Single institution followed by national implementation of systematic surgical quality control and feedback for radical prostatectomy: a 20-year journey

Abstract

Purpose The demand for objective and outcome-based facts about surgical results after radical prostatectomy (RP) is increasing. Systematic feedback is also essential for each surgeon to improve his/her performance. Methods RP outcome data (e.g., pT-stage and margin status) have been registered at Sahlgrenska University Hospital (SUH) since 1988 and patient-related outcome measures (PROM) have been registered since 2001. The National Prostate Cancer Registry (NPCR) has covered all Regions in Sweden since 1998 and includes PROM-data from 2008. Initially PROM was on-paper questionnaires but due since 2018 all PROMs are collected electronically. In 2014 an on-line "dashboard" panel was introduced, showing the results for ten quality-control variables in real-time. Since 2017 all RP data on hospital, regional, and national levels are publicly accessible on-line on "www.npcr.se/RATTE N". Results The early PROM-data from SUH have been used for internal quality control. As national clinical and PROM-data from the NPCR have been made accessible on-line and in real-time we have incorporated this into our pre-existing protocol. Our data are now internally available as real-time NPCR reports on the individual surgeons' results, as well as ePROM data. We can compare the results of each surgeon internally and to other departments' aggregated data. The public can access data and compare hospital level data on "RATTEN". Conclusions The process of quality control of RP locally at SUH, and nationally through the NPCR, has been long but fruitful. The online design, with direct real-time feedback to the institutions that report the data, is essential.

How reliable are surgeon‐reported data? A comparison of the British Association of Urological Surgeons radical prostatectomy audit with the National Prostate Cancer Audit Hospital Episode Statistics‐linked database

“…In 2015, a specific radical prostatectomy register was introduced and, in 2017, the NPCR made radical prostatectomy outcome data publically available (www.npcr.se/RATTEN) [17]. Surgeons complete an online form after each procedure and other staff then input peri-operative outcomes [18]. Whilst the Swedish radical prostatectomy dataset has not yet been validated, the data quality of the NPCR has previously been evaluated.…”

“…The data collection process has engaged a generation of surgeons in a culture of self-audit and has facilitated the 'benchmarking' of contemporary UK practice [4,5]. However the validity of this surgeon-entered dataset and its potential to inform health policy and research has been questioned because of potential risks of selection and recall bias [6]. To date, the quality and accuracy of such a surgeon-entered dataset, spanning a national health system with a national registry, have not been tested.…”

Effect of Quality Control Program in Surgical Management of Early Cervical Cancer

“…Methods such as checklists or guidelines, accumulation of patient data, analysis of surgical outcome and detailed feedback on operative results to the surgeons have been tested in several institutions around the world. 2 15 16 17 Also in Korea, many efforts have been made to improve patient safety and quality of care in various fields of medicine, such as in regional trauma center as well as in NICU. 18 19 To our knowledge, our study is the first to analyze the effect of institutional systemic QC on various quality indicators in early cervical cancer management.…”

Surgical safety

“…takes surgical safety to another level [8]. Keeping track of complications, patient-reported outcomes and success rates is at the verge of being common practice [9]. Trustworthy feedback on performance drives intrinsic motivation for improvement [9].…”

“…Keeping track of complications, patient-reported outcomes and success rates is at the verge of being common practice [9]. Trustworthy feedback on performance drives intrinsic motivation for improvement [9]. Furthermore, an unprecedented amount of surgical knowledge is at the surgeons' fingertips thanks to the internet, social media, online courses, etc.…”