National Key Performance Indicators Research Articles

Where next for type B aortic dissection?

In April 2021 the acute aortic dissection toolkit was launched by NHS England.1 It was designed to improve the care of patients with acute aortic dissection (AD) by raising awareness of the condition and introduced seven key principles of management including better governance, 24/7 rotas and specialist care. Each NHS region in England was encouraged to form an AD group, benchmark their current service against the toolkit principles and then try to improve their management of these patients by addressing deficiencies. The toolkit provided tools for self-assessment together with protocols to improve deficiencies by sharing best practice. A regular series of regional meetings has been held with clinicians and managers to advise and help progress – engagement with the process and feedback has been good. National key performance indicators are being developed to monitor the overall effect of the toolkit. Although the toolkit applies to all dissections, there is inevitably a bias towards management of type A dissections because many need urgent cardiac surgical repair. So where next and what about type B dissections?

Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis.

Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred. This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days. This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week. National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis. There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P < 0.001). The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.

Assessing driver safety behaviour in Greece

The objective of this research is to assess drivers' road safety behavior in Greece in relation to speeding, seat-belt and helmet use and driver distraction and identify the characteristics that are associated with these behavioral patterns. Data were collected from roadside observations at randomly selected locations in all regions of Greece, in order to obtain a representative sample. The national Key Performance Indicators were calculated and Negative Binomial Regression models were developed for each indicator. 27% of Greek drivers were found to exceed the legal speed limits and 9% of drivers used a handheld mobile phone while driving. The use of helmet was found relatively high (88%), while the use of seat-belt was relatively low (65%). The results allow to evaluate drivers' behavior and can provide useful support to decision makers working for the improvement of safety in Greece.

Availability of stroke services and hospital facilities at different hospital levels in Thailand: a cross-sectional survey study

BackgroundStroke has one of the biggest burden of disease in Thailand and all health regions have been tasked to develop their service delivery to achieve the national key performance indicators set out by the Thai service plan strategy 2018–2022. Our aim was to characterise stroke services and hospital facilities by investigating differences in facilities across different hospital levels in Thailand.MethodsSelf-complete questionnaires were distributed to 119 hospitals in 12 health regions between November–December 2019. Participants were health professionals whose main responsibilities are related to stroke service provision in their hospital. Descriptive statistics were used to report differences of stroke service provision between advanced-level, standard-level and mid-level referral hospitals.ResultsThirty-eight (32% response rate) completed questionnaires were returned. All advanced-level, standard-level (100%) and 55% of mid-level referral hospitals provided stroke units. Neurologists were available in advanced-level (100%) and standard-level referral hospitals (50%). Standard-level and mid-level referral hospitals only had a quarter of rehabilitation physicians compared to advanced-level referral hospital. Home-based rehabilitation was provided at 100% in mid-level but only at 16% and 50% in advanced-level and standard-level referral hospitals.ConclusionsSetting up a stroke unit, as a national goal that was set out in the service plan strategy 2018–2022, was achieved fully (100%) in advanced-level and standard-level referral hospitals including key essential supportive components. However, capacity in hospitals was found to be limited and stroke service delivery needs to be improved especially at mid-level referral hospitals. This should include regular organisational surveys and the use of electronic records to facilitate monitoring of clinical/health outcomes of patients.

A high-volume ERCP service led by surgeons is associated with good outcomes and meets national key performance indicators: results from a British district general hospital.

Endoscopic retrograde cholangiopancreatography (ERCP) is a common, but technically challenging procedure used in the management of hepatopancreaticobiliary (HPB) disease. It is traditionally performed by medical gastroenterologists. In 2014, the British Society of Gastroenterology (BSG) proposed key performance indicators to evaluate and set standards of ERCP practice. This study aimed to compare our ERCP outcomes against these targets, in a centre where ERCP is exclusively performed by surgeons. A retrospective analysis of all ERCPs undertaken over a 38months in a District General Hospital in the United Kingdom (UK), by three Upper Gastrointestinal Surgeons. Study outcomes were based upon, and compared against, BSG key performance indicators, including number of ERCPs per annum, proportion of successful cannulations of bile duct and stone clearance, ERCP-specific complications and mortality. The unit's caseload over this period was 1324, equating to approximately 418 per annum (BSG minimum 200 per unit). Management of bile duct stones was the commonest indication for ERCP. Overall, 95% (1253/1324) of bile ducts were cannulated and 92% (645/698) for those undergoing their first ERCP. Bile duct clearance was achieved in 80% of patients (BSG recommend > 75%) and the successful stenting of extra-hepatic strictures in 94% (BSG recommend > 80%). The overall complication rate was 4.3% (BSG standard < 6%). Procedure-specific mortality was 0.3% (4/1324) where death was either caused by pancreatitis or sepsis. A high-volume ERCP service led and performed exclusively by surgeons meets all BSG performance indicators, with good procedural and patient outcomes. Formal training pathways should be developed to encourage more surgical centres to provide an ERCP service and deal with what are common surgical pathologies.

