Quality improvement in hospitals' surgery-related processes: A systematic review

Beyranvand, Tina; Aryankhesal, Aidin; Hashjin, Asgar Aghaei

doi:10.47176/mjiri.33.129

Cited by 7 publications

(8 citation statements)

References 45 publications

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Section: Discussionmentioning

confidence: 99%

“…We found few studies using QI methods,86–88 and few studies used implementation science methods10 12 17 89 which is of concern, as benefits of using these methods to support the delivery of evidence-based QI practices into routine healthcare, have been clearly demonstrated as critical to close the implementation gap. Indeed, there is wide acceptance that there is an implementation gap10 90 in scale up of evidenced based interventions into routine care in LMICs in general, and in surgical and anaesthesia care in particular 10 17 89 90. Over the last two decades there have been seminal publications on implementation science including the Consolidated Framework for Implementation Research, which was originally published in 2009,91 Proctor’s Implementation Outcomes in 201120 and the Expert Recommendations of Implementing Change in 2015 19.…”

Section: Discussionmentioning

confidence: 99%

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Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Brima

Morhason-Bello

Charles³

et al. 2022

BMJ Open

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ObjectivesTo systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to evaluate the impact of the intervention and implementation learning.DesignWe conducted a systematic literature review and narrative synthesis.SettingLiterature on hospital-based quality improvement studies in sub-Saharan Africa reviewed until 31 December 2021.ParticipantsMEDLINE, EMBASE, Global Health, CINAHL, Web of Science databases and grey literature were searched.InterventionWe extracted data on intervention characteristics and how the intervention was delivered and evaluated.Primary and secondary outcome measuresImportantly, we assessed whether clinical, process and implementation outcomes were collected and separately categorised the outcomes under the Institute of Medicine quality domains. Risk of bias was not assessed.ResultsOf 1573 articles identified, 49 were included from 17/48 sub-Saharan African countries, 16 of which were low-income or lower middle-income countries. Almost two-thirds of the studies took place in East Africa (31/49, 63.2%). The most common intervention focus was reduction of surgical site infection (12/49, 24.5%) and use of a surgical safety checklist (14/49, 28.6%). Use of implementation and quality improvement science methods were rare. Over half the studies measured clinical outcomes (29/49, 59.2%), with the most commonly reported ones being perioperative mortality (13/29, 44.8%) and surgical site infection rate (14/29, 48.3%). Process and implementation outcomes were reported in over two thirds of the studies (34/49, 69.4% and 35, 71.4%, respectively). The most studied quality domain was safety (44/49, 89.8%), with efficiency (4/49, 8.2%) and equitability (2/49, 4.1%) the least studied domains.ConclusionsThere are few hospital-based studies that focus on improving the quality of surgical and anaesthesia care in sub-Saharan Africa. Use of implementation and quality improvement methodologies remain low, and some quality domains are neglected.PROSPERO registration numberCRD42019125570

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Brima

Morhason-Bello

Charles³

et al. 2022

BMJ Open

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“…7 PDSA can be used in various surgical context and objectives such as to improve the quality of postoperative procedures, process mapping and finding improvable points in surgery, to improve communication between patient and medical staff, and to reduce patient waiting time before surgery. 8 Preoperative waiting time was lowered from 0.46 days to 0.29 days in 2008 following the implementation of a surgery admission unit for patients undergoing major elective surgery in Spain. 9 A study conducted at a university hospital in the Netherlands showed, initiation of an outpatient preoperative evaluation reduces preoperative admission time by a factor of 0.89 (95% CI, 0.88-0.91), rate of same-day admissions increased from 5.26% (692/13,162) to 7.72% (542/7024), and cancellation rate for medical reasons only reduced from 1.95% to 0.93%.…”

Section: Introductionmentioning

confidence: 99%

Reduction of In-Hospital Preoperative Waiting Time of Elective Surgeries in the Amidst of COVID-19 Pandemic: Experience from Ethiopia

Teklewold¹,

Abebe²,

Anteneh³

et al. 2022

DHPS

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Background:The higher demand for surgical services during the advancement of the COVID-19 pandemic has resulted from the need for a pre-admission negative result, the need for extra resources, and a shortage of skilled expertise. This quality improvement project aimed to reduce the in-hospital preoperative waiting time of elective cases to less than 24 hours. Methods: The study was conducted in a tertiary care center. Following the collection of baseline data, we formed a multidisciplinary team to analyze the root causes and intervention ideas of delay using fishbone and driver diagrams, respectively. We prioritize key drivers and implemented several low-cost interventions using Plan-Do-Study-Act (PDSA) model. We monitored the average inhospital preoperative waiting time of patients. Results: Overall, in-hospital preoperative waiting time for elective cases has been reduced from a baseline of 4.89 days to 1.32 days on average by the end of 10 months of initiating the project. Similarly, monthly elective case cancellation rate due to COVID-19related reason has been reduced from baseline 62.5% of the total cancellation to 0%. Due to this, the average monthly inpatient bed utilization has increased from 2.21 patients per month during pre-COVID-19 period to 5.9 patients per month in each bed of the surgical ward by the end of the project. Conclusion:The implementation of a quality improvement project can optimize operation theatre efficiency, inpatient bed utilization, and reduce the surgical backlog. Meticulous and rigorous effort has to be laid down to do root cause analysis, generate feasible change ideas, and continuous follow-up, and testing of multiple PDSA cycles is required to impact an improvement and sustain it in the long run. The emergence of COVID-19 pandemic could be used as an opportunity to reduce the length of stay in the hospital.

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“…As surgery is one of the most resource-intensive areas of clinical medicine, there is a growing trend for quality improvement initiatives to improve the efficiency, quality, and safety of surgical care, to reduce unnecessary consumption of resources, and to increase patient satisfaction [ 6 ]. Some commonly used indicators to measure surgical care resource utilization include hospital length of stay (LOS), reoperation, and readmission.…”

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confidence: 99%

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

et al. 2022

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Background As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures. Methods We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting. Results MIS patients had shorter LOS compared to open approach: − 1.87 days for lobectomy, − 1.34 days for colon resection, − 0.47 days for rectal resection, and − 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: − 0.13 days for lobectomy, − 0.28 days for colon resection, − 0.67 days for rectal resection, and − 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates. Conclusion Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

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Quality improvement in hospitals' surgery-related processes: A systematic review

Cited by 7 publications

References 45 publications

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Reduction of In-Hospital Preoperative Waiting Time of Elective Surgeries in the Amidst of COVID-19 Pandemic: Experience from Ethiopia

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

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