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An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?
Cancer, 2015-05, Vol.121 (10), p.1581-1587
Lewis, Carol M.
Monroe, Marcus M.
Roberts, Dianna B.
Hessel, Amy C.
Lai, Stephen Y.
Weber, Randal S.
2015
Details
Autor(en) / Beteiligte
Lewis, Carol M.
Monroe, Marcus M.
Roberts, Dianna B.
Hessel, Amy C.
Lai, Stephen Y.
Weber, Randal S.
Titel
An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?
Ist Teil von
Cancer, 2015-05, Vol.121 (10), p.1581-1587
Ort / Verlag
United States
Erscheinungsjahr
2015
Link zum Volltext
Quelle
MEDLINE
Beschreibungen/Notizen
BACKGROUND An evaluation system was established for measuring physician performance. This study was designed to determine whether an initial evaluation with surgeon feedback improved subsequent performance. METHODS After an evaluation of an initial cohort of procedures (2004‐2008), surgeons were given risk‐adjusted individual feedback. Procedures in a postfeedback cohort (2009‐2010) were then assessed. Both groups were further stratified into high‐acuity procedure (HAP) and low‐acuity procedure (LAP) groups. Negative performance measures included the length of the perioperative stay (2 days or longer for LAPs and 11 days or longer for HAPs); perioperative blood transfusions; a return to the operating room within 7 days; and readmission, surgical site infections, and mortality within 30 days. RESULTS There were 2618 procedures in the initial cohort and 1389 procedures in the postfeedback cohort. Factors affecting performance included the surgeon, the procedure's acuity, and patient comorbidities. There were no significant differences in the proportions of LAPs and HAPs or in the prevalence of patient comorbidities between the 2 assessment periods. The mean length of stay significantly decreased for LAPs from 2.1 to 1.5 days (P = .005) and for HAPs from 10.5 to 7 days (P = .003). The incidence of 1 or more negative performance indicators decreased significantly for LAPs from 39.1% to 28.6% (P < .001) and trended downward for HAPs from 60.9% to 53.5% (P = .081). CONCLUSIONS Periodic assessments of performance and outcomes are essential for continual quality improvement. Significant decreases in the length of stay and negative performance indicators were seen after feedback. Therefore, an audit and feedback system may be an effective means of improving quality of care and reducing practice variability within a surgical department. Cancer 2015;121:1581–1587. © 2015 American Cancer Society. After an initial audit, individual surgeons are provided with their own performance data and anonymized departmental performance. A subsequent audit reveals a significant decrease in the postoperative length of stay and the prevalence of negative performance indicators.
Sprache
Englisch
Identifikatoren
ISSN: 0008-543X
eISSN: 1097-0142
DOI: 10.1002/cncr.29238
Titel-ID: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4777516
Format
–
Schlagworte
Adult
,
Aged
,
audit
,
Blood Component Transfusion - statistics & numerical data
,
Cancer Care Facilities
,
feedback
,
Feedback, Psychological
,
Female
,
Head and Neck Neoplasms - mortality
,
Head and Neck Neoplasms - surgery
,
head neck cancer
,
head neck surgery
,
Hospital Mortality
,
Hospitals, University
,
Humans
,
Incidence
,
Length of Stay - statistics & numerical data
,
Male
,
Medical Audit
,
Middle Aged
,
Patient Readmission - statistics & numerical data
,
performance improvement
,
Program Development
,
Quality Improvement
,
Quality Indicators, Health Care - statistics & numerical data
,
Reoperation - statistics & numerical data
,
Surgeons - standards
,
Surgeons - statistics & numerical data
,
Surgical Wound Infection - epidemiology
,
Texas - epidemiology
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