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Implementation and Evaluation of Quality Improvement Training in Surgery: A Systematic Review. Ann Surg 2021; 274:e489-e506. [PMID: 34784666 DOI: 10.1097/sla.0000000000004751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. BACKGROUND There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. METHODS We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully. RESULTS There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and "lean" principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. CONCLUSIONS The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.
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Myers JS, Kin JM, Billi JE, Burke KG, Harrison RV. Development and validation of an A3 problem-solving assessment tool and self-instructional package for teachers of quality improvement in healthcare. BMJ Qual Saf 2021; 31:287-296. [PMID: 33771908 DOI: 10.1136/bmjqs-2020-012105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE A3 problem solving is part of the Lean management approach to quality improvement (QI). However, few tools are available to assess A3 problem-solving skills. The authors sought to develop an assessment tool for problem-solving A3s with an accompanying self-instruction package and to test agreement in assessments made by individuals who teach A3 problem solving. METHODS After reviewing relevant literature, the authors developed an A3 assessment tool and self-instruction package over five improvement cycles. Lean experts and individuals from two institutions with QI proficiency and experience teaching QI provided iterative feedback on the materials. Tests of inter-rater agreement were conducted in cycles 3, 4 and 5. The final assessment tool was tested in a study involving 12 raters assessing 23 items on six A3s that were modified to enable testing a range of scores. RESULTS The intraclass correlation coefficient (ICC) for overall assessment of an A3 (rater's mean on 23 items per A3 compared across 12 raters and 6 A3s) was 0.89 (95% CI 0.75 to 0.98), indicating excellent reliability. For the 20 items with appreciable variation in scores across A3s, ICCs ranged from 0.41 to 0.97, indicating fair to excellent reliability. Raters from two institutions scored items similarly (mean ratings of 2.10 and 2.13, p=0.57). Physicians provided marginally higher ratings than QI professionals (mean ratings of 2.17 and 2.00, p=0.003). Raters averaged completing the self-instruction package in 1.5 hours, then rated six A3s in 2.0 hours. CONCLUSION This study provides evidence of the reliability of a tool to assess healthcare QI project proposals that use the A3 problem-solving approach. The tool also demonstrated evidence of measurement, content and construct validity. QI educators and practitioners can use the free online materials to assess learners' A3s, provide formative and summative feedback on QI project proposals and enhance their teaching.
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Affiliation(s)
- Jennifer S Myers
- Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeanne M Kin
- Quality, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John E Billi
- Medicine and Learning Health Sciences, Michigan School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Integrative Systems and Design, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen G Burke
- Biobehavioral Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard Van Harrison
- Learning Health Sciences, University of Michigan Health System, Ann Arbor, Michigan, USA
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Brown A, Lafreniere K, Freedman D, Nidumolu A, Mancuso M, Hecker K, Kassam A. A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts? BMJ Qual Saf 2020; 30:337-352. [PMID: 33023936 DOI: 10.1136/bmjqs-2020-010887] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/11/2020] [Accepted: 08/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND With the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes. METHODS A realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts. RESULTS 18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes. CONCLUSION This research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.
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Affiliation(s)
- Allison Brown
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada .,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kyle Lafreniere
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David Freedman
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aditya Nidumolu
- Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Matthew Mancuso
- Undergraduate Medical Education, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Kent Hecker
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Postgraduate Medical Education, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Palee P, Wongta N, Khwanngern K, Jitmun W, Choosri N. Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol. Int J Med Inform 2020; 141:104166. [PMID: 32570197 DOI: 10.1016/j.ijmedinf.2020.104166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/30/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To develop and evaluate a serious game to deliver knowledge about the cleft lip with or without cleft palate (CL/P) protocol used in Craniofacial Center, Chiang Mai University. METHODS The game "Cleft Island" was developed then extensively evaluated using different criteria, including the measured knowledge gained by participants, and gameplay experience. A group of 53 fourth and fifth-year medical students (male: 24, female: 29) were recruited to take part in an experiment. They were from the Faculty of Medicine, Chiang Mai University, and had just rotated to the Department of Surgery. Three evaluations were conducted: 1) to test whether the players had competently gained CL/P knowledge; 2) to evaluate the usability of the game according to the System Usability Scale (SUS); and 3) to evaluate the game experience in terms of a Game Experience Questionnaire (GEQ) test. RESULTS The results indicate a statistically significant improvement of medical students' knowledge after performing the Wilcoxon Signed-Ranks test (p < 0.5) between pre-test and post-test scores of the same medical student group; the acceptable average SUS score (M = 55.28) of the serious game; a moderate degree of experience of the GEQ components including positive affect (M = 2.64), competence (M = 2.49), and immersion (M = 2.21). CONCLUSIONS Cleft Island can be used as an effective supplementary instructional material, which has the potential to provide significant knowledge of CL/P treatment protocol for the players. As far as the authors are aware, this is the first study to implement and assess a serious game for training in CL/P protocol.
