Limits...
Systematic methods for measuring outcomes: How they may be used to improve outcomes after Radical cystectomy.

Siddiqui KM, Izawa JI - Arab J Urol (2015)

Bottom Line: These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken.To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly.This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.

ABSTRACT
In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.

No MeSH data available.


Related in: MedlinePlus

Cumulative log-likelihood ratio charts for (A) death within 30 days of RC, and (B) pulmonary embolus. (C) A cumulative failure chart for pulmonary embolus. (D–F) cumulative log-likelihood ratio charts for uretero-intestinal leak, unplanned re-operation and myocardial infarction, respectively.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4561925&req=5

f0005: Cumulative log-likelihood ratio charts for (A) death within 30 days of RC, and (B) pulmonary embolus. (C) A cumulative failure chart for pulmonary embolus. (D–F) cumulative log-likelihood ratio charts for uretero-intestinal leak, unplanned re-operation and myocardial infarction, respectively.

Mentions: Chalasani et al. [18] reported the outcomes for 150 consecutive RCs performed by one surgeon, using CUSUM charts. We used the method described by Rogers et al. [19] and show the results in both formats, i.e., cumulative-failure charting and the cumulative log-likelihood ratio. Fig. 1A, shows the 30-day mortality for RC. The benchmarks are shown, and if the graph crosses the bottom control line then the performance is confirmed to be acceptable, and if it overshoots the upper limit then it is unacceptable. Another example, that of pulmonary embolism as an outcome, is shown Fig. 1B and C, where the information on pulmonary embolism is shown in both formats. There were three cases of pulmonary embolism in this series. The boundary lines were set with an acceptable pulmonary embolism rate of 0.4% and an unacceptable rate of 2%; as the plot has not yet crossed both the upper and lower limit, no conclusions can be drawn, and monitoring is recommended to continue. Fig. 1D–F shows CUSUM graphs for leakage of the uretero-ileal anastomosis, unplanned re-operations and postoperative myocardial infarctions. These clearly show that CUSUM charts can be effectively used for monitoring all outcomes after RC.


Systematic methods for measuring outcomes: How they may be used to improve outcomes after Radical cystectomy.

Siddiqui KM, Izawa JI - Arab J Urol (2015)

Cumulative log-likelihood ratio charts for (A) death within 30 days of RC, and (B) pulmonary embolus. (C) A cumulative failure chart for pulmonary embolus. (D–F) cumulative log-likelihood ratio charts for uretero-intestinal leak, unplanned re-operation and myocardial infarction, respectively.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4561925&req=5

f0005: Cumulative log-likelihood ratio charts for (A) death within 30 days of RC, and (B) pulmonary embolus. (C) A cumulative failure chart for pulmonary embolus. (D–F) cumulative log-likelihood ratio charts for uretero-intestinal leak, unplanned re-operation and myocardial infarction, respectively.
Mentions: Chalasani et al. [18] reported the outcomes for 150 consecutive RCs performed by one surgeon, using CUSUM charts. We used the method described by Rogers et al. [19] and show the results in both formats, i.e., cumulative-failure charting and the cumulative log-likelihood ratio. Fig. 1A, shows the 30-day mortality for RC. The benchmarks are shown, and if the graph crosses the bottom control line then the performance is confirmed to be acceptable, and if it overshoots the upper limit then it is unacceptable. Another example, that of pulmonary embolism as an outcome, is shown Fig. 1B and C, where the information on pulmonary embolism is shown in both formats. There were three cases of pulmonary embolism in this series. The boundary lines were set with an acceptable pulmonary embolism rate of 0.4% and an unacceptable rate of 2%; as the plot has not yet crossed both the upper and lower limit, no conclusions can be drawn, and monitoring is recommended to continue. Fig. 1D–F shows CUSUM graphs for leakage of the uretero-ileal anastomosis, unplanned re-operations and postoperative myocardial infarctions. These clearly show that CUSUM charts can be effectively used for monitoring all outcomes after RC.

Bottom Line: These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken.To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly.This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.

ABSTRACT
In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.

No MeSH data available.


Related in: MedlinePlus