O61: TEXTBOOK SURGICAL OUTCOMES IN OESOPHAGO-GASTRIC CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS

Abstract Introduction High quality surgery remains the cornerstone of treating oesophago-gastric malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit (DUCA) have defined ten surgical and perioperative ‘textbook’ parameters that correlate with improved overall survival. The aim of this project was to examine the proportion of patients attaining ‘textbook’ outcomes for oesophagectomy and gastrectomy in our unit before and after the introduction of national key performance indicators (KPIs). Method A retrospective review of all oesophagectomies and gastrectomies from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 ‘textbook’ parameters were studied pre- and post-KPI introduction. Result 269 and 284 patients underwent oesophagectomy and gastrectomy respectively, 167 pre-KPI and 386 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p=0.6), gender (71% male, 29% female vs 68% male, 22% female, p=0.48), ASA grade (p=0.6) or tumour stage (p=0.37) pre- and post-KPI. In the pre-KPI era, 28/167 (17%) patients achieved all ten textbook parameters, compared with 157/386, (41%, p=0.001) post-KPI. This compares favourably to DUCA ‘textbook’ data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p=0.002), a reduction in margin positivity (21% vs 7%, p= 0.001) and peri-operative mortality (6% vs 2%, p=0.03) post-KPI. Conclusion There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving ‘textbook’ outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives. Take-home message National KPIs improve peri-operative outcomes in oesophago-gastric cancer.

249 TEXTBOOK SURGICAL OUTCOMES IN ESOPHAGEAL CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS.

Abstract High quality surgery remains the cornerstone of treating esophageal malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit have defined ten surgical and perioperative “textbook” parameters that correlate with improved overall survival in patients undergoing esophageal resection. In 2013, national key performance indicators were introduced in Ireland against which esophageal cancer resection was to be benchmarked. This project examines the effect of introducing the KPIs on the proportion of patients attaining “textbook” outcomes for esophagectomy. Methods A retrospective review of all esophagectomies and from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 “textbook” parameters were studied pre- and post-KPI introduction. Results 269 underwent esophagectomy, 77 pre-KPI and 192 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p = 0.6), gender (72% male, 28% female vs 67% male, 23% female, p = 0.43), ASA grade (p = 0.6) or tumour stage (p = 0.37) pre- and post-KPI. In the pre-KPI era, 13/77 (17%) patients achieved all ten textbook parameters, compared with 79/192, (41%, p = 0.001) post-KPI. This compares favourably to DUCA “textbook” data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p = 0.002), a reduction in margin positivity (21% vs 7%, p = 0.001) and reduced peri-operative mortality (6% vs 2%, p = 0.03) post-KPI. Conclusion There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving “textbook” outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives.

What are the perceptions of stakeholders on the utility of the nKPIs for Indigenous services?