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Affiliation(s)
- Patison Palee
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Noppon Wongta
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Krit Khwanngern
- Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Suthep, Muang, Chiang Mai, 50200, Thailand; Center of Data Analytics and Knowledge Synthesis for Healthcare, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Waritsara Jitmun
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Noppon Choosri
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand; Center of Data Analytics and Knowledge Synthesis for Healthcare, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand.
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Hajjar-Nejad MJ, Kubicki N, Morales D, Kavic SM. Multilevel Quality Improvement Teams: An Alternative Approach for Surgical Academic Training Programs to Meet ACGME Core Competency Milestones. JOURNAL OF SURGICAL EDUCATION 2019; 76:785-794. [PMID: 30472060 DOI: 10.1016/j.jsurg.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/02/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Quality improvement (QI) activities are an integral part of residency training. We started the process to implement team-based, multilevel QI project streams within our academic surgical residency by studying resident perceptions. OBJECTIVE Our residency carried out 6 QI projects in line with the American Council for Graduate Medical Education competencies. A resident survey was completed in 2016 to measure resident perceptions of an individual versus team-based QI project approach. METHODS This was a descriptive study looking at resident's preference for team projects and ongoing projects within the training program. We started in 2014 utilizing Wait's Team Action Projects in surgery paradigm to conduct 6 QI projects. After initiation of projects, we allotted 2 full years to pass prior to assessing resident perceptions via a 12-item survey. RESULTS Notably, this was a descriptive study aiming to capture resident perceptions on team-based QI and the foundational elements necessary to create and sustain such projects by integrating into our curriculum from the intern year. In 2016, 40 residents completed surveys (72.7% response rate), all (100%) opined that they preferred team-based approaches over individual ones, and 75% were on board to move forward with only a team-based approach in the future. CONCLUSIONS This was a pivotal start to adopting a team-based QI project strategy in the future and laid a solid foundation to build upon. We found residents in our program desire to work within teams early on to develop effective solutions to clinical problems. Residents perceived that the team-based model resulted in an improved resident experience with the QI process and improved patient care. We hope to publish a series of articles updating our progress as we move forward in this endeavor.
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Affiliation(s)
| | - Natalia Kubicki
- University of Maryland School of Medicine, Baltimore, Maryland
| | - David Morales
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, Maryland.
