Mutual reporting of process and outcomes enhances quality outcomes for colon and rectal resections

Galandiuk, Susan; Rao, Mohan; Heine, Michael F.; Scherm, Michael J.; Polk, Hiram C.

doi:10.1016/j.surg.2004.06.021

Cited by 21 publications

(21 citation statements)

References 22 publications

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“…The final post-intervention rates of timely antibiotic prophylaxis (87.6% vs clearly-not-on-time ; 76.5% vs clearly-problematic ; 72.9% vs potentially-problematic ) in this study was comparable to these figures. We did not reach the final rates of timely administration attained by some interventional studies, with final rates of between 94% and 99% compliance to antibiotic prophylaxis timing guidelines 7 11 35 38 44. This might be explained by the fact that the research protocol used in this study did not include a ‘policing’ or monitoring function intended to directly improve antibiotic timing as those other interventional studies did through computerised recording, implementing new antibiotic documentation practices or team pressure.…”

Section: Discussionmentioning

confidence: 75%

“…These baseline rates indicated considerable room for improvement in antibiotic administration practices prior to team briefing implementation. Other interventional studies report final rates of timely administration ranging between 60.6% and 99% 7 11 30 31 34 35 40 43–45. The final post-intervention rates of timely antibiotic prophylaxis (87.6% vs clearly-not-on-time ; 76.5% vs clearly-problematic ; 72.9% vs potentially-problematic ) in this study was comparable to these figures.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice

Lingard

Regehr

Cartmill

et al. 2011

BMJ Quality & Safety

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BACKGROUND Suboptimal communication within healthcare teams can lead to adverse patient outcomes. Team briefings were previously associated with improved communication patterns, and we assessed the impact of briefings on clinical practice. To quantify the impact of the preoperative team briefing on direct patient care, we studied the timing of preoperative antibiotic administration as compared to accepted treatment guidelines. STUDY DESIGN A retrospective pre-intervention/post-intervention study design assessed the impact of a checklist-guided preoperative team briefing on prophylactic antibiotic administration timing in surgical cases (N=340 pre-intervention and N=340 post-intervention) across three institutions. χ(2) Analyses were performed to determine whether there was a significant difference in timely antibiotic administration between the study phases. RESULTS The process of collecting and analysing these data proved to be more complicated than expected due to great variability in documentation practices, both between study sites and between individual practitioners. In cases where the timing of antibiotics administration was documented unambiguously in the chart (n=259 pre-intervention and n=283 post-intervention), antibiotic prophylaxis was on time for 77.6% of cases in the pre-intervention phase of the study, and for 87.6% of cases in the post-intervention phase (p<0.01). CONCLUSIONS Use of a preoperative team checklist briefing was associated with improved physician compliance with antibiotic administration guidelines. Based on the results, recommendations to enhance timely antibiotic therapy are provided.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice

Lingard

Regehr

Cartmill

et al. 2011

BMJ Quality & Safety

View full text Add to dashboard Cite

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“…However, most colon resections for both benign and malignant disease in the United States are performed in non-THs by general surgeons rather than board-certified colorectal surgeons. 8 This research suggests that patients undergoing oncology resections in THs may benefit from the availability and use of certain resources but that these resources may be of greater utility for higher-mortality resections than for less complex ones. Research conducted by Schrag et al 9 reaffirmed this notion.…”

Section: Commentmentioning

confidence: 99%

“…8 There is some evidence within the literature to support improved outcomes in teaching hospitals for patients undergoing resections for colon and rectal cancer on the basis of the volume-outcome ratio. 9–11 Few reports, however, describe the inclusion of benign colonic disease in these considerations.…”

mentioning

confidence: 99%

“…Less specialized procedures for benign disease make up the bulk of surgical volume and colon resections performed in non-THs and the United States as a whole. 8,12 Khuri et al, 13 in an analysis of the Veterans Affairs National Surgical Quality Improvement Program data showed that, following volume adjustment, care at non-THs was associated with lower charges and decreased length of stay (LOS) compared with THs. This may also be true for colon resections performed in non-THs.…”

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confidence: 99%

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Teaching Hospital Status and Operative Mortality in the United States

et al. 2010

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Objective To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect. Design Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level. Setting A total of 1045 hospitals located in 38 states in the United States that were included in the NIS. Patients All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS. Main Outcome Measures Operative mortality, length of stay (LOS), and total charges. Results A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P=.03), increased LOS (P=.003), and a nonsignificant trend toward an increase in total charges (P=.36). Conclusions With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.

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Perioperative Care

2008

Surgery of the Anus, Rectum &Amp; Colon

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Mutual reporting of process and outcomes enhances quality outcomes for colon and rectal resections

Cited by 21 publications

References 22 publications

Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice

Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice

Teaching Hospital Status and Operative Mortality in the United States

Perioperative Care

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