Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details

Abstract

Background Variable approaches to intraoperative communication impede our understanding of surgical decision-making and best practices. This is critical among hernia repairs, where improved outcomes are reliant on understanding the impact of different patient characteristics and surgical approaches. In this context, a hernia-specific synoptic operative note was piloted as part of an effort to create a statewide hernia registry. We aimed to understand the impact of the synoptic operative note on variable missingness and evaluate barriers and facilitators to improved intraoperative communication and note adoption. Methods In January 2020, the Michigan Surgical Quality Collaborative (MSQC) registry was expanded to capture herniaspecific intraoperative variables. A synoptic operative note for hernia repair was piloted at 8 hospitals. The primary outcome was change in hernia variable communication, measured by missingness. Using a sequential explanatory mixed-methods design, we performed semi-structured interviews with data abstractors (n = 4) and surgeons (n = 4) at 5 pilot sites to assess barriers and facilitators of implementation. Interviews were iteratively analyzed using content analysis with both deductive and inductive approaches. Results From January to June 2020, 870 hernia repairs were performed across 8 pilot and 53 control sites. Pilot sites had significantly less missingness for all hernia-specific variables. At pilot sites, 46% of notes were fully complete in regard to hernia variables, compared to 21% at control sites (p value < 0.001). While collection of intraoperative variables improved after synoptic note implementation, low note adoption was reported. Facilitators of improved variable collection were (1) communication with data abstractors and (2) stakeholder acknowledgment of widespread benefit, while barriers included (1) surgeon resistance to practice change, (2) EMR/technology, and (3) interruptions to communication and implementation. Conclusion This mixed-methods evaluation of a synoptic operative note implementation suggests that sustained communication, particularly with abstractors, was the most impactful intervention. Future implementation efforts may have improved effectiveness with interventions supplementary to surgeon-level direction.

Adequate Reporting Among Ventral Hernia Repair Operative Reports: A Cross-Sectional Study of Prevalence of Details and Association With Clinical Outcomes

“… 11 Synoptic reports have been shown to be superior to narrative reports in terms of documenting quality measures and increasing operative note completeness. 11 – 13 …”

“… 14 Previous work has shown that many hernia operative reports are poorly detailed, however, the relationship between the quality of an operative note and the patient outcomes is unknown. 13 …”

Enhancing Operative Documentation of Emergency Laparotomy: A Systematic Review and Development of a Synoptic Reporting Template

“…They are, however, time consuming and may take longer than a hand-written or dictated report to complete (14). The increase workload and the need for change has resulted in some resistance to their broader adoption (15).…”

Enhancing operative documentation of emergency laparotomy: a systematic review and development of a synoptic reporting template

“…However, they are time-consuming and may take longer to complete than a handwritten or dictated report [ 14 ]. The increased workload and need for change have resulted in resistance to broader adoption [ 15 ].…”