scholarly journals Striving for excellence in abortion services

2006 ◽  
Vol 30 (4) ◽  
pp. 468 ◽  
Author(s):  
Ea C Mulligan
Keyword(s):  
Quality Improvement ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Potential Effect ◽  
Outcome Data ◽  
Uterine Perforation ◽  
Complication Rates ◽  
Incomplete Abortion ◽  
Positive Results

The legalisation of abortion allowed the publication of surgical outcome data demonstrating low complication rates. South Australian data from the outcomes of surgery conducted at the Pregnancy Advisory Centre illustrate the monitoring of complication rates such as uterine perforation, continuing pregnancy and incomplete abortion to improve surgical outcomes. While quality improvement systems produce positive results, there are many barriers to their uptake in Australia. Hostility towards abortion has the potential effect of retarding the adoption of improved techniques.

Impact of Age and Comorbidity on the Short-Term Surgical Outcome after Laparoscopy-Assisted Distal Gastrectomy for Adenocarcinoma

2013 ◽  
Vol 79 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Han-A Park ◽  
Seong-Heum Park ◽  
Sung-Il Cho ◽  
You-Jin Jang ◽  
Jong-Han Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Distal Gastrectomy ◽  
Outcome Data ◽  
University Hospitals ◽  
Short Term ◽  
Aged Patients ◽  
Systemic Complications

The aim of this study was to determine whether age and comorbidity are valuable risk factors of the short-term surgical outcome after laparoscopy-assisted distal gastrectomy (LADG) in patients with adenocarcinoma. A series of 387 patients who underwent LADG at three university hospitals between March 2006 and December 2010 were retrospectively studied. To compare the short-term surgical outcomes of LADG of elderly patients with those of younger patients, patients were categorized into an elderly group (older than 70 years of age) and a younger group (70 years of age or younger). For another comparative analysis to identify risk factors of postoperative complications after LADG, patients were categorized into two groups: those with complications and those without complications. With the exception of sex ratio and comorbidity rate, two age groups were nonsignificantly different in terms of demographic, operative, pathologic, and short-term surgical outcome data. Our data support the safety and feasibility of LADG in elderly patients. However, our data show that comorbidity is an important predictor of postoperative systemic complications after LADG. Patients with an age-adjusted Charlson comorbidity index (CCI) of 3 or greater were found to be at a greater risk of developing systemic complications, which suggests that age-adjusted CCI is a useful predictor of systemic complications after LADG and that it could be used routinely for the perioperative care of aged patients with comorbidity. We recommend age-adjusted CCI be used in comparative clinical research studies on the surgical outcomes across surgeons and hospitals.

Economic impact of the use of the National Surgical Quality Improvement Program

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Alvine Fansi ◽  
Angela Ly ◽  
Julie Mayrand ◽  
Maggy Wassef ◽  
Aldanie Rho ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Analysis ◽  
Economic Impact ◽  
Quality Improvement Program ◽  
Economic Evaluations ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
The Cost

Objectives The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is a validated, risk-adjusted database for improving the quality and security of surgical care. ACS NSQIP can help participating hospitals target areas that need improvement. The aim of this study was to systematically review the literature analyzing the economic impact of using NSQIP. This paper also provides an estimation of annual cost savings following the implementation of NSQIP and quality improvement (QI) activities in two hospitals in Quebec. Methods In June 2018, we searched in seven databases, including PubMed, Embase, and NHSEED for economic evaluations based on NSQIP data. Contextual NSQIP databases from two hospitals were collected and analyzed. A cost analysis was conducted from the hospital care perspective, comparing complication costs before and after 1 year of the implementation of NSQIP and QI activities. The number and the cost of complications are measured. Costs are presented in 2018 Canadian dollars. Results Out of 1,612 studies, 11 were selected. The level of overall evidence was judged to be of moderate to high quality. In general, data showed that, following the implementation of NSQIP and QI activities, a significant decrease in complications and associated costs was observed, which improved with time. In the cost analysis of contextual data, the reduction in complication costs outweighed the cost of implementing NSQIP. However, this cost analysis did not take into account the costs of QI activities. Conclusions NSQIP improves complication rates and associated costs when QI activities are implemented.

