Clinical Outcome Indicators

Patient Safety Indicators Clinical Outcome Indicators Patient Experience Indicators Improvement Plans

We are dedicated to delivering care that not only meets but exceeds the standards of clinical excellence. To evaluate the effectiveness and impact of our treatments in improving patients’ health, we closely monitor a range of Clinical Outcome Indicators.

These indicators measure the success and quality of clinical practices and medical interventions across various departments within our hospital. Through analysing these outcomes, our clinical teams gain valuable insights that guide the implementation of best practices, refinement of treatment protocols, and continuous enhancement of patient care quality, all with the ultimate goal to achieve better patient outcomes.

Clinical Outcomes

Our survival rate for patients who underwent a kidney transplant after 6 months and 12 months is 100%, higher than global predicted survival rate of 92% - 97%.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Survival rate renal transplant ≥ 6 months	≥ 91% ¹	100%	100%	100%
Survival rate renal transplant ≥ 12 months	≥ 92% ²	100%	100%	100%
Graft rejection below 12 months	≤ 11% ¹	0%	0%	0%

Indication:

Better than benchmark

Less than benchmark

*Reference:

National Library of Medicine (https://www.ncbi.nlm.nih.gov/)
Nephrology Dialysis Transplantation (https://academic.oup.com/ndt)

Our services not only assure the patient's safety during surgery but also prioritise care throughout the hospital stay and therapy following surgery.

Total Knee Replacement

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Percentage of patients receiving anti embolic therapies within post op day 1	> 90% ¹	Not Monitored	95%	99.6%
Average length of stay for post-primary total knee replacement patients	< 5% ³	3.7	3.9	3.0
Percentage of patients with surgical site infection	< 1% ²	0%	0%	0%

Indication:

Better than benchmark

Less than benchmark

*Reference:

National Library of Medicine (https://www.ncbi.nlm.nih.gov/)
Bryon Jun et al., Journal of Orthopaedic Surgery: Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery, July 2018
Technical Specifications For Key Performance Indicators (KPI) Clinical Services Medical Programme 2021, Ministry of Health

Orthogeriatric Hip fracture (Fracture liaison program)

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2024
Geriatric Hip fracture surgery done within 48 hours of admission	> 75%	95.2%

Indication:

Better than benchmark

Less than benchmark

Our one-stop cancer centre has been established since 2016. We strive to do everything possible to ensure that our patients receive high-quality cancer diagnosis, treatment, and care.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
30 days mortality rate for stem cell transplant patients	< 14% ¹	Not Monitored	Not monitored	0%

Indication:

Better than benchmark

Less than benchmark

*Reference:

(https://ashpublications.org/blood/article/144/Supplement%201/3482/529526/The-Ability-of-Currently-Used-Scoring-Systems-to)

12 Months Local Control Rate for Breast Cancer Brain Metastasis Treated with Gamma Knife

Clinical Outcome Indicator	12 Months Local Control Rate (University of Pittsburgh)	12 Months Local Control Rate (Sunway Cancer Centre)
Breast cancer brain metastasis treated with Gamma Knife	71%	96%

*Reference:

University of Pittsburgh: Numbers (350 patients) are based on patients between 1990 and 2009
SCC: Numbers (34 out of 56 patients) are based on patient with brain metastatic Breast Cancer treated from 2017-2024

12 Months Local Control Rate for Brain Metastasis with All Primary Cancers Treated with Gamma Knife

Clinical Outcome Indicator	12 Months Local Control Rate (JLGK0901)	12 Months Local Control Rate (Sunway Cancer Centre)
Brain metastasis with all primary cancers treated with Gamma Knife	87%	90%

*Reference:

JLGK0901: Numbers (1194 patients) are based on patients between 2009 and 2012 (based on the local recurrence rate reported)
SCC: Numbers (115 out of 194 patients) are based on patient with brain metastatic treated from 2017-2024