Abstract Background The Australian Commonwealth Government has introduced national key Performance Indicators, (nKPIs), for Indigenous primary health care services, including Aboriginal Community Controlled Health Organisations (ACCHOs). The nKPIs aim to assist in the monitoring of Indigenous people's health and aid ACCHOs to monitor their service delivery. The nKPI development and its ongoing implementation have involved stakeholders including the Council of Australian Governments; national and jurisdictional ACCHO peak bodies; government departments; software developers, and researchers. While high-level information is available about the nKPIs, there is very little publicly available information about how they were developed and implemented. This presentation discusses perspectives from stakeholders on the development and implementation of the nKPIs. Methods Stakeholder interviews (n = 15) aimed to understand the utility and appropriateness of the nKPIs and barriers/enablers to implementation. Stakeholders with knowledge of the development, management or reporting of the nKPIs were recruited. The analysis was conducted inductively and deductively and organised using NVivo. Results The interviews focused on the history of the nKPIs and the context within which these are collected and managed. Several key themes and sub-themes arose from the stakeholder interviews. These themes included the nKPI purpose, development, implementation, and appropriateness. Several interviewees considered the nKPI development process to be flawed, leading to poor data quality and an increased burden on ACCHOs. Conclusions The ACCHO sectors' needs and perspectives were mostly ignored in the development process. Numerous research papers and government documents highlight the need for active engagement of Indigenous people to be actively engaged in the design of policies, programs, and frameworks seeking to improve the health of Indigenous people. Key messages The nKPI implmentation issues could have been avoided had they been developed in partnership with Indigenous organisations. Indigenous policy development needs to be developed in partnership with Indigenous people.

What are the perceptions of Indigenous organisation staff on the utility of the nKPIs?

Abstract Background This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness. Methods A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo. Results Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance Conclusions Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs. Key messages Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.

AB098. Textbook surgical outcomes in oesophageal cancer: the influence of national key performance indicators

AB098. Textbook surgical outcomes in oesophageal cancer: the influence of national key performance indicators

Examination of UNECE Recommendations to Enhance Energy Efficiency in Buildings using DEMATEL

Achieving Energy efficiency in Buildings is one of the national Key Performance Indicators in many countries. Because Major part of the generated energy is consumed by buildings, it is evident that achieving energy efficiency in buildings compliments in conservation of energy and its resources along with attaining sustainability. This research work is analysis of such building energy efficiency recommendations for Enhancing energy efficiency in buildings. The recommendations discussed in this paper were proposed by United Nations Economic commission for Europe (UNECE) for UNECE region consisting of 56 member countries. This paper analyses the UNECE recommendations, their cause and effects through Decision making trial and evaluation laboratory (DEMATEL) methodology. The results showed that among all the recommendations, the two that had greater potential in achieving the goal of energy efficiency in buildings are a) National and local authorities’ coordination for continuous development and implementation of building codes and b) Energy policy and legislation. The paper also discusses managerial applications of this research work and provides insight into the recommendations.

Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department.

ObjectiveThe aim of this study is to improve rates of day of surgery admission (DOSA) for all suitable elective thoracic surgery patients.DesignLean Six Sigma (LSS) methods were used to enable improvements to both the operational process and the organizational working of the department over a period of 19 months.SettingA national thoracic surgery department in a large teaching hospital in Ireland.ParticipantsThoracic surgery staff, patients and quality improvement staff at the hospital.Intervention(s)LSS methods were employed to identify and remove the non-value-add in the patient’s journey and achieve higher levels of DOSA. A pre-surgery checklist and Thoracic Planning Meeting were introduced to support a multidisciplinary approach to enhanced recovery after surgery (ERAS), reduce rework, improve list efficiency and optimize bed management.Main Outcome Measure(s)To achieve DOSA for all suitable elective thoracic surgery patients in line with the National Key Performance Indicator of 75%. A secondary outcome would be to further decrease overall length of stay by 1 day.ResultsOver a 19 month period, DOSA has increased from 10 to 75%. Duplication of preoperative tests reduced from 83 to <2%. Staff and patient surveys show increased satisfaction and improved understanding of ERAS.ConclusionsUsing LSS methods to improve both operational process efficiency and organizational clinical processes led to the successful achievement of increasing rates of DOSA in line with national targets.

