Measurement of process as quality control in the management of acute surgical emergencies

Stevenson, Karen; Gibson, Simon C.; MacDonald, David B.; Hole, David; Rogers, Paul N.; Byrne, Dominique; Kingsmore, David

doi:10.1002/bjs.5620

Cited by 23 publications

(16 citation statements)

References 16 publications

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“…17 These surrogates, although not accurately reflecting health care outcomes for individual patients, are nonetheless powerful indicators of certain dimensions of care averaged over many patients with similar conditions or similar treatments within specific-care settings. Analysis of such secondary databases is often accurate and relatively straightforward.…”

Section: Discussionmentioning

confidence: 99%

Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures

Theodosopoulos¹,

Ringer²,

McPherson³

et al. 2012

JNS

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Object Health care reform debate includes discussions regarding outcomes of surgical interventions. Yet quality of medical care, when judged as a health outcome, is difficult to define because of impediments affecting accuracy in data collection, analysis, and reporting. In this prospective study, the authors report the outcomes for neurosurgical treatment based on point-of-care interactions recorded in the electronic medical record (EMR). Methods The authors' neurosurgery practice collected outcome data for 19 physicians and ancillary personnel using the EMR. Data were analyzed for 5361 consecutive surgical cases, either elective or emergency procedures, performed during 2009 at multiple hospitals, offices, and an ambulatory spine surgery center. Main outcomes included complications, length of stay (LOS), and discharge disposition for all patients and for certain frequently performed procedures. Physicians, nurses, and other medical staff used validated scales to record the hospital LOS, complications, disposition at discharge, and return to work. Results Of the 5361 surgical procedures performed, two-thirds were spinal procedures and one-third were cranial procedures. Organization-wide compliance with reporting rates of major complications improved throughout the year, from 80.7% in the first quarter to 90.3% in the fourth quarter. Auditing showed that rates of unreported complications decreased from 11% in the first quarter to 4% in the fourth quarter. Complication data were available for 4593 procedures (85.7%); of these, no complications were reported in 4367 (95.1%). Discharge dispositions reported were home in 86.2%, rehabilitation center in 8.9%, and nursing home in 2.5%. Major complications included culture-proven infection in 0.61%, CSF leak in 0.89%, reoperation within the same hospitalization in 0.38%, and new neurological deficits in 0.77%. For the commonly performed procedures, the median hospital LOS was 3 days for craniotomy for aneurysm or intraaxial tumor and less than 1 day for angiogram, anterior cervical discectomy with fusion, or lumbar discectomy. Conclusions With prospectively collected outcome data for more than 5000 surgeries, the authors achieved their primary end point of institution-wide compliance and data accuracy. Components of this process included staged implementation with physician pilot studies and oversight, nurse participation, point-of-service data capture, EMR form modification, data auditing, and confidential surgeon reports.

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Section: Discussionmentioning

confidence: 99%

Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures

Theodosopoulos¹,

Ringer²,

McPherson³

et al. 2012

JNS

View full text Add to dashboard Cite

show abstract

“…It would require a much larger study to comment on whether survival rates are affected by a care pathway but our study certainly suggests that a care pathway ‘focuses the mind’ of those caring for patients with acute pancreatitis and raises the standard of care that patients receive. Improvements in process of care are reflected in quality of care 8. In conclusion, our care pathway in acute pancreatitis has helped in stratifying decision making and raised quality of care.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been shown in unselected general surgical emergency patients that measurement of process of care could be used as an accurate surrogate for quality of care 8. Furthermore, that increasing awareness of correct process of care increased quality of care and decreased errors in management 8…”

Section: Introductionmentioning

confidence: 99%

Impact of a care pathway in acute pancreatitis

McCallum

Hicks²,

Seymour³

2011

Postgraduate Medical Journal

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Background Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with acute pancreatitis at our institution but aspects of care that could be improved. Methods For this re-audit, a simple written care pathway for the management of those presenting with acute pancreatitis was introduced in our institution from February to July 2009. The audit standards were set against the British Society of Gastroenterology (BSG) guidelines for management of acute pancreatitis and were compared with the previous region wide audit. Results Marked improvements were noted in the rates of abdominal imaging achieved within 24 h of diagnosis (35.2% vs 47.7%), severity stratification within 48 h of diagnosis (28.7% vs 75%), critical care admission for those classified as severe (39.3% vs 63.6%) and definitive treatment during index admission (22.2% vs 38.5%). Survival rates were 100% for this audit cycle and 95% for all patients within the region wide audit. Despite these improvements, care still does not reach the standards set out by BSG. Conclusion Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis.

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“…11,12 Issuing role descriptions that highlight what is expected of personnel has been shown to result in a significant improvement of care for patients undergoing emergency surgery. 13 Lean interventions and plan-do-study-act cycles have also been used to improve care for patients undergoing emergency surgery 14 but have not been tested for emergency admissions. 15 Emergency laparotomy has a high risk of mortality that is based on variability in patient factors and the quality of care at institutions.…”

Section: Discussionmentioning

confidence: 99%

Emergency Error

2015

AORN Journal

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Measurement of process as quality control in the management of acute surgical emergencies

Abstract: Process can be measured objectively and used as a measure of quality of care. Interventions to increase awareness reduced process error rates and adverse events.

Cited by 23 publications

References 16 publications

Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures

Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures

Impact of a care pathway in acute pancreatitis

Emergency Error

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