Putting data at the heart of patient care
Miguel Sousa Uva and Márcio Madeira, cardiothoracic surgeons practising in Portugal, tell EACTS about the importance of embedding the use of data to improve outcomes for patients.
The EACTS Quality Improvement Programme is empowering members and the wider surgical community to raise standards of care by providing tools and insights to support healthcare professionals through better collection and use of surgical data. The EACTS databases make it possible to compare and benchmark hospital data from across Europe; measure outcomes using statistical tools and bespoke reports; and identify areas of improvement in clinical practice.
We caught up with Miguel Sousa Uva and Márcio Madeira to talk about how a rigorous focus on data management and quality improvement can help remove obstacles to improving outcomes for patients.
Miguel is Head of the department of cardiac surgery at Hospital Santa Cruz in Lisbon, and a Past President of EACTS. He has been closely involved in the Quality Improvement Programme since its inception. Márcio is a cardiac surgeon and researcher at Centro Hospitalar de Lisboa Ocidental. Miguel and Márcio agree on the benefits of the wider application of data to drive improvements in outcomes.
“Data is the baseline of everything,” says Miguel. “Without data you don’t know what to do, you cannot compare with others, and you cannot inform patients.
“Patients deserve to be informed. They have the right to know what the outcomes are for the procedure you are recommending to them.”
Márcio says: “Data is knowledge and knowledge is essential for best practice, to be a better surgeon and to make better decisions. Data informs what we do now and helps us to understand the quality of patients’ lives after procedures.
“We need to be able to compare our procedures with other procedures to decide which one is better for each patient. Data is essential.”
Miguel and Márcio believe that access to robust data is crucial to improving outcomes for patients. Miguel says: “Without data you cannot know if you are improving or not. It is really essential to have data. This is why data collection must be at the heart of our practice. Unfortunately, in the real world, this is easier said than done. Data collection can be difficult to implement.”
Data already plays a critical role in their working lives but they know that patients are not yet feeling the full benefits because of limitations around data collection and analysis.
“I use data to inform my practice every day,” says Márcio. “We need to know what we are doing, if we are doing well. How can we improve? Can we make a better decision for each patient? That is very important.
“But in reality, right now, it is not possible to have this information for every patient because we don’t have the staff or the equipment. We do what we can in our spare time.
“The main problem is finding people to fill in the data. It isn’t mandatory and we can’t hire people to do the job. Doctors and nurses are busy doing their work, and the staff are very busy so sometimes they can’t fill in the data, which is a major issue. A lot of data is not complete.
“If we could do it for every pathology and for every kind of patient, we would have data to analyse from different perspectives, which would give us a better view of what we are doing and what we can do in the future.”
Miguel shares Márcio’s frustration. “The main obstacles are organisation and motivation,” he says. “We need to do more to make surgeons understand that it is in their interest, and their patient’s interest, to have data in order to improve.”
Márcio would like to see data collection made mandatory. “We would be able to hire staff to collect the data and work with clinical staff to screen it to ensure that it is correct. This way, we will reduce the workload of surgeons and the data will be more complete.”
A new database giving surgical teams advanced tools to improve clinical practice
Miguel and Márcio see the development of the EACTS Adult Cardiac Database (ACD) as a significant opportunity to embed data collection and database management in cardiothoracic surgery practice. The ACD enables surgical teams from participating cardiac hospitals to benchmark data from their own hospitals and countries against data from around Europe and beyond.
The ACD can drive standardisation, says Miguel. “If hospitals collect data in the same way, following the same ACD data dictionary, it will be easier to compare data.”
The ACD is the only database for people to compare across hospitals from different countries, complementing the work of national registries. Surgeons can benefit from EACTS support for data curation and mapping.
Márcio says: “The ACD has a user-friendly interface, which makes it easy to use and gather insights. While automation is not yet available, if more hospitals join the database and more data is standardised, we can work towards automation to make it even easier to upload data.” There is no cost to participating hospitals, even if they are not EACTS members, while members can access the interactive viewer for free and can request data for research.
Miguel is hopeful that through the ACD, EACTS will raise the level of awareness of the importance of data collection. He would like to see Europe match the ambition of the STS Adult Cardiac Surgery Database in America, which holds data on nearly 10 million procedures from more than 4,300 surgeons, including 95% of adult cardiac surgery procedures.
“Europe should aim to get to the same stage,” he says. “I know it is more difficult because we are not a single country. We are myriad countries, with different cultures and different settings. But looking at the American example, Europeans should get together and understand that it is in our interest, and in the interest of our specialty, to improve, to get big data.”
Says Márcio: “In the US they know what they are doing in each state. They compare and they screen, and a lot of science comes from that. Europe needs that, a database to make science, to compare outcomes, to compare procedures with other procedures, or to know if there is some problem with diseases in some countries and what we can do to improve.
“I can only see advantages. Of course, there is a cost that needs to be paid but that cost will be outweighed by the benefits.”
Open now, hospitals, centres and national registries are encouraged to join the ACD, and to take the opportunity to improve data collection and generate insights to identify areas of improvement in clinical practice.