Implementation of Universal Newborn Hearing Screening (UNHS)

Permanent childhood hearing impairment (PCHI) is the commonest birth condition with a prevalence of 1-3/1000. This rises to 10/1000 for neonates who have been in Neonatal Intensive Care Unit. The early detection of PCHI, and the initiation of medical and educational interventions, has been demonstrated to significantly improve long-term outcomes for children with hearing loss and their families. Early identification, via universal new-born hearing screening gives babies a better ‘life chance' of developing speech and language skills and of making the most of social and emotional interaction from an early age. While the detection of early hearing is vitally important to a child’s development, it also means that support and information can be provided to parents at an early stage. Prior to the rollout of UNHS, the age of diagnosis of childhood hearing loss and habilitation in Ireland was difficult to ascertain with confidence due to the absence of National ICT system, but anecdotally was reported to be when children were aged over 2 years. The National Audiology Report1 recommended the introduction of UNHS, which commenced April 2011 and was rolled out on a phased basis, becoming a national programme in November 2013. Whilst this seems by inference to refer purely to hearing screening service for newborns; the programme actually spans a multitude of professionals (including ENT Consultants, Paediatricians, Audiologists, Visiting Teachers for the Deaf and Social Workers) across a range of services nationally (including Maternity Hospitals, Paediatric Hospitals, Cochlear Implant Team, Primary Care Services and Advocacy Services) who provide operational, clinical and managerial input to ensure the delivery of a high quality service. The implementation of UNHS required the development of new care pathways, up skilling of professionals, engagement with stakeholders, and procurement of a screening provider with a UNHS specific ICT system for the reporting of key performance indicators. To provide quality assurance and drive improvements local UNHS multidisciplinary governance groups were established to monitor services and provide input to the National Technical Group for Children’s Hearing Services (NTGCHS) who has overall responsibility for developing and managing the programme. Outcomes: To date the programme has been delivered nationally with over 250,000 children screened by 100 screeners based at 19 maternity sites. The programme outcomes will be reported, demonstrating that comprehensive national key performance indicators have been consistently met or exceeded, along with favourable benchmarking against international programmes. Next steps including ongoing team building and the development of a national audiology clinical management system to ensure continued integrated working will also be outlined. Key transferable learning points Necessity for quality ICT system for operational and service monitoring Establishing baseline KPIs and reviewing relevance Establishment of governance documentation Development of local and national groups to provide oversight Ensuring all stakeholders engage with governance groups Reference: 1. Health Services Executive. National Audiology Review. Dublin. 2011. Available from: http://www.hse.ie/eng/services/publications/corporate/AudiologyReview.pdf

Key performance indicators for Australian mental health court liaison services.

The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group). Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion. A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed. This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery.

Furthering the quality agenda in Aboriginal community controlled health services: understanding the relationship between accreditation, continuous quality improvement and national key performance indicator reporting.

A rapidly expanding interest in quality in the Aboriginal-community-controlled health sector has led to widespread uptake of accreditation using more than one set of standards, a proliferation of continuous quality improvement programs and the introduction of key performance indicators. As yet, there has been no overarching logic that shows how they relate to each other, with consequent confusion within and outside the sector. We map the three approaches to the Framework for Performance Assessment in Primary Health Care, demonstrating their key differences and complementarity. There needs to be greater attention in both policy and practice to the purposes and alignment of the three approaches if they are to embed a system-wide focus that supports quality improvement at the service level.

Medium-Sized Ground Source Heat Pump Incubator Design and Research of Condenser

Based on kind of medium-sized ground source heat pump incubator condenser’s design and research, incubator can get good uniformity temperature filed. Incubation experiments showed that the incubator reached the national key performance indicators. Compared with the traditional way of heating incubation, the experiment got a high rate of hatchability and child health. Energy saving effect is remarkable and achieve good social and economic benefits.

007 “Virtual ED”: utilisation of a discrete event simulation-based framework in identifying “real-time” strategies to improve Patient Experience Times in an Emergency Department

Objectives and BackgroundsEmergency Department (ED) overcrowding and associated excessive Patient Experience Times (PETs) have proven deleterious impacts on patient mortality, morbidity and overall length of hospital stay. Health systems constantly...