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Feng X, Colvin J, French J, Wey J. Utilization of Quality Improvement Methodology to Standardize Communication of Outside Hospital Transfers in a General Surgery Program. JOURNAL OF SURGICAL EDUCATION 2018; 75:1544-1550. [PMID: 29886121 DOI: 10.1016/j.jsurg.2018.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/09/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE There is no standardized method of communication regarding the arrival of outside hospital (OSH) transfers at our institution. We utilized quality improvement methodologies to enhance sign-out, benefiting both resident workflow and patient care. DESIGN A dynamic census log of pending OSH transfers was created. Total number of OSH transfers (with or without prior notification), time to admission orders, and resident self-reported preparedness in receiving/triaging OSH admissions were measured before and after implementation of the census log tool. SETTING Quaternary referral hospital in Cleveland, Ohio. PARTICIPANTS The census log was made available to General Surgery residents on receiving surgical teams. After the data collection period, it was made available to all residents in the program. RESULTS A total of 93 patients were transferred to receiving surgical teams during our 13-week study period. Resident notification of the OSH transfer prior to patient's arrival increased from 44.7% pre- to 70.3% postimplementation of the tool (p = 0.03). When residents received prior notification of pending transfers, time to place admission orders decreased from 81.2 ± 79.9 minutes to 40.4 ± 36.8 minutes (p = 0.0029). Junior residents' self-reported preparedness in admitting an OSH transfer did not significantly differ when they received prior notification versus when they did not. In contrast, senior residents' self-reported higher levels of preparedness in the instances where they received prior notification of a pending transfer. CONCLUSIONS In light of the recent Clinical Learning Environment Review program set forth by the Accreditation Council for Graduate Medical Education, trainees are expected to engage in improvement processes as it relates to patient safety and transitions of care. The development and implementation of our tool demonstrate that quality improvement methodologies can be effectively applied to resident workflow challenges, improving both trainee education and patient care.
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Affiliation(s)
| | | | | | - Jane Wey
- Cleveland Clinic, Cleveland, Ohio.
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Mrdutt MM, Isbell CL, Regner JL, Hodges BR, Munoz-Maldonado Y, Thomas JS, Papaconstantinou HT. NSQIP-Based Quality Improvement Curriculum for Surgical Residents. J Am Coll Surg 2017; 224:868-874. [DOI: 10.1016/j.jamcollsurg.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
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Gillen JR, Ramirez AG, Farineau DW, Hoke TR, Schirmer BD, Williams MD, Lau CL. Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice. JOURNAL OF SURGICAL EDUCATION 2016; 73:1052-1059. [PMID: 27372271 PMCID: PMC5124388 DOI: 10.1016/j.jsurg.2016.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. PROJECT DESIGN Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. PROJECT EXECUTION Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. DISCUSSION This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice.
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Affiliation(s)
- Jacob R Gillen
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - Adriana G Ramirez
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Diane W Farineau
- Office of Graduate Medical Education, University of Virginia Health System, Charlottesville, Virginia
| | - Tracey R Hoke
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Michael D Williams
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christine L Lau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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Kachooei AR, Talaei-Khoei M, Faghfouri A, Ring D. Factors associated with operative treatment of enthesopathy of the extensor carpi radialis brevis origin. J Shoulder Elbow Surg 2016; 25:666-70. [PMID: 26995457 DOI: 10.1016/j.jse.2015.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 12/16/2015] [Accepted: 12/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated the factors associated with variation in the rate of surgery for enthesopathy of the extensor carpi radialis brevis (eECRB). METHODS We used a large database from 3 academic hospitals including 5964 patients with the diagnosis of eECRB from 2001 to 2007. Of those, 244 patients (4%) had surgery for eECRB. We used the date of the first encounter as the date of diagnosis. We also recorded the date of the first cortisone injection and surgery for eECRB. We used Cox multivariable regression analysis to find factors associated with surgery. We considered the following explanatory factors: age, sex, race, diabetes, a diagnosis of major depression, a diagnosis of an anxiety disorder, hospital, provider (surgeon vs. nonsurgeon), corticosteroid injection, and the time from diagnosis to the first cortisone injection. RESULTS The hazard ratio of having surgery was 12-times greater if the initial provider was an orthopedic surgeon rather a nonsurgeon and 1.7-times greater at 1 of the 2 hospitals. The rate of surgery varied substantially, ranging from 0% to 22%. Corticosteroid injection delayed the time to surgery but was ultimately associated with a higher rate of surgery. The majority (86%) of surgeries were done within 1 year of the first documented office visit. CONCLUSIONS It seems likely that an emphasis on the preferences and values of the patient rather than the surgeon would decrease the variation in surgery rates for eECRB observed in this study. Methods for optimizing the influence of patient preferences and values on decision making (eg, decision aids) merit additional study.
