, were reported in the Second Australian atlas of healthcare variation (the second Atlas), recently published by the Australian Commission on Safety and Quality in Health Care (the Commission).1 The amount of variation seen is unlikely to be explained by differences in patient needs, and so indicates opportunities for delivering more effective patient care and getting better outcomes for individuals and for the community.2


        • 1 Australian Commission on Safety and Quality in Health Care, Sydney, NSW
        • 2 University of Newcastle, Newcastle, NSW


        Competing interests:

        We all work for the Australian Commission on Safety and Quality in Health Care, which published the second Atlas.

        • 1. Australian Commission on Safety and Quality in Health Care, Australian Institute of Health and Welfare. Second Australian atlas of healthcare variation. Sydney: ACSQHC, 2017.
        • 2. Australian Commission on Safety and Quality in Health Care, National Health Performance Authority. First Australian atlas of healthcare variation. Sydney: ACSQHC, 2015.
        • 3. Australian Orthopaedic Association. Australian Orthopaedic Association National Joint Replacement Registry annual report 2015. Adelaide: AOA, 2015.
        • 4. Muthuri SG, Hui M, Doherty M, Zhang W. What if we prevent obesity? Risk reduction in knee osteoarthritis estimated through a meta-analysis of observational studies. Arthritis Care Res 2011; 63: 982-990.
        • 5. Organisation for Economic Co-operation and Development. Focus on health: geographic variations in health care. Paris: OECD, 2014.
        • 6. Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the knee: clinical care standard. Sydney: ACSQHC, 2017.
        • 7. Arthritis Australia. Time to move: osteoarthritis. Arthritis Australia, 2014.
        • 8. Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66: 433-439.
        • 9. Brand C, Hunter D, Hinman R, et al. Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? Int J Rheum Dis 2011; 14: 181-190.
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        • 11. Council of Presidents of Medical Colleges. National Health Summit on Obesity: report and consensus statement. Canberra: CPMC, 2016.
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        • 15. Medical Board of Australia. Good medical practice: a code of conduct for doctors in Australia: MBA, 2014.
        Online responses are no longer available. Please refer to our instructions for authors page for more information.

          Untapped potential in Australian hospitals for organ donation after circulatory death

          Sandeep S Rakhra, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell and David V Pilcher
          Med J Aust 2017; 207 (7): . || doi: 10.5694/mja16.01405
          Published online: 25 September 2017

          Abstract

          Objective: To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates.

          Design: Retrospective cohort study.

          Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife. Ideal and expanded organ donation criteria were derived from international and national guidelines, and from expert opinion. Potential DCD organ donors were identified by applying these criteria to patients who had been intubated and were neither confirmed as being brain-dead nor likely to have met brain death criteria at the official time of death.

          Results: 8780 eligible patients were identified, of whom 202 were actual DCD donors. For 193 potential ideal (61%) and 313 potential expanded criteria DCD donors (72%), organ donation had not been discussed with their families; most were potential donors of kidneys (416 potential donors) or lungs (117 potential donors). Potential donors were typically older, dying of non-neurological causes, and more frequently had chronic organ disease than actual donors. Identifying all these potential donors, assuming a consent rate of 60%, would have increased Australia’s donation rate from 16.1 to 21.3 per million population in 2014.

          Conclusions: The untapped potential for DCD in Australia, particularly of kidneys and lungs, is significant. Systematic review of all patients undergoing end-of-life care in critical care environments for donor suitability could result in significant increases in organ donation rates.

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          • 1 Alfred Health, Melbourne, VIC
          • 2 Austin Health, Melbourne, VIC
          • 3 Australian Organ and Tissue Authority, Canberra, ACT
          • 4 University of Melbourne, Melbourne, VIC
          • 5 Monash Health, Melbourne, VIC
          • 6 Centre for Inflammatory Diseases, Monash University, Melbourne, VIC
          • 7 St Vincent's Hospital, Sydney, NSW
          • 8 Monash University, Melbourne, VIC


          Correspondence: sandeeprakhra@gmail.com
          Acknowledgements: 

          We acknowledge and thank all data collectors and audit officers who contribute to the DonateLife Audit. The DonateLife organisation is funded by the Australian Government. This particular research project was not funded.

