Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study

Jackson, Timothy; Schramm, David; Moloo, Husein; Fairclough, Lee; Maeda, Azusa; Beath, Tricia; Nathens, Avery B.

doi:10.9778/cmajo.20170166

Cited by 8 publications

(8 citation statements)

References 21 publications

(10 reference statements)

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“…In addition to reducing LOS after CRS, these protocols have been demonstrated to reduce mortality, complications and other adverse patient outcomes [33][34][35]. Other system-level initiatives, such as ON-SQIN [36] (an event-monitoring and planning initiative) have been demonstrated…”

Section: Discussionmentioning

confidence: 99%

Surgeon factors but not hospital factors associated with length of stay after colorectal surgery – A population based study

Bayat,

Kennedy,

Victor

et al. 2023

Colorectal Disease

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AimLength of stay (LOS) after colorectal surgery (CRS) is a significant driver of healthcare utilization and adverse patient outcomes. To date, there is little high‐quality evidence in the literature examining how individual surgeon and hospital factors independently impact LOS. We aimed to identify and quantify the independent impact of surgeon and hospital factors on LOS after CRS.MethodsA retrospective population‐based cohort study was conducted using validated health administrative databases, encompassing all patients from the province of Ontario, Canada. All patients from 121 hospitals in Ontario who underwent elective CRS between 2008 and 2019 in Ontario were included, and factors pertaining to these patients and their treating surgeon and hospital were assessed. A negative binomial regression model was used to assess the independent effect of surgeon and hospital factors on LOS, accounting for a comprehensive collection of determinants of LOS. To minimize unmeasured confounding, the analysis was repeated in a subgroup comprising patients undergoing lower‐complexity CRS without postoperative complications.ResultsA total of 90,517 CRS patients were analysed. Independent of patient and procedural factors, low surgeon volume (lowest volume quartile) was associated with a 20% increase in LOS (95% CI: 12–29, p < 0.0001) compared to high surgeon volume (highest volume quartile). In the 22,639 patients undergoing uncomplicated lower‐complexity surgeries, a 43% longer LOS was seen in the lowest volume surgeon quartile (95% CI: 26–61, p < 0.0001). In both models, more years‐in‐practice was associated with a small increase in LOS (RR 1.02, 95% CI: 1.02–1.03, p < 0.0001). Hospital factors were not significantly associated with increased LOS.ConclusionsSurgeon factors, including low surgeon volume and increasing years‐in‐practice, were strongly and independently associated with longer LOS, whereas hospital factors did not have an independent impact. This suggests that LOS is driven primarily by surgeon‐mediated care processes and may provide actionable targets for provider‐level interventions to reduce LOS after CRS.

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Section: Discussionmentioning

confidence: 99%

Surgeon factors but not hospital factors associated with length of stay after colorectal surgery – A population based study

Bayat,

Kennedy,

Victor

et al. 2023

Colorectal Disease

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“…The Michigan collaborative demonstrated that compared to participation in the ACS TQIP, which provides benchmarking reports specific to Trauma centers, participation in both ACS TQIP and the Michigan collaborative resulted in better outcome in terms of mortality and hospice admissions (19). Similarly, in Ontario, we previously demonstrated that the community of practice established as a result of the regional collaborative successfully provided hospitals with access to resources to enhance their quality-improvement capacity and initiatives, resulting in significant reduction in postoperative complications including UTI (11). Some of the participating hospitals in Ontario also demonstrated that programs aimed at reducing postoperative infections had positive impact on other outcomes such as the lengths of hospital stay and healthcare costs (20,21).…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 95%

“…In Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN) was established by Health Quality Ontario (now part of Ontario Health) in 2015 as a regional collaborative of ACS NSQIP to promote perioperative quality improvement through a community of practice. In our initial assessment, we demonstrated that the capacity for quality improvement increased across member hospitals and that the rates of SSI and UTI decreased in a subset of hospitals that specifically targeted these complications (11). To further promote change, a provincial campaign was launched in 2017 by ON-SQIN with a goal to reduce the incidence of postoperative infections.…”

Section: Introductionmentioning

confidence: 99%

Committed to Better Outcomes: Reducing Infection after Surgery Across the Ontario Surgical Quality Improvement Network

Jackson¹,

Beath²,

Ahmad³

et al. 2021

Journal of the American College of Surgeons

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…132 Other national and regional quality improvement programs have been instituted. 19,20,138,139 Given the scope of this review, individual programs will not be discussed in detail. At the institutional level, however, execution of the quality improvement program usually faces barriers to implementation.…”

Section: Quality Improvement Initiativementioning

confidence: 99%

Quality and Safety Improvement in Spine Surgery

Jiang

Wilson

Badhiwala

et al. 2020

Global Spine Journal

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Study Design: Review article. Objectives: A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. Methods: A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. Results: Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. Conclusion: Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.

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Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study

Cited by 8 publications

References 21 publications

Surgeon factors but not hospital factors associated with length of stay after colorectal surgery – A population based study

Surgeon factors but not hospital factors associated with length of stay after colorectal surgery – A population based study

Committed to Better Outcomes: Reducing Infection after Surgery Across the Ontario Surgical Quality Improvement Network

Quality and Safety Improvement in Spine Surgery

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