Our maternity ward strives to ensure that expectant mothers have a safe delivery at Sunway Medical Centre. Hence, we monitor key performance indicators (KPIs) in the maternity ward to ensure that all patients receive high-quality care.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Maternal mortality rate	0% ¹	0%	0%	0%
Incidence of 3rd and 4th degree perineal tear following vaginal delivery	≤ 3.04% ²	0%	0%	0%

Indication:

Better than benchmark

Less than benchmark

*Reference:

National Library of Medicine (https://www.ncbi.nlm.nih.gov/)
Australian Council Healthcare Standard (ACHS); Australasian Clinical Indicator Report, 2015 -2022 (24th Edition)

Our eye center is a leading facility committed to providing exceptional eye care and vision services to our patients. The outcomes of treatment are of paramount importance to us, as they ensure that our patients receive the highest quality and most effective care.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Visual recovery with uncorrected visual acuity of 6/9 or better on post-laser vision correction Day 1 visit	≥ 90% ¹	85%	93%	94%
Visual outcome better or same after 6 months of corneal transplantation	≥ 75% ²	100%	91%	86%

Cataract Surgery

Measures	*Benchmarking Published data	Achievement
Measures	*Benchmarking Published data	2025
Percentage of patients without pre-existing ocular co-morbidity obtain visual acuity of 6/12 or better following cataract surgery (Within 3 months)	94.70% ³	97%
Percentage of patients developed infectious endophthalmitis following cataract surgery (within 3 months)	0.04% ³	0.00%
Percentage of patients had intra-op complications - PCR rate	1.60% ³	0.63%

Indication:

Better than benchmark

Less than benchmark

*Reference:

Journal of Cataract and Refraction Surgery, Volume 29, Issue 7, July 2003
Malaysia Transplant Registry 2015
The 12th Report of the National Eye Database 2018

These measures are benchmarked with various Australia hospitals registered under the Australia Council Healthcare Standard (ACHS) and exceed the average aggregated scores of these institutions.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Oesophagus perforation secondary to oesophagus dilatation procedure	≤ 0.32% ¹	0%	0%	0%

Indication:

Better than benchmark

Less than benchmark

*Reference:

Australian Council Healthcare Standard (ACHS); Australasian Clinical Indicator Report, 2015-2022 (24th Edition).

Our cardiologists are committed to providing patient care grounded in best practices. To evaluate our performance and outcomes, we are actively monitoring a range of metrics. These metrics help us determine our effectiveness in delivering optimal results and maintaining high standards of care.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Percutaneous coronary intervention (PCI) door to balloon time within 90 minutes	≥ 73.91%¹	83%	87%	82%
Major complication rate during diagnostic coronary angiogram	< 1% ²	0%	0%	0%
Major complication rate during percutaneous coronary intervention (PCI)	< 1% ²	0.3%	0%	0.8%

Indication:

Better than benchmark

Less than benchmark

*Reference:

Australian Council Healthcare Standard (ACHS); Australasian Clinical Indicator Report,2015-2022 (24th Edition).
Malaysian Society for Quality and Health (MSQH) : Performance Indicator, 6th Edition, 2022

Sunway Medical Centre is committed to the well-being and recovery of our stroke patients. Our dedicated team closely monitors progress using key performance metrics to ensure that every patient receives the best possible support, leading to positive outcomes and an improved quality of life.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Stroke patients restored to their capabilities for activities of daily living (ADL) / working after ADL intervention	> 75% ¹	85%	96%	92%

Indication:

Better than benchmark

Less than benchmark

*Reference:

Malaysian Society for Quality and Health (MSQH) : Performance Indicator, 6th Edition, 2022

Patient - Reported Outcome Measurements (PROMs)

Orthopaedic
Neurology

A Patient-Reported Outcome Measurements survey is a special tool used within healthcare; its purpose is to capture patients' views concerning own health status, quality of life, and the results of medical treatments. These questionnaires focus on the outcomes of symptoms, function, or general well-being after receiving certain care or having a particular intervention.

