Tale of Two Centres-Exploring Bedside Challenges to Implementing a Clinical Quality Registry for Abdominal Wall...

In an effort to improve hernia care and mesh product surveillance, the Australia and New Zealand Hernia Society (ANZ Hernia) has been setting up a prototype binational learning healthcare system virtual clinical quality registry (CQR) for clinical use. The aim of this study was to assess the feasibility for clinicians to enrol patients for a prototype hernia CQR in a typical clinical environment across two metropolitan centres in Australia.

All English-speaking adult patients with capacity to consent and who were being managed for abdominal wall hernias by participating clinicians at the Queen Elizabeth Hospital (Adelaide) or at St Vincent's Private Hospital (Sydney) during specified periods were eligible for inclusion. Participating clinicians were recruited and encouraged to provide feedback. The total number of eligible patients for each recruitment period was determined from clinical records. The literature was reviewed to summarise existing hernia registries.

Over a continuous 6-month recruitment period, the conditional recruitment rate of eligible patients encountered by participating clinicians was 34.7% (25 of 74) at TQEH (07/08/2024-02/02/2025) and 48.7% (58 of 119) at SVPHS (15/08/2025-10/02/2025). In the absence of incentives and sustained funding, clinician goodwill alone was insufficient to achieve the minimal standards required by the Australian Commission on Safety and Quality in Health Care for CQRs. An in-depth analysis of the CQR was conducted.

The prototype ANZ Hernia CQR would benefit from a redesign to address the structural issues identified, if meaningful system-wide quality improvement is to be delivered across Australia and New Zealand as envisioned.