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Affiliation(s)
- Amir Reza Kachooei
- Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Talaei-Khoei
- Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Aram Faghfouri
- Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Ring
- Orthopedic Hand and Upper Extremity Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Comprehensive Care Dell Medical School University of Texas, Austin, TX, USA.
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Erem HH, Aytac E. The Use of Surgical Care Improvement Projects in Prevention of Venous Thromboembolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:15-22. [PMID: 27638625 DOI: 10.1007/5584_2016_102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Venous thromboembolism (VTE) is a potentially mortal complication in patients undergoing surgery. Deep venous thrombosis and pulmonary embolism can be seen up to 40 % of patients who have no or inappropriate VTE prophylaxis during perioperative period.In addition to the preoperative and intraoperative preventive measures, the standardization of postoperative care and follow-up are essential to reduce VTE risk. Modern healthcare prioritizes patient's safety and aims to reduce postoperative morbidity by using standardized protocols. Use of quality improvement projects with well-organized surgical care has an important role to prevent VTE during hospital stay. Present surgical care improvement projects have provided us the opportunity to identify patients who are vulnerable to VTE. Description and introduction of the quality standards for VTE prevention in the educational materials, meetings and at the medical schools will increase the VTE awareness among the health care providers. You are going to find the characteristics of the major surgical quality improvement projects and their relations with VTE in the chapter.
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Affiliation(s)
- Hasan Hakan Erem
- Department of General Surgery, Gumussuyu Military Hospital, Istanbul, 34349, Turkey.
| | - Erman Aytac
- Department of General Surgery, Acibadem University, School of Medicine, Istanbul, Turkey
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Ruiz Orjuela ET, Ortiz Pimiento NR. LEAN HEALTHCARE: UNA REVISIÓN BIBLIOGRÁFICA Y FUTURAS LÍNEAS DE INVESTIGACIÓN. ACTA ACUST UNITED AC 2015. [DOI: 10.22517/23447214.11181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
La filosofía Lean a través del tiempo ha evolucionado y ha sido implementada en varios tipos de empresas tanto en el sector manufacturero como en el de los servicios, lo cual se evidencia en el gran número de estudios que investigan sobre la implementación de lean en dichos sectores. El propósito de este estudio es analizar las tendencias de las publicaciones, identificar los autores más influyentes y describir las futuras investigaciones en la aplicación de Lean en el sector salud. En esta investigación se presentan los resultados de un análisis bibliométrico realizadas a las publicaciones científicas acerca de la filosofía Lean Healthcare durante el periodo 1990-2015, en la base de datos: Isi Web of Knowladge, Scopus y PubMed. Los resultados de esta investigación contribuyen a identificar tópicos emergentes y ser un marco de referencia para futuras investigaciones en este tema de investigación.
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Alameddine MB, Claflin J, Scally CP, Noble DM, Reames BN, Englesbe MJ, Wong SL. Resident Surgeons Underrate Their Laparoscopic Skills and Comfort Level When Compared With the Rating by Attending Surgeons. JOURNAL OF SURGICAL EDUCATION 2015; 72:1240-6. [PMID: 26395401 PMCID: PMC4662891 DOI: 10.1016/j.jsurg.2015.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The development of operative skills during general surgery residency depends largely on the resident surgeons' (residents) ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skills and comfort level of residents from both the residents' and attending surgeons' (attendings') perspectives. DESIGN We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both residents and attendings completed a survey in which they rated the residents' operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Residents' and attendings' evaluations of residents' performance were compared using 2-sided t tests. SETTING The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution. PARTICIPANTS All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1 and August 31, 2013. Data were collected for 28 of the institution's 54 trainees. RESULTS Attendings rated residents higher than what residents rated themselves on a 5-point Likert-type scale regarding depth perception (3.86 vs. 3.38, p < 0.005), bimanual dexterity (3.75 vs. 3.36, p = 0.005), efficiency (3.58 vs. 3.18, p < 0.005), tissue handling (3.69 vs. 3.23, p < 0.005), and comfort while performing a case (3.86 vs. 3.38, p < 0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p = 0.85), the level of difficulty of the case (2.98 vs. 2.85, p = 0.443), and the degree of teaching done by the attending during the case (3.61 vs. 3.54, p = 0.701). CONCLUSIONS A gap exists between residents' and attendings' perception of residents' laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess and be in general agreement with attendings on their level of laparoscopic skills and comfort level while performing a case.
