Quality assessment in surgery: riding a lame horse.

Details

Serval ID
serval:BIB_4C22B38CC328
Type
Article: article from journal or magazin.
Collection
Publications
Title
Quality assessment in surgery: riding a lame horse.
Journal
Annals of Surgery
Author(s)
Dindo D., Hahnloser D., Clavien P.A.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
2010
Volume
251
Number
4
Pages
766-771
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: Quality assessment in surgery is paramount for patients and health care providers. In our center, quality assessment is based on the recording of preoperative risk factors of each patient and a well-established grading system to track complications. Our prospective quality database is administrated by residents. However, the validity of such data collection is unknown.
METHODS: To evaluate the validity of the recorded data, a specially trained study nurse audited our prospective quality database over a 6-month period. In the first 3 months, the audit was done in an undisclosed manner. Then, the audit was disclosed to the residents who were again subjected to a teaching course. Thereafter, the audit was continued in a disclosed manner for another 3 months, and data were compared between the 2 periods. Furthermore, we inquired about the strategies to assess surgical quality in 108 European medical centers.
RESULTS: Surprisingly, residents failed to report most complications; 80% (164/206) and 79% (275/347; P = 0.27) of the negative postoperative events were not recorded during the first and the second period, respectively. When captured, however, grading of complications was correct in 97% of the cases. Moreover, comorbidities were incorrectly assessed in 20% of the patients in the first period and in 14% thereafter (P = 0.07). The survey disclosed that residents and junior staff are responsible of recording surgical outcome in 80% of the participating European centers.
CONCLUSIONS: Recording of outcome by surgical residents is unreliable,despite active and focused training. Hence, surgery should be evaluated by dedicated personnel.
Keywords
Data Collection, Databases, Factual, Europe, General Surgery/education, Humans, Internship and Residency, Outcome Assessment (Health Care), Postoperative Complications/classification, Quality Assurance, Health Care/methods, Surgical Procedures, Operative/standards
Pubmed
Web of science
Create date
07/10/2014 14:18
Last modification date
20/08/2019 14:00
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