          Competing interests:

          No relevant disclosures.

          • 1. Australia and New Zealand Organ Donation Registry. ANZOD Registry annual report 2015. Adelaide: ANZOD Registry, 2015. http://www.anzdata.org.au/anzod/ANZODReport/2015/2015ANZOD_annrpt.pdf (accessed Nov 2015).
          • 2. Australian Organ and Tissue Donation and Transplantation Authority. Annual report 2014–15. Canberra: AOTDTA, 2015. http://www.donatelife.gov.au/sites/default/files/OTA_AR2015.pdf (accessed Dec 2015).
          • 3. International Registry in Organ Donation and Transplantation. Final numbers 2014. IRODT, 2015. http://www.irodat.org/img/database/pdf/NEWSLETTER2015_December2.pdf (accessed Feb 2017).
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          • 8. Suárez F, Otero A, Solla M, et al. Biliary complications after liver transplantation from Maastricht category-2 non-heart-beating donors. Transplantation 2008; 85: 9-14.
          • 9. Callaghan CJ, Charman SC, Muiesan P, et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open 2013; 3: e003287.
          • 10. Agopian VG, Petrowsky H, Kaldas FM, et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg 2013; 258: 409-421.
          • 11. Macdonald P, Verran D, O’Leary M, et al. Heart transplantation from donation after circulatory death donors. Transplantation 2015; 99: 1101-1102.
          • 12. Dhital KK, Iyer A, Connellan M, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet 2015; 385: 2585-2591.
          • 13. Pilcher D, Gladkis L, Arcia B, et al. Estimating the number of organ donors in Australian hospitals — implications for monitoring organ donation practices. Transplantation 2015; 99: 2203-2209.
          • 14. Opdam HI, Silvester W. Potential for organ donation in Victoria: an audit of hospital deaths. Med J Aust 2006; 185: 250-254. <MJA full text>
          • 15. Opdam HS, Silvester W. Identifying the potential organ donor: an audit of hospital deaths. Intensive Care Med 2004; 30: 1390-1397.
          • 16. Kirchner C, Raduenz S, Fruehauf NR, et al. Estimated organ donor potential in German maximum care hospitals. Transplant Proc 2013; 45: 1310-1312.
          • 17. Sheehy E, Conrad SL, Brigham LE, et al. Estimating the number of potential organ donors in the United States. N Engl J Med 2003; 349: 667-674.
          • 18. Coulson TG, Pilcher DV, Graham SM, et al. Single-centre experience of donation after cardiac death. Med J Aust 2012; 197: 166-169. <MJA full text>
          • 19. Transplantation Society of Australia and New Zealand. Clinical guidelines for organ transplantation from deceased donors; version 1.0. Apr 2015. http://www.donatelife.gov.au/sites/default/files/TSANZ%20Clinical%20Guidelines%20for%20Organ%20Transplantation%20from%20Deceased%20Donors_Version%201.0_April%202016.pdf (accessed Dec 2015).
          • 20. British Transplantation Society. Transplantation from deceased donors circulatory death. 2013. https://bts.org.uk/wp-content/uploads/2016/09/15_BTS_Donors_DCD-1.pdf (accessed Oct 2015).
          • 21. Scalea JR, Redfield RR, Rizzari MD, et al. When do DCD donors die? Outcomes and implications of DCD at a high-volume, single-center OPO in the United States. Ann Surg 2016; 263: 211-216.
          • 22. Canadian Institute for Health Information. Deceased organ donor potential in Canada: report. Dec 2014. https://www.cihi.ca/sites/default/files/organdonorpotential_2014_en_0.pdf (accessed Feb 2016).
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            REM sleep behaviour disorder: not just a bad dream

            Elie Matar and Simon JG Lewis
            Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00321
            Published online: 18 September 2017

            Summary

             

            • Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by the loss of the normal atonia during the REM stage of sleep, resulting in overt motor behaviours that usually represent the enactment of dreams. Patients will seek medical attention due to sleep-related injuries or unpleasant dream content.
            • Idiopathic RBD which occurs independently of any other disease occurs in up to 2% of the older population. Meanwhile, secondary RBD is very common in association with certain neurodegenerative conditions. RBD can also occur in the context of antidepressant use, obstructive sleep apnoea and narcolepsy.
            • RBD can be diagnosed with a simple screening question followed by confirmation with polysomnography to exclude potential mimics.
            • Treatment for RBD is effective and involves treatment of underlying causes, modification of the sleep environment, and pharmacotherapy with either clonazepam or melatonin.
            • An important finding in the past decade is the recognition that almost all patients with idiopathic RBD will ultimately go on to develop Parkinson disease or dementia with Lewy bodies. This suggests that idiopathic RBD represents a prodromal phase of these conditions.
            • Physicians should be aware of the risk of phenoconversion. They should educate idiopathic RBD patients to recognise the symptoms of these conditions and refer as appropriate for further testing and enrolment into research trials focused on neuroprotective measures.

             


            • 1 Brain and Mind Centre, University of Sydney, Sydney, NSW
            • 2 Royal Prince Alfred Hospital, Sydney, NSW


            Correspondence: simon.lewis@sydney.edu.au
            Acknowledgements: 

            This work was conducted by the ForeFront project team and SJGL is supported by an NHMRC–ARC Dementia Research Development Fellowship (1110414). ForeFront is a large collaborative research group dedicated to the study of neurodegenerative diseases and is funded by grants from the National Health and Medical Research Council of Australia (1037746), Dementia Research Team (1095127), NeuroSleep Centre of Research Excellence (1060992), Australian Research Council Centre of Excellence in Cognition and its Disorders Memory Program (CE110001021) and the Sydney Research Excellence Initiative 2020. We thank Dr Negar Memarian for providing the polysomnography recording data shown in Box 2.

            Competing interests:

            No relevant disclosures.

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            • 91. Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson’s disease. Mov Disord 2015; 30: 1600-1611.
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              The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis

              Justine Maree Naylor, Andrew Hart, Rajat Mittal, Ian Harris and Wei Xuan
              Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01362
              Published online: 18 September 2017

              Abstract

              Objective: To compare the effectiveness of rehabilitation after total knee arthroplasty (TKA) in models with or without an inpatient rehabilitation component.

              Design, setting and participants: A propensity score-matched cohort of privately insured patients with osteoarthritis who underwent primary, unilateral TKA in one of 12 Australian hospitals between August 2013 and January 2015 were included. Those discharged to an inpatient facility because of poor progress or who experienced significant complications within 90 days of surgery were excluded.

              Intervention: Discharge after surgery to an inpatient rehabilitation facility or home.

              Main outcome measures: Patient-reported knee pain and function (Oxford Knee Score; at 90 and 365 days after surgery) and health rating (EuroQol “today” health scale; at 35, 90 and 365 days). Inpatient and community-based rehabilitation provider charges were also assessed.

              Results: 258 patients (129 pairs) from a sample of 332 were matched according to their propensity scores for receiving inpatient rehabilitation; covariates used in the matching included age, sex, body mass index, and markers of health and impairment. The only significant difference in outcomes was that EuroQol health scores were better on Day 35 for patients not undergoing inpatient rehabilitation (median difference, 5; IQR, –10 to 19; P = 0.01). Median rehabilitation provider charges were significantly higher for those discharged to inpatient therapy (total costs: median difference, $9500; IQR, $7000–11 497; P < 0.001; community therapy costs: median difference, $749; IQR, $0–1980; P < 0.001).

              Conclusions: Rehabilitation pathways incorporating inpatient rehabilitation did not achieve better joint-specific outcomes or health scores than alternatives not including inpatient rehabilitation. Given the substantial cost differences, better value alternatives should be considered for patients after uncomplicated TKA.