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Affiliation(s)
| | - Jake Claflin
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Christopher P Scally
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
| | - David M Noble
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Bradley N Reames
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
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Ramanathan R, Duane TM, Kaplan BJ, Farquhar D, Kasirajan V, Ferrada P. Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2015; 72:e286-e293. [PMID: 26111820 DOI: 10.1016/j.jsurg.2015.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/29/2015] [Accepted: 05/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency. DESIGN A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program. SETTING Urban tertiary academic medical center. PARTICIPANTS General surgery residents, faculty, and medical students. RESULTS An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation. CONCLUSION An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members.
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Affiliation(s)
- Rajesh Ramanathan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Therese M Duane
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Brian J Kaplan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Doris Farquhar
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Vigneshwar Kasirajan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
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Demehri FR, Claflin J, Alameddine M, Sandhu G, Magas CP, Virgin K, Gauger PG. Surgical Baseball Cards: Improving Patient- and Family-Centered Care. JOURNAL OF SURGICAL EDUCATION 2015; 72:e267-e273. [PMID: 26341167 DOI: 10.1016/j.jsurg.2015.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/14/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Busy surgical services with diverse team members and frequent handoffs create barriers to patient- and family-centered care. The aim of this study was to determine whether the use of cards containing team member names, roles, and photographs-"Surgical Baseball Cards" (SBCs)-would improve patient recognition of caregivers and whether this would improve patient satisfaction. DESIGN A prospective, controlled study was performed of all adult patients admitted to 2 academic acute care general surgery services with alternating admitting days. Surgical team members on one service had SBCs to give patients at introduction, whereas the control service used no such tool. Before discharge, patients completed a survey consisting of a quiz requiring matching of caregiver photographs to names and roles (5-point maximum), questions rating select elements of patient satisfaction (5-point Likert scale), and an opportunity to provide comments. SETTING Department of Surgery, University of Michigan, Ann Arbor, MI, a university teaching hospital. PARTICIPANTS A total of 162 patients were included over 2 months, with at least a 24-hour admission to an acute care general surgery service. RESULTS Overall, 60% of patients in the intervention arm received SBCs. Per-unit SBC cost was 0.16 USD. Patients who received SBCs had significantly improved identification of team members based on name (1.7 ± 1.4 vs 1.2 ± 1.5, p = 0.02) and role (1.6 ± 1.4 vs 0.9 ± 1.2, p = 0.02) than controls did. All the SBC recipients and 88% of controls felt that SBCs should be implemented hospital-wide. SBC recipients reported a trend toward increased comfort with resident involvement in care (4.6 ± 0.7 vs 4.5 ± 0.9, p = 0.14). Among themes discerned from free-response comments, 46% of SBC recipients commented on the innovative nature of SBCs and 29% noted improved team identification. Overall, 17% of SBC recipients commented positively on patient-centered care (vs 3% of controls), whereas 5% commented negatively on patient-centered care (vs 15% of controls); 8% of SBC recipients commented positively on coordination of care (vs 1% of controls), whereas 5% commented negatively on coordination of care (vs 24% of controls). CONCLUSIONS SBCs provide reasonable value by improving patient recognition of healthcare team members and understanding of team member roles, and they are associated with positive patient feedback regarding coordination of care and patient-centered care.
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Affiliation(s)
- Farokh R Demehri
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Jake Claflin
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Mitchell Alameddine
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Christopher P Magas
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Kristen Virgin
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul G Gauger
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
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Obi AT, Alvarez R, Reames BN, Moote MJ, Thompson MA, Wakefield TW, Henke PK. A prospective evaluation of standard versus battery-powered sequential compression devices in postsurgical patients. Am J Surg 2015; 209:675-81. [DOI: 10.1016/j.amjsurg.2014.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/24/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
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