Virtual ED: Utilisation of a Discrete Event Simulation-Based Framework in Identifying "Real-Time’ Strategies to Improve Patient Experience Times in an Emergency Department

Objectives and Backgrounds Emergency Department (ED) overcrowding and associated excessive Patient Experience Times (PETs) have proven deleterious impacts on patient mortality, morbidity and overall length of hospital stay. Health systems constantly seek cost-effective organisational strategies to reduce ED crowding and improve patient outcomes, but complex change implementation is constrained by the necessity of maintaining concurrent safe patient-care. Computer modelling in a “virtual reality” has been successfully utilised in industries outside medicine, in providing innovative “real-time” solutions to outdated practices. Therefore a bespoke “Virtual ED” computer model, based on a Discrete Event Simulation (DES) -Based Framework was constructed to determine the best simulation scenarios needed for effective “real-time” strategies to improve PETs in a Dublin teaching hospital ED. The three simulation scenarios tested were: (1) Increasing medical staffing. (2) Increasing assessment space. (3) Enforcing the national 6-h boarding limit. Methods A collaborative interactive decision support model was constructed to analyse patient flow through the ED, considering the variability in patients9 arrival rate, the complexity levels of patients9 acuity, and the dynamic interactions between key resources (eg, clinical staffing, physical capacity, and spatial relationships). ED Process Mapping utilised IDEF0, for modelling complex systems in a hierarchical form and Extend Suite V.7 software was used to develop the DES—based framework model. Historical, anonymised ED patient data of 59 986 patient episodes (tracking times, indirect acuity and clinical resource utilisation) was analysed from the “real-time” ED Information System. Baseline ED Key Performance Indicators (KPIs), PETS and resource utilisation was determined for comparison with the DES model. Distinct study scenario variables (Abstract 007 table 1) were added to the DES model and run for 3 month continuous blocks to eliminate confounders. Continuous verification and validation of the ED simulation model was ensured by using Kolmogorov–Smirnov goodness of fit test with a 5% significance level. The ultimate results of the simulation model were validated using three techniques; face validation, comparison testing, and hypothesis testing, with the deviation between actual and simulated results ranging from 1% to 9% with an average of only 5% deviation. Results The “Virtual ED” model shows that adoption of the cost-neutral scenario 3 (Abstract 007 table 2) has the greatest impact on PETs at every stage, especially among patients who are ultimately discharged directly from ED care (48% improvement PETs). Scenario 3 reduces an over-reliance on overstretched nursing resources, while improving the utility of physicians. Furthermore while scenario 3 improves the PETs of boarders, the more expensive Scenarios 1 and 2 have negligible impact on ED boarding times. Conclusions The use of an interactive DES-based framework accurately determines the best simulation scenarios and identifies the most effective “real-time” strategies in improving PETs in an ED environment. While increasing medical staffing or trolley numbers might seem intuitively beneficial to overall PETs, our “Virtual ED” reveals that simply enforcing the national Key Performance Indicator 6-h boarding limit for EDs, would have a greater impact on reducing PETs for all ED patients than increasing medical staff or assessment cubicles. Before instigating potentially ineffectual and costly “real-time” strategies, the construction of novel simulation scenarios in a “Virtual ED” may allow implementation of more effective yet inexpensive bespoke alternatives.

Unplanned General Surgical Re-Admissions – How Many, Which Patients and Why?

The unplanned re-admission rate is a national key performance indicator employed by the UK Department of Health. An adjusted figure, based on admission information data on the hospital electronic Patient Administration System (PAS), but adjusted to take account of case mix is compared with a calculated 'expected'. While previous studies have investigated unplanned re-admission rates in age-, procedure- or process-specific conditions, 'all-cause' general surgical re-admission rate is yet to be studied. The aim of this study was to assess the accuracy of hospital unplanned re-admission data, and identify patterns or possible causes of unplanned general surgical re-admissions. Retrospective audit of case note records of all patients identified from the hospital electronic PAS as unplanned, general surgical re-admissions over a period of 4 consecutive months. Of all 161 re-admissions in this study, 46 (29%) were unrelated to the index admission, planned or involved patient self-discharge during the index admission. Of the 'genuine', unplanned re-admissions, 80 (78%) followed an emergency index admission, 58 (56%) had chronic or recurrent symptoms, for which 26 (25%) were on waiting lists. Fourteen (14%) were multiple admissions of 4 patients, while 8 (8%) re-admissions required further surgery for significant postoperative complications. Unplanned. general surgical re-admission rates collated from hospital PAS systems may be inaccurate. Nearly half of 'genuine', unplanned re-admissions involved patients with chronic and/or recurrent symptoms, which are predictable and may be preventable. Significant postoperative complications accounted for few re-admissions in this study.