By Dr. John Birkmeyer
Improving surgical quality has become increasingly important to hospitals as providers are pushed to shoulder more risk under value-based reimbursement models. Given that surgery patients account for a significant portion of a hospital’s preventable costs (for example: unplanned intubation, severe sepsis, pulmonary embolism, and organ space surgical site infection), quality and efficiency improvements can strongly impact the bottom line.
Quality, as with most things, is multifaceted. Outcomes are partly attributable to the quality of care surgery patients receive throughout their hospital stays. Of course, the technical quality of surgical procedures is also a major factor.
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The challenge for surgical quality officers, then, centers on bolstering current surgical training methods. Doing so improves not only the technical quality of surgeons across various procedures, but also the operating room processes themselves.
Providing opportunities for feedback
Clinical observation and a large volume of evidence suggest wide variation in the technical quality and skill among surgeons. That’s due, in some measure, to a lack of continuing education, a key component of which is peer interaction. For example, surgeons who engage in higher levels of peer interaction have a higher likelihood of passing a maintenance of certification examination, and higher scores, according to a 2014 study of 568 surgeons published in JAMA Surgery.
Certainly, surgeons have the potential to improve much faster after their formal training with both purposeful practice and meaningful feedback, best delivered through peer interaction. The problem is that surgeons rarely watch one another operate and generally have no source of feedback on how they can improve once they’ve completed training. That is changing, though. As a result of the evolution of surgical practice toward videoscopic and robotic surgery, surgeons have new opportunities to obtain practice and feedback in more impactful ways than ever before.
Following the digital trail
Thanks to the “digital trail” of data from such surgeries, advances in technology and analytics have created opportunities for evaluating surgeons’ techniques. The digital trail includes real-time information on a patient’s history, vital signs, imaging and other parameters.
It’s also increasingly