The Hip Disability and Osteoarthritis Outcome Score (HOOS) assesses hip pain, mobility, and daily functional ability from the patient’s perspective, both before and after surgery. These scores allow us to evaluate treatment effectiveness and monitor improvements in hip function and overall well-being.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is used to measure patients’ perspectives of their knee before and after surgery. It provides valuable insights into knee pain, function, and quality of life, enabling us to evaluate surgical outcomes and monitor each patient’s recovery progress.

Patient-Reported Outcome Measures (PROMs) are questionnaires that capture patients’ perspectives on their health, symptoms, and overall well-being. They offer insights into how a condition or its treatment affects daily life — information that clinical tests alone may not reveal.

The QOLIE-10P is a type of PROM specifically designed to assess health-related quality of life in patients with epilepsy. It evaluates how bothersome the condition is and asks patients to prioritise the areas of life most affected by it. Key aspects assessed include medication effects, mental and emotional function, daily activities, energy, worries about seizures, and overall quality of life.

Clinicians use this during routine follow-ups to track whether a patient’s quality of life is improving, stable, or declining.

Patients showed significant gains in energy, emotional stability, and memory, and felt more confident their seizures would not recur. Some patients experienced a decrease in work concentration, while others reported adverse medication-related effects. However, overall, the treatment provided at Sunway Medical Centre, Sunway City had a positive impact on both their physical and psychological health.

Prevention and Control of Infection

Patient safety and high-quality care have always been our priority. In Sunway Medical Centre, an infection control team collects data on Hospital Acquired Infection (HAI) to ensure we can control the spread of infection by adhering to stringent infection control practices.

What is Hospital Acquired Infection?
Hospital Acquired Infection is an infection that you may get during your hospitalisation.

In Sunway Medical Centre, our HAI rate is lower than the universal rate. We are benchmarking our data with the Ministry of Health.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Hospital Acquired Infection (HAI) rate	< 5% ¹	0.06%	0.07%	0.04%

Breakdown of HAI
Data below are the subset of Hospital Acquired Infection. The lower rate implies our dedicated team deliver care and treatment based on the best practices. Our target is benchmarked with the national accreditation body.

Measures	*Benchmarking Published data	Achievement
Measures	*Benchmarking Published data	2022	2023	2024
Ventilator-associated pneumonia (VAP)	< 10 per 1000 ventilator days ¹	3.36	4.12	0.56
Catheter blood stream iInfection (CRBSI)	< 5 per 1,000 line-days ¹	0.6	0.81	0.12
Surgical site infection (clean elective surgeries)	< 2% ¹	0.6%	0.1%	0.06%
Catheter-associated urinary tract infection (CAUTI)	< 0.5 per 1,000 catheter days ¹	0.28	0.81	0.08

Indication:

Better than benchmark

Less than benchmark

*Reference:

Malaysian Society for Quality and Health (MSQH) : Performance Indicator, 6th Edition, 2022

Emergency Services

Sunway Medical Centre, Sunway City is committed to addressing patients' needs during emergencies. We currently provide two specialised emergency services: adult and paediatric care, designed to cater to the diverse needs of our patients and ensure our patients receive timely and effective treatment.

To uphold the highest standards of care, we continuously monitor various metrics and benchmark our service performance with various hospitals via the Australian Council Healthcare Standard system.

Clinical Outcome Indicator	*Benchmarking Published Data	Achievement
Clinical Outcome Indicator	*Benchmarking Published Data	2022	2023	2024
Red Zone patients seen by Medical Officer immediately within 5 minutes after triaged	97.9% ¹	99%	100%	100%
Yellow Zone patients seen by Medical Officer within 15 minutes after triaged	71.8% ¹	89%	95%	94%
Green Zone patients seen by Medical Officer within 30 minutes after triaged	65.8% ¹	87%	93%	93%
Ambulance calls response time within 5 minutes	100% ²	100%	100%	100%

Indication:

Better than benchmark

Less than benchmark

*Reference:

Australian Council Healthcare Standard (ACHS); Australasian Clinical Indicator Report,2015 – 2022 (24th Edition)
Nuffieldtrust : Ambulance response times, 2024