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              • 1 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW
              • 2 Ingham Institute of Applied Medical Research, Sydney, NSW
              • 3 South Western Sydney Local Health District, Sydney, NSW


              Acknowledgements: 

              This study was partially supported by a grant from the HCF Research Foundation to Justine Naylor, Ian Harris and Wei Xuan. We acknowledge the contribution made by Helen Badge, project manager of the larger investigation in which this study was nested.

              Competing interests:

              This study was partially funded by a grant awarded by the HCF Research Foundation, but the funder had no influence on the study design or the research plan.

              • 1. Australian Orthopaedic Association. National Joint Replacement Registry: hip, knee and shoulder arthroplasty annual report 2016. Adelaide: AOA, 2016. https://aoanjrr.sahmri.com/documents/10180/275066/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty (accessed June 2017).
              • 2. Hart A, Bergeron SG, Epure L, et al. Comparison of US and Canadian perioperative outcomes and hospital efficiency after total hip and knee arthroplasty. JAMA Surg 2015; 150: 990-998.
              • 3. Briggs T. A national review of adult elective orthopaedic services in England: getting it right first time. London: British Orthopaedic Association, 2015. https://www.boa.ac.uk/wp-content/uploads/2015/03/GIRFT-National-Report-MarN.pdf (accessed Mar 2017).
              • 4. Peel TN, Cheng AC, Liew D, et al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res 2015; 67: 782-790.
              • 5. Health Insurance Consultants Australia. The growing cost of hip and knee replacements [media release]. 13 Feb 2014. http://www.hica.com.au/health-insurance-news/the-growing-cost-of-hip-and-knee-replacements (accessed Mar 2017).
              • 6. Health Insurance Consultants Australia. New prostheses list advisory committee could reduce private insurance costs [media release]. 12 Sept 2016. http://www.hica.com.au/health-insurance-news/new-prostheses-list-advisory-committee-could-reduce-private-insurance-costs (accessed Mar 2017).
              • 7. Buhagiar, MA, Naylor JM, Harris IA, et al. Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (the HIHO study): study protocol for a randomized controlled trial. Trials 2013; 14: 432.
              • 8. Buhagiar, MA, Naylor JM, Harris IA, et al. Effect of inpatient rehabilitation vs a monitored home program on mobility in patients with total knee arthroplasty: the HIHO randomized clinical trial. JAMA 2017; 317: 1037-1046.
              • 9. Mahomed NN, Davis AM, Hawker G, et al. Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: a randomized controlled trial. J Bone Joint Surg Am 2008; 90: 1673-1680.
              • 10. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70: 41-55.
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              • 17. Chatterji R, Naylor JM, Harris IA, Descallar J. An equivalence study: are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes 2017; 15: 18.
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                Von Meyenburg complexes in a patient with obstructive jaundice

                Vipin Gupta and Govind Makharia
                Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01344
                Published online: 18 September 2017

                Biliary hamartomas were an incidental finding in a 33-year-old man who was investigated for recurrent episodes of biliary colic. A T2-weighted coronal image showed multiple small hyperintense lesions of similar size scattered in both lobes of the liver (Figure). Biliary microhamartomas (von Meyenburg complexes) are rare and usually multiple. They occur because of ductal plate malformation and are composed of dilated intralobular and interlobular bile ducts.1 They generally remain asymptomatic and do not affect liver functions, and are most commonly detected incidentally.2 Differential diagnosis of this rare clinical entity includes multiple simple liver cysts, Caroli disease and, less commonly, metastatic liver disease (with necrosis).


                • All India Institute of Medical Sciences, New Delhi, New Delhi, India


                Correspondence: govindmakharia@gmail.com
                Competing interests:

                No relevant disclosures.