Short-term Complication Rates Following Anterior Urethroplasty: An Analysis of National Surgical Quality Improvement Program Data

Urology ◽  
2018 ◽  
Vol 111 ◽  
pp. 197-202 ◽  
Author(s):  
John M. Lacy ◽  
Ramiro J. Madden-Fuentes ◽  
Adam Dugan ◽  
Andrew C. Peterson ◽  
Shubham Gupta
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Program ◽  
Complication Rates ◽  
Short Term ◽  
Improvement Program ◽  
Surgical Quality ◽  
Program Data

scholarly journals The Provision of Primary and Revision Elbow Replacement Surgery in the NHS

2018 ◽  
Vol 10 (2_suppl) ◽  
pp. S5-S12 ◽  
Author(s):  
Stuart Hay ◽  
Rohit Kulkarni ◽  
Adam Watts ◽  
David Stanley ◽  
Ian Trail ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Surgical Outcomes ◽  
Surgical Procedure ◽  
Best Practice ◽  
Replacement Surgery ◽  
Practice Recommendations ◽  
Procedure Guidelines ◽  
Elbow Replacement ◽  
First Time ◽  
British Orthopaedic Association

BESS Surgical Procedure Guidelines (SPGs). Optimising Surgical Outcomes for Shoulder and Elbow patients. The British Elbow and Shoulder Society (BESS) SPGs are a series of evidence and consensus Best Practice Recommendations developed by BESS surgeons and physiotherapists to help drive quality improvement and achieve the best possible surgical outcomes for UK patients. This SPG on primary and revision elbow replacement surgery is supported and endorsed by both the British Orthopaedic Association (BOA) and the Getting It Right First Time (GIRFT) Programme.

scholarly journals Surgical Outcomes of Phacoemulsification Surgery in a Restructured Asian Training Hospital

1970 ◽  
Vol 12 (4) ◽  
pp. 201-207
Author(s):  
David Zhiwei Law ◽  
Seng Chee Loon ◽  
Wan Ling Wong ◽  
Marilou Sevilla Ebreo ◽  
Xiang Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Outcomes ◽  
Perioperative Complications ◽  
University Hospital ◽  
Complication Rates ◽  
Corrected Visual Acuity ◽  
Duration Of Surgery ◽  
National University ◽  
Chi Squared ◽  
Best Corrected Visual Acuity

Aim: To evaluate the surgical outcomes of phacoemulsification performed at National University Hospital, Singapore, with emphasis on the results achieved by residents.Methods: This was a retrospective analysis of surgical outcomes of patients who underwent phacoemulsification in a restructured hospital in 2008. The study included 318 eyes of patients of predominantly Asian descent. Pre- and postoperative best-corrected visual acuity, perioperative complications and associations of patient, surgical and surgeon factors were studied. One-way analysis of variance for means, chi-squared test for proportions, and multivariate analyses were performed to determine factors associated with postoperative best-corrected visual acuity outcomes. Main outcome measures included postoperative best-corrected visual acuity, degree of improvement in best-corrected visual acuity, and achievement of specific best-corrected visual acuity targets of 6/9 and 6/12 at postoperative months 1 and 3.Results: Duration of surgery of less than 20 minutes was found to be significantly associated with better postoperative best-corrected visual acuity. Level of surgical experience was also associated with betterpostoperative best-corrected visual acuity at postoperative months 1 (p < 0.001) and 3 (p = 0.004). While senior consultants produced the best postoperative best-corrected visual acuity outcomes, the results achieved by residents were comparable to those reported in prior resident-only studies. For surgeries performed by residents, the overall rate of posterior capsule rupture was 3.1% with a 0.0% rate of vitreous loss.Conclusions: The continued close guidance and training of ophthalmology residents in a restructured Asian training hospital will ensure that complication rates remain low while maintaining postoperative outcomes at safe levels.

New Product Decisions - The Process and Outcome for a Community Health System

2011 ◽  
Vol 16 (2) ◽  
pp. 74-84 ◽  
Author(s):  
Jose Delp ◽  
Lynn Hadaway
Keyword(s):  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Negative Impact ◽  
Relevant Literature ◽  
Outcome Data ◽  
Passive Safety ◽  
Radiology Department ◽  
Complication Rates ◽  
Safety Mechanism ◽  
Catheter System

Abstract Purpose: To compare patient outcomes and evaluate safety features and costs associated with a new catheter system and securement dressing. Background: The need to improve dwell times for short peripheral catheters and reduce complication rates, along with improvements in clinical practice in radiology and enhanced staff safety were driving factors leading to a change in peripheral catheters and securement systems. Review of Relevant Literature: Several reports of catheter stabilization devices have shown improved clinical outcomes with their use. Currently available studies on this new catheter system include one small evaluation and a randomized trial comparing a traditional round hub catheter coupled with a supplemental securement device and the new catheter system with an integrated stabilization platform combined with a securement dressing. Passive safety mechanisms on peripheral catheters may produce fewer needlestick injuries than mechanisms requiring the user to activate the device. Methods: After a learning period, the following seven months were designated the intervention period. Outcome data from the same seven-month period of the preceding year were used for comparison. The data were divided into scheduled and unscheduled restarts. Data from two hospitals are reported separately and in combination. Data from the two periods were analyzed for equivalence or noninferiority. Results: Clinical outcomes for both periods are virtually equivalent, demonstrating that one system is not inferior to the other regarding catheter complications. However the catheter system with the integrated stabilization platform was less costly and safer due to a passive safety mechanism. Problems with high pressure injection in the radiology department were also solved with the new catheter system. Conclusions: While any product change can be a challenging experience, we accomplished these changes in an orderly manner without negative impact on patient outcomes and reducing costs. Improvements in radiology were also attributed to these changes, along with enhanced staff safety. Implications for Practice: The catheter designed with an integrated stabilization platform, a pre-attached extension set, and a passive safety mechanism produced benefits for radiology staff without negatively affecting patient outcomes in other clinical areas. These product changes were implemented in an organized manner and involved all stakeholders in the process.

Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

2018 ◽  
Vol 29 (10) ◽  
pp. 968-973 ◽  
Author(s):  
Divyashree Shanthamurthy ◽  
Abi Manesh ◽  
Naveena GP Zacchaeus ◽  
Lisa R Roy ◽  
Priscilla Rupali
Keyword(s):  
Surgical Procedures ◽  
Median Duration ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Tertiary Care ◽  
Perioperative Outcomes ◽  
Care Hospital ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Cd4 Cell

It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0–18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.

scholarly journals The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

2020 ◽  
Vol 9 (12) ◽  
pp. 4006
Author(s):  
Thomas Lustenberger ◽  
Simon Lars Meier ◽  
René Danilo Verboket ◽  
Philipp Störmann ◽  
Maren Janko ◽  
...  
Keyword(s):  
Complication Rate ◽  
Surgical Outcomes ◽  
Surgical Complications ◽  
Situational Awareness ◽  
Surgical Complication ◽  
Surgical Site Infections ◽  
Care Bundle ◽  
Trauma Patients ◽  
Complication Rates ◽  
Time Period

Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

Control Charts in Healthcare Quality Improvement

2012 ◽  
Vol 51 (03) ◽  
pp. 189-198 ◽  
Author(s):  
S. N. van der Veer ◽  
K. J. Jager ◽  
N. Peek ◽  
N. F. de Keizer ◽  
A. Koetsier
Keyword(s):  
Quality Improvement ◽  
Control Charts ◽  
Clinical Information ◽  
Outcome Data ◽  
Skewed Distribution ◽  
Direct Patient Care ◽  
Shewhart Control Charts ◽  
Pdsa Cycle ◽  
Shewhart Control ◽  
Two Phases

SummaryObjectives: Use of Shewhart control charts in quality improvement (QI) initiatives is increasing. These charts are typically used in one or more phases of the Plan Do Study Act (PDSA) cycle to monitor summaries of process and outcome data, abstracted from clinical information systems, over time. We summarize methodological criteria of Shewhart control charts and investigate adherence of published QI studies to these criteria.Methods: We searched Medline, Embase and CINAHL for studies using Shewhart control charts in QI processes in direct patient care. We extracted methodological criteria for Shewhart control charts, and for the use of these charts in PDSA cycles, from textbooks and methodological literature.Results: We included 34 studies, presenting 64 control charts of which 40 control charts plotted two phases of the PDSA cycle. The criterion to use 10–35 data points in a control chart was least adhered to (48.4% non-adherence). Other criteria were: transformation of the data in case of a skewed distribution (43.7% non adherence), when comparing data from two phases of the PDSA cycle the Plan phase (the first phase) needs to be stable (40.0% non-adherence), using a maximum of four different rules to detect special cause variation (14.1% non-adherence), and setting control limits at three standard deviations from the mean (all control charts adhered).Conclusion: There is room for improvement with regard to the methodological construction of Shewhart control charts used in QI processes. Higher adherence to all methodological criteria will decrease the risk of incorrect conclusions about the process being monitored.

Outcome Data and Quality: The Critical Role of Policy

2003 ◽  
Vol 31 (2) ◽  
pp. 2-6
Author(s):  
Russell Renhard
Keyword(s):  
Quality Improvement ◽  
Health Outcomes ◽  
Control Strategies ◽  
Critical Role ◽  
Outcome Data ◽  
Policy Debate ◽  
Australian Health ◽  
Clinical Level

Health outcomes data are a major focus of the Australian health policy debate and the national research agenda. There is general agreement that health outcomes data should be collected. Outcomes data have been shown to be a powerful stimulant to service quality at the clinical level. It is argued here that policy which places health outcomes data at the centre of resource allocation and competitive cost control strategies is likely to undermine its capacity to stimulate quality at the clinical level. Policy is needed to support the role of health outcomes data so that it is relevant to clinicians and is seen as being fundamental to quality improvement processes at the organisational level. Governments and other funding bodies require that services be accountable for the quality of their services. By using health outcomes data this quality guarantee can be based on evidence that the data are analysed routinely and, where appropriate, clinical services are modified and improved. Without this clear role for health outcomes data, they may become yet another ‘top-down’ accountability tool that has little relevance to clinicians and therefore loses its value as a stimulant to quality improvement.

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