Process mapping as a framework for performance improvement in emergency general surgery

DeGirolamo, Kristin; D’Souza, Karan; Hall, William M.; Joos, Émilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick D.; Hameed, Morad

doi:10.1503/cjs.004417

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…In North America and the UK, process mapping has been used to identify sources of variation in management and areas of inefficiency in surgical care [26][27][28]. DiGirolamo et al [29] studied the management of small bowel obstruction and used process mapping to identify patient flow in the emergency department and operating room capacity as key sources of inefficiency. Likewise, McLaughlin et al [30] used process mapping in their institutional redesign of neurosurgical care to identify opportunities for care standardization.…”

Section: Discussionmentioning

confidence: 99%

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana

Smiley

Ofori²,

Spangler

et al. 2018

World j. surg.

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Background The Volta River Authority Hospital (VRAH) is a district hospital associated with a large public works project in Akosombo, Ghana, that has developed a reputation for high-quality care. We hypothesized that this stems from a culture of safety and standardized processes typical of high-risk engineering environments. To investigate this, we evaluated staff and patient perceptions of safety and quality, as well as perioperative process variability. Materials and methodsThe Safety Attitudes Questionnaire (SAQ) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety. Perioperative general surgery and obstetrical procedure observations generated process maps, which were analyzed for variability and waste. Results Thirty-one SAQs were administered. 83% of workers held a positive perception of teamwork, and 77.4% held a positive perception of safety culture. Fifteen HCAHPS surveys of surgical inpatients showed a median hospital rating of 10 [IQR 8.5-10] on a ten-point scale. 90% gave maximal scores for pain management and 84.4% for nurse communication. Ten general surgery and obstetrical procedures were observed for which process map analysis was notable for no consistent waste steps and 100% adherence to the World Health Organization Safe Surgery Checklist. Conclusions Surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Perioperative process mapping supports this culture, with low levels of variability and waste, and is useful for evaluating standardization of care. VRAH demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.

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Section: Discussionmentioning

confidence: 99%

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana

Smiley

Ofori²,

Spangler

et al. 2018

World j. surg.

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“…Phase 2: 85% of the studies stated that data and information had been gathered to inform the PM exercise as a substitute for (55%), or in addition to (30%), the group knowledge generated in the facilitated process mapping sessions. This included evidence-based best practice recommendations [ 34 – 155 ], interviews [ 64 , 73 – 148 , 154 , 156 , 158 , 160 ], and more detailed approaches such as observations, operational data collection, time-and-motion studies, and video footage [ 48 , 78 – 81 , 141 , 143 – 146 , 150 , 159 , 163 – 169 ].…”

Section: Resultsmentioning

confidence: 99%

Process mapping in healthcare: a systematic review

Antonacci

Lennox

Barlow

et al. 2021

BMC Health Serv Res

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Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. Methods We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. Results The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. Conclusion The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. Trial Registration Prospero ID: CRD42017082140

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“…Process mapping has been used in emergency general surgery as well as cardiac surgery to isolate each segment of a patient’s experience, measure the times and look for significant variability between sequence and timing for different patients at each stage of their surgical journey. 19 , 20 An emergency general surgery model of care is an organizational structure that provides protected operating time for surgical emergencies, as well as structures and processes designed to improve the care of patients with general surgical emergencies. 21 Evidence from hospitals using the emergency general surgery model shows important benefits, including decreases in time to surgical evaluation, time to the operating room, length of stay, morbidity, mortality, cost and nighttime operating.…”

Section: Discussionmentioning

confidence: 99%

Major morbidity and mortality associated with delays to emergent surgery in children: a risk-adjusted analysis

Butterworth

Živković

Kim

et al. 2023

cjs

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Background: Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population. Methods: We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children’s Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ 2 test for univariate analysis and logistic regression for multivariate analysis. Results: There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d–18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20–2.94) compared to no delay. Conclusion: Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.

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Process mapping as a framework for performance improvement in emergency general surgery

Cited by 12 publications

References 14 publications

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana

Process mapping in healthcare: a systematic review

Major morbidity and mortality associated with delays to emergent surgery in children: a risk-adjusted analysis

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