This document discusses how data from the Swedish PeriOperative Register (SPOR) can be used to improve patient care. Some key points: - SPOR contains over 23 reports and over 100 charts and tables that provide statistics on outcomes, processes, and quality indicators for surgical care. These reports see over 10,000 downloads annually. - The reports can help hospitals identify problems, benchmark performance, and drive quality improvement. Examples shown include reports on postoperative pain levels, cancellation rates, WHO checklist compliance, and outcomes for hip fracture patients. - One hospital used SPOR data to identify high mortality for hip fractures, made changes to increase daytime operating and length of stay, and saw mortality drop significantly in

1. Using SPOR data to
improve patient care
Gunnar Enlund
Senior Consultant
of Anaesthesia and Intensive Care
Co CEO Swedish PeriOperative Register (SPOR)
ANIVA, Uppsala University Hospital
Uppsala, Sweden

2. None, No financial conflicts
Disclosure of Interest

3. www.spor.se

4. 23 Reports are On-line - all the time

5. How many reports in SPOR ?
• 3 public reports – open for all
• 23 reports only for members
• These 23 reports contains:
• 85 Figures and Charts
• 88 Tables with numeric statistics

6. 23 Reports being used 2016 -
More than 10.000 downloads !
0 200 400 600 800 1000 1200
spr_gardagens_utfall
spr_processdata
spr_postoperativ_smarta
spr_sena_strykningar
spr_who_checklist
spr_alder_operationsfrekvens
spr_hoftfraktur
spr_avvikelser_komplikationer
spr_mortalitet_vanligaste
spr_ifyllnadsgrad
spr_akutprioritering
spr_postop_avvikelser_komplikationer
spr_vanligaste_operationerna
spr_mortalitet_ingreppsspecifik
spr_processdata_vecka
spr_ombokningar_strykningar
spr_funktionsbedomning_asa
spr_mortalitet_asa_alder
spr_akutprioritering_utfall
spr_postoperativt_illamaende
spr_antibiotikaprofylax
spr_excel_export
spr_variabelinformation
>10 000
Reports 2016

7. First report –
How much corrupt data?

8. SPOR gives feed back to hospitals to
correct their data input!
79 logical controls of the data. 17-09-05.

9. All Controls and Validation rules
on the homepage www.spor.se

10. The Swedish hospitals gets validated
by becoming members of SPOR!
The importance of this
is not understood by many today!
The work to validate SPOR is going
right into the heart of how true the
registration of surgery is done in
Sweden today.

11. Now I will give you some examples
of reports of special interest!
0 200 400 600 800 1000 1200
spr_gardagens_utfall
spr_processdata
spr_postoperativ_smarta
spr_sena_strykningar
spr_who_checklist
spr_alder_operationsfrekvens
spr_hoftfraktur
spr_avvikelser_komplikationer
spr_mortalitet_vanligaste
spr_ifyllnadsgrad
spr_akutprioritering
spr_postop_avvikelser_komplikationer
spr_vanligaste_operationerna
spr_mortalitet_ingreppsspecifik
spr_processdata_vecka
spr_ombokningar_strykningar
spr_funktionsbedomning_asa
spr_mortalitet_asa_alder
spr_akutprioritering_utfall
spr_postoperativt_illamaende
spr_antibiotikaprofylax
spr_excel_export
spr_variabelinformation
>10 000
Reports 2016
Excel rapport release Jan 2017

12. 1. What happend Yesterday?
(over 1000 downloads)

13. Falun –2017-08-30 – all reports are sent
back at 05:00 in the morning of 170831.
Wednesday 2017-08-30 Falun

14. Yesterday Outcome compared with
planned activity
The differens is marked with color –
good planning has a target time!