                • 1. Desmet VJ. Ludwig symposium on biliary disorders — part I. Pathogenesis of ductal plate abnormalities. Mayo Clin Proc 1998; 73: 80-89.
                • 2. Brancatelli G, Federle MP, Vilgrain V, et al. Fibropolycystic liver disease: CT and MR imaging findings. Radiographics 2005; 25: 659-670.
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                  Thunderstorm asthma outbreak of November 2016: a natural disaster requiring planning

                  Steven J Lindstrom, Jeremy D Silver, Michael F Sutherland, Andrew BA Treloar, Ed Newbigin, Christine F McDonald and Jo A Douglass
                  Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00285
                  Published online: 18 September 2017

                  Learning from a tragedy to increase public awareness and improve responses in future thunderstorm asthma events

                  Thunderstorm asthma is the occurrence of acute asthma either during or immediately after a thunderstorm and it is often characterised by a surge in emergency asthma presentations. The epidemic of thunderstorm asthma in Melbourne, Australia, on 21 November 2016 was the most extreme such event ever worldwide, with nine fatalities currently the subject of a coronial inquiry.1,2 Hospitals and ambulance services were placed under record pressure, and supplies of reliever medications were exhausted at some health services.1 Key tasks for the future are to predict the thunderstorms most likely to lead to asthma outbreaks and to define how best to respond. Further research to better anticipate these outbreaks is crucial and planning for the inevitable recurrence must occur at patient, institutional and state-wide levels.


                  • 1 Austin Health, Melbourne, VIC
                  • 2 University of Melbourne, Melbourne, VIC
                  • 3 NSW Regional Office, Australian Bureau of Meteorology, Sydney, NSW
                  • 4 Royal Melbourne Hospital, Melbourne, VIC


                  Acknowledgements: 

                  We thank Edwin Lampugnani (University of Melbourne) for kindly supplying the image in . Jeremy Silver's work was funded by the MacKenzie Postdoctoral Fellowship scheme at the University of Melbourne.

                  Competing interests:

                  In the past 5 years, Jo Douglass has received honoraria for educational presentations from AstraZeneca, GlaxoSmithKline, Stallergenes Greer, Novartis, Alphapharm, Shire, Mundipharma and Seqirus; has sat on advisory boards for Novartis, GlaxoSmithKline, Astra-Zeneca, Pieris, Stallergenes Greer and Seqirus; and has undertaken contracted and investigator-initiated research for GlaxoSmithKline, Novartis, AstraZeneca and Sanofi-Aventis. Jeremy Silver and Ed Newbigin are investigators on the National Medical and Health Research Council PBH grant 1116107, which partners with Stallergenes Greer. Christine McDonald has received honoraria for education presentations or advisory board participation from GlaxoSmithKline, Novartis and Pfizer.

                  • 1. Inspector-General for Emergency Management. Review of response to the thunderstorm asthma event of 21–22 November 2016: final report. Melbourne: State of Victoria; 2017. http://www.igem.vic.gov.au/documents/CD/17/233820 (accessed June 2017).
                  • 2. Victorian Department of Health and Human Services. The November 2016 Victorian epidemic thunderstorm asthma event: an assessment of the health impacts. The Chief Health Officer’s report, 27 April 2017. Melbourne: State of Victoria, 2017. https://www2.health.vic.gov.au/emergencies/thunderstorm-asthma-event/response (accessed June 2017).
                  • 3. Queensland University of Technology. Final report: literature review on thunderstorm asthma and its implications for public health advice. https://www2.health.vic.gov.au/about/publications/researchandreports/thunderstorm-asthma-literature-review-may-2107 (accessed June 2017).
                  • 4. Marks GB, Colquhoun JR, Girgis ST, et al. Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax 2001; 56: 468-471.
                  • 5. Girgis ST, Marks GB, Downs SH, et al. Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk? Eur Respir J 2000; 16: 3-8.
                  • 6. Adams RJ, Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J Allergy Clin Immunol 2002; 109: 636-642.
                  • 7. Erbas B, Akram M, Dharmage SC, et al. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clin Exp Allergy 2012; 42: 799-805.
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                  • 10. Howden ML, McDonald CF, Sutherland MF. Thunderstorm asthma — a timely reminder. Med J Aust 2011; 195: 512-513. <MJA full text>
                  • 11. Eifan AO, Durham SR. Pathogenesis of rhinitis. Clin Exp Allergy 2016; 46: 1139-1151.
                  • 12. Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines — 2016 revision. J Allergy Clin Immunol 2017; doi: 10.1016/j.jaci.2017.03.050 [Epub ahead of print].
                  • 13. Peat JK, Tovey E, Mellis CM, et al. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin Exp Allergy 1993; 23: 812-820.
                  • 14. Pulimood TB, Corden JM, Bryden C, et al. Epidemic asthma and the role of the fungal mold Alternaria alternata. J Allergy Clin Immunol 2007; 120: 610-617.
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                  • 17. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev 2010; 8: CD001186.
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                    Public reporting of clinician-level data

