Population-based data from the NSW Cancer Registry were linked to NSW Admitted Patient Data Collection (APDC) and Registry of Births Deaths and Marriages (RBDM). Timelier outcomes data were obtained from linked APDC and RBDM data. Higher-volume hospitals were defined as performing >6 specified procedures annually. Monitoring of hospitals and continuous feedback loops and formalised referral networks for surgery were implemented. Clinicians facilitated and guided consolidation efforts. A thematic analysis of factors associated with success was conducted on hospitals maintaining the suggested minimum average of >6 surgeries over a sustained period.
In 2005, 50% (57/115) of oesophagectomies were performed in hospitals (n=22) performing <6 surgeries annually. In 2011, that figure had decreased to 25% (36/144, n=12 hospitals) and in 2016 was 13% (18/135, n=8 hospitals). A similar pattern was observed for pancreatectomy. For pancreatectomy, post-operative outcomes remained the same or improved even with an increase in the proportion of people undergoing surgery. This coincided with developing and strengthening formal referral networks between regional and metropolitan hospitals. Specialist gastrointestinal surgeons were engaged with a multidisciplinary team developing patient information sheets. An evaluation of the process highlighted the importance of timely, relevant data; effective clinician engagement; and support of system administrators.
Consolidation of surgery to higher-volume hospitals can be successfully achieved and sustained; however the interaction of contextual and other factors is important to understand and address to achieve sustainability and effectiveness. This work extends our understanding of achieving sustained system change across multiple settings.