Variable life adjusted display (VLAD):

Variable life adjusted display (VLAD) has been widely used in multiple disciplines within the healthcare setting for clinical outcomes trend presentation, including cardiac surgery.

The ability to pick up downward trends in performance at an early stage in trauma care suggested the VLAD system might be an answer to an early warning system specifically to surgical outcome quality.


Risk adjustment model in emergency general surgical operations is difficult to derive due to a wide variety of diseases, procedures and patient risk profile.
In our study we described the use of administrative data as risk-adjustment model in the VLAD charts to monitor outcome of emergency general surgical operations in the Prince of Wales Hospital.

Target Teams : General Teams
- Team 1 : Hepatobillary & Pancreatic Surgery
- Team 2 : Upper Gastro-intestinal Surgery
- Team 3 : Colorectal Surgery
- Team 4 : Vascular Surgery
Case Type : Emergency
Period : Beyond July 2013


We retrieved all emergency operation data from the SOMIP database for PWH from 1 July 2012 to 30 June 2013.
Hospital administrative data were then retrieved of the corresponding cases:
- diagnosis and procedure codes
- the 3M International Refined Diagnostic Related Group of risk of mortality (ROM) and severity level (SOI)
- Blood test results
Risk-adjustment model constructed by logistic regression.
Upper and lower CUSUM limit corresponding to halve and twice the odds of mortality was set as the boundary of accepted performance.
For VLAD curve fell below this limit, it served as an "alarm" for action.

Emergency Operations

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