                    Rachel Canaway, Marie M Bismark, David Dunt and Margaret A Kelaher
                    Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01402
                    Published online: 18 September 2017

                    There is much debate about public disclosure of individual doctors’ performance to increase hospital quality and safety, but research is lacking

                    In 2016, media coverage of a cluster of preventable deaths of babies born at a Victorian health service1 shone a spotlight in Australia on the role of public reporting of hospital performance data in assuring quality and safety. The subsequent Victorian government review2 suggested that the Victorian health system must develop a culture of candour with improved transparency at every level of the hospital system “through greater public reporting of outcomes data and support for a just culture in hospitals”.2 Other failures in hospital quality have similarly triggered inquiries and health system reform in Australia.3,4 For example, Queensland’s Bundaberg Hospital scandal in 2005 triggered changes to public reporting to further encourage cultures in hospitals to move away from the “name–shame–blame” approach.5


                    • Centre for Health Policy, University of Melbourne, Melbourne, VIC


                    Correspondence: mkelaher@unimelb.edu.au
                    Competing interests:

                    No relevant disclosures.

                    • 1. Medew J. Hundreds more baby deaths revealed in Victorian hospitals. The Age 2017; 28 June. http://www.theage.com.au/victoria/hundreds-more-baby-deaths-revealed-in-victorian-hospitals-20160628-gpu0sh.html (accessed Aug 2017).
                    • 2. Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the Review of Hospital Safety and Quality Assurance in Victoria. Melbourne: Victorian Government, 2016.
                    • 3. Scott IA, Ward M. Public reporting of hospital outcomes based on administrative data: risks and opportunities. Med J Aust 2006; 184: 571-575. <MJA full text>
                    • 4. Marasco SF, Ibrahim JE, Oakley J. Public disclosure of surgeon-specific report cards: current status of the debate. ANZ J Surg 2005; 75: 1000-1004.
                    • 5. Duckett SJ, Collins J, Kamp M, Walker K. An improvement focus in public reporting: the Queensland approach. Med J Aust 2008; 189: 616-617. <MJA full text>
                    • 6. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: Part 1-history, rationale, consequences. Ann Thorac Surg 2011; 92: S2-S11.
                    • 7. Pearse J, Mazevska D. The impact of public disclosure of health performance data: a rapid review. Sydney: Sax Institute, 2012.
                    • 8. Rechel B, McKee M, Haas M, et al. Public reporting on quality, waiting times and patient experience in 11 high-income countries. Health Policy 2016; 120: 377-383.
                    • 9. Minami CA, Dahlke A, Bilimoria KY. Public reporting in surgery: an emerging opportunity to improve care and inform patients. Ann Surg 2015; 261: 241-242.
                    • 10. Campanella P, Vukovic V, Parente P, et al. The impact of public reporting on clinical outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2016; 16: 296.
                    • 11. Hibbard JH, Stockard J, Tusler M. Hospital performance reports: impact on quality, market share, and reputation. Health Aff 2005; 24: 1150-1160.
                    • 12. Oakley J. Surgeon report cards, clinical realities, and the quality of patient care. Monash Bioeth Rev 2009; 28: 21.1-21.6.
                    • 13. Behrendt K, Groene O. Mechanisms and effects of public reporting of surgeon outcomes: A systematic review of the literature. Health Policy 2016; 120: 1151-1161.
                    • 14. Faber M, Bosch M, Wollersheim H, et al. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care 2009; 47: 1-8.
                    • 15. Henderson A. Surgical report cards: the myth and the reality. Monash Bioeth Rev 2009; 28: 20.01-20.20.
                    • 16. Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Intern Med J 2012; 42: 569-574.
                    • 17. Gallagher MP, Krumholz HM. Public reporting of hospital outcomes: a challenging road ahead. Med J Aust 2011; 194: 658-660. <MJA full text>
                    • 18. Azzam DG, Neo CA, Itotoh FE, Aitken RJ. The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years. Med J Aust 2013; 199: 539-542. <MJA full text>
                    • 19. Ganai S. Disclosure of surgeon experience. World J Surg 2014; 38: 1622-1625.
                    • 20. Sherman KL, Gordon EJ, Mahvi DM, et al. Surgeons’ perceptions of public reporting of hospital and individual surgeon quality. Med Care 2013; 51: 1069-1075.
                    • 21. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: Part 2 – implementation. Ann Thorac Surg 2011; 92: S12-S23.
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                      Road safety: serious injuries remain a major unsolved problem

