Old COTDS software

1. Old COTDS software • Installed on individual computers. • Need to have Microsoft Access installed (version specific) • Not very useful in a networked environment • Updates – individual computers • Data – on different computers and have to be integrated before analysis can be made

2. Old COTDS software • Same user name and password for all users • Single user has to enter patient’s data as well as operation data. • Prone for frequent crashes. • Database – limited to 10,000 records and becomes slow. • Surgeon and Anaesthetist have to enter data at same sitting.

3. New COTDS software • Web based • No need to install on individual computers • Updates at central server. Transparent to user. • Need internet connection. • Every user is logged. • Audit trail to check on deletions

4. New COTDS software • Report in excel format automatically generated at end of month. • Nurse enters patient’s details. • Doctors enter op data only. • Surgeon and Anaesthetist can enter data at different times.

8. 1.0 General Information 2.0 Patient Demographics 2.1 Gender 2.2 Race 2.3 Age 3.0 Patient Movement 3.1 Arrival From 3.2 Ward Breakdown 3.3 Discharged To 4.0 Hospital Statistics 4.1 Paying Status 4.2 Class 5.0 Operation Status 6.0 Surgical Data 6.1 Discipline 6.2 Operation Status & Discipline 6.3 Operation Status & Fee Type 6.4 Duration of Surgery 7.0 Anaesthetic Data 7.1 Anaesthetic Technique 7.2 Duration of Anaesthesia 7.3 ASA Status 7.4 Location of Pre-op Assessment 7.5 Intra-Op Complications 7.6 Recovery Room Complications Data Analysis for Hospital Seremban1 July 2004 – 15 June 2005

9. 8.0 Procedure Coding System 8.1 Organ Top 20 8.2 Organ & Procedure Top 20 8.3 Organ & Pathology Top 20 9.0 Personnel 9.1 System Users 9.2 Surgeons & their Disciplines 9.3 Roles in Surgery 9.4 Surgeons’ Roles in Surgery 9.5 Anaesthetists’ Roles in Surgery 9.6 Nurses’ Roles in Surgery Data Analysis for Hospital Seremban1 July 2004 – 15 June 2005

10. Between the period of 1 July 2004 to 15 June 2005, A total of 8875 patients were registered for surgery, and a total of 8252 procedures* were performed at Hospital Seremban. • Mean number of patients registered per month: 772 • Mean number of procedures per month: 718 *Note – This discrepancy is due to surgeries not performed on registered patients on the day of scheduled surgery

11. Gender 5419 Female patients (60.11%) 3453 male patients (38.91%) 3 patients of unknown gender Patient Demographics (Gender)

12. Patient Demographics (Race) Race • Malay (4955 or 55.83% of all patients) • Indian (2152 or 24.25%) • Chinese (1535 or 17.29%)

13. Patient Demographics (Age) • 26-30yrs age group is the commonest (767 cases or 8.64% of all patients) • 2nd, 31-35yrs with 674 cases (7.59%) • 3rd, 21-25yrs with 651 cases (7.34%) • Youngest patients: less than 2 months old (27 cases or 0.30%) • Oldest patient: 96-100yrs (3 cases) • Birth date was not entered in 2609 cases (29.39%)

15. Operation Status 3847 (49.18%) Elective Cases 3976 (50.82%) Emergency Cases

16. General Surgery performed 1962 surgeries (25.08%) Orthopaedics 1566 (20.02%) Gynaecology 1385 (17.70%) Surgical Data (Discipline)

17. Surgical Data (Operation Status & Discipline) • Out of a total of 7823 surgeries, Department of General Surgery conducted the highest number of surgeries, amounting to 1962, which is 25.08% • Dept of General Surgery also conducted the most number of emergency surgeries, amounting to 1172, which is 29.48% of all emergency surgeries (3976) • Dept of Orthopaedics conducted the highest number of elective surgeries, amounting to 835, which is 21.71% of all elective surgeries (3847)

18. Anaesthetic Data (Anaesthesia Technique)

19. Most surgeries were performed under Spinal Anaesthesia (1369, or 15.43%) • General Anaesthesia with IPPV constituted 1311 or 14.77% • General Anaesthesia with Spontaneous Respiration constituted 569 or 6.4% • Local Anesthesia constituted 8 or 0.01% • The following anaesthetic techniques were not performed: • Intravenous Regional Anaesthesia (Bier’s Block) • 5479 were unspecified

20. Procedure Coding System • The COTDS 2004 captures procedure data via a 3-tiered procedure coding system inherited by the previous system • The 3 tiers are: • Organ • Pathology • Procedure • There is a one-to-many hierarchical relationship between each tier to increase user-friendliness in procedure selection • This format also enables the COTDS 2004 to drill up and down the 3 tiers

21. Procedure Coding System • Lower Segment Caesarean Section (LSCS) was the commonest procedure, with 1389 cases (16.83%) • This was followed by Cataract extraction with Intra-Ocular Lens (IOL) Implant, with 419 (5.08%) • 3rd highest was Appendicectomies, with 415 or 5.03% • Total Caesarean Sections (inclusive of LSCS, LSCS + Bilateral Tubal Ligation, and Classical Caesarean Sections) totals 1602, which is 19.41% of all surgeries performed, and forms 72.19% of all surgeries performed on the pregnant uterus

22. Personnel (System Users) • Each user of COTDS 2004 needs to be registered in the system and the system assigns access rights based on their job functions • There were a total of 227 registered users in the COTDS system during the study period • 28 of them were anaesthetists • 6 nurses (3 anaesthesia nurses, and 3 unspecified) • 193 Surgeons

23. 63 Surgeons from General Surgery (32.64% of all surgeons) 55 from Orthopaedics & Traumatology 46 from Gynaecology Personnel (Surgeons & their disciplines)

24. Personnel (Roles in Surgery) • COTDS 2004 tracks surgical teams involved in each surgery, these teams are separated into Surgeon, Anaesthetist, and Nurse • These personnel are further subdivided into roles during surgery • Roles for Surgeons: • Supervisor • Surgeon • 1st, 2nd, & 3rd Assistant • Roles for Anaesthetists: • Supervisor & Relief Supervisor • 1st & 2nd anaesthetist • Anaesthetic Assistant • Relief Anaesthetist

25. Personnel (Roles in Surgery) • Roles for Nurses: • 1st Scrub Nurse • 2nd Scrub Nurse • Circulating Nurse • Relief Circulating Nurse • Relief Scrub Nurse