15. Another day can look like this!
Monday 2017-08-28 Eskilstuna

16. Falun 170830 again – a good day!

17. Falun –2017-08-30- Changing time

18. Operation time
Staff time ( Patient time)
Changing time
Planned vs Actual

19. SPOR can answer the question:
How many operations should be
pushed into the schedule?

20. 2. Process data – can be chosen in
almost any combinations ( >900) A
1. Hospitals
2. Operation
theatre Units
3. Surgical Clinics
4. Acute,
Elective, Both
5.Timeperiod
6. With/ Without
Anesthesia

21. Process – Emegency surgery

22. When is emergency surgery done?
Mostly in early evening – 40 %
15 %
Night
time

23. Process – Emergency surgery = red
- actually a very stable process
It´s the planned activity that is the problem

24. Elective surgery daytime /
On Call surgery 18 % of our work

25. Process of the week

26. Torsten Gordhs picture of pain!

27. 3. Postoperative pain (>630)

28. The VAS Score for highest level of
postoperative pain – all operations

29. Surgery with the highest pain score - EDC
Sorted by unit, Sweden compares

30. EDC – You find your most painful
procedures at your operating unit

31. EDC – the Code for
Sagittal Ramus Osteotomi on the Jaw
- compare your results with Sweden –
and after that – time for action!

32. 4. Late Cancellations (600)

33. Quality Goal – less than 3 % ?

34. Patient need for
surgery has
changed.

35. Late Cancellations –
different work is needed due to
different reasons

36. Late Cancellations –
How to avoid them ?
7. Patient no show -… 18,5% to 0 %
St Göran hospital in Stockholm
Every Friday lunch they sit down and go trough
the late cancellations that week.
They really try to understand the true reasons
for the cancellation in detail
They also work to find ways to counteract that it
will not happen again.

37. The WHO-question

38. 5. WHO Checklista 2017 (600)

39. WHO Checklista 2017

40. WHO-developement 2013 - 2017

41. WHO – checklist – is it still needed?
Mortality vs WHO in Stockholm
 Björn Holmström has preliminary results for
Stockholms Läns Landsting for the year 2016
 When WHO checklist was used -
mortality 4,0 %. (47.780 patients)
 When WHO checklist was not used –
mortality 7,6 %. ( 6.850 patients)
 This is a trend that SPOR can see in all over
Sweden.

42. WHO-developement 2013 – 2017 ( + 16 %)
if 10 % x 650.000 op x 3,6% = 2340 lives

43. A bit about hip fractures

44. 7. Hip Fractures –
a practical example from Eskilstuna

45. Age distribution for Hip fractures –
a bit younger – socioeconmic?

46. Normal distribution – Waiting time –
Patient time – Operation time

47. Mälarsjukhuset 2013 Mortality Hip Fracture

48. Mälarsjukhuset 2014 + 2015
Mortality Hip Fracture

49. Mälarsjukhuset 2016 Mortality Hip Fracture
314 patients

50. Mälarsjukhuset 2017 Mortality Hip Fracture

51. Mälarsjukhuset
Hip Fracture Mortality 2013 - 2017
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
<30 <90 <180 <365 <30 <90 <180 <365
Mälarsjukhuset 2013 - 2017
Mälarsjukhuset to the left, Sweden to the right
2013 2014 2015 2016 2017

52. Comments from Peter Landell – the
new Ortopedic chief surgeon 2016 A
 He looks at SPOR figures each second
week
 He spotted the high mortality rates 2016
+ 6 %
 Earlier 60% of the fractures were operated
on within inom 24 tim, but now 85%
 This is the greatest reason for the
improvement

53. Comments from Peter Landell – the
new Ortopedic chief surgeon 2016 B
 A redirection of operating resources for
fracture surgery daytime has been made
 Internal prioritation and focus for Hip
Fractures on the clinic
 The postoperative care has improved–
they stay a coulpe more days – aming for
11 days on the ward. Better patient
training.

54. Wating Time
from
Op Notification
to Operating
starting time

55. Mälarsjukhuset 2017 Mortality for Hip
Compared with 2016 – 22 lifes saved (out of 314)

56. 15. Mortalitet Specific statistic
for every typ of surgery

57. 15. Mortality – A specific operation -
Check at home!

58. Take a walk with SPOR!
SPOR homepage: www.spor.se

59. 11. Emergency surgery – (430)
Compared with Planned surgery

60. 12. Emergency Surgery (220)
Comparision planned to actual start time

61. Waiting time from Surgery Request to
start time op surgery - does it matter?

62. Mortality rises when waiting is
prolonged 2016 (top), 2015 ( bottom)