                      Ben Beck, Peter A Cameron, Mark C Fitzgerald, Rodney T Judson, Warwick Teague, Ronan A Lyons and Belinda J Gabbe
                      Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00015
                      Published online: 11 September 2017

                      Abstract

                      Objective: To investigate temporal trends in the incidence, mortality, disability-adjusted life-years (DALYs), and costs of health loss caused by serious road traffic injury.

                      Design, setting and participants: A retrospective review of data from the population-based Victorian State Trauma Registry and the National Coronial Information System on road traffic-related deaths (pre- and in-hospital) and major trauma (Injury Severity Score > 12) during 2007–2015.

                      Main outcomes and measures: Temporal trends in the incidence of road traffic-related major trauma, mortality, DALYs, and costs of health loss, by road user type.

                      Results: There were 8066 hospitalised road traffic major trauma cases and 2588 road traffic fatalities in Victoria over the 9-year study period. There was no change in the incidence of hospitalised major trauma for motor vehicle occupants (incidence rate ratio [IRR] per year, 1.00; 95% CI, 0.99–1.01; P = 0.70), motorcyclists (IRR, 0.99; 95% CI, 0.97–1.01; P = 0.45) or pedestrians (IRR, 1.00; 95% CI, 0.97–1.02; P = 0.73), but the incidence for pedal cyclists increased 8% per year (IRR, 1.08; 95% CI; 1.05–1.10; P < 0.001). While DALYs declined for motor vehicle occupants (by 13% between 2007 and 2015), motorcyclists (32%), and pedestrians (5%), there was a 56% increase in DALYs for pedal cyclists. The estimated costs of health loss associated with road traffic injuries exceeded $14 billion during 2007–2015, although the cost per patient declined for all road user groups.

                      Conclusions: As serious injury rates have not declined, current road safety targets will be difficult to meet. Greater attention to preventing serious injury is needed, as is further investment in road safety, particularly for pedal cyclists.

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                      • 1 Monash University, Melbourne, VIC
                      • 2 Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC
                      • 3 National Trauma Research Institute, Melbourne, VIC
                      • 4 Private Medical Centre, Royal Melbourne Hospital, Melbourne, VIC
                      • 5 Royal Children's Hospital, Melbourne
                      • 6 Farr Institute, Swansea University, Swansea, Wales, United Kingdom


                      Correspondence: ben.beck@monash.edu
                      Acknowledgements: 

                      The Victorian State Trauma Registry (VSTR) is funded by the Department of Health and Human Services, the State Government of Victoria, and the Transport Accident Commission. Ben Beck received salary support from the National Health and Medical Research Council (NHRMC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence (1029983). Peter Cameron was supported by an NHMRC Practitioner Fellowship (545926) and Belinda Gabbe by an NHMRC Career Development Fellowship (GNT1048731). Warwick Teague’s role as director of trauma services at the Royal Children’s Hospital, Melbourne, is supported by a grant from the Royal Children’s Hospital Foundation. We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing VSTR data. We also thank Sue McLellan for her assistance with the data, Pam Simpson for her statistical support, and David Attwood from the Transport Accident Commission for his suggestions and advice.

                      Competing interests:

                      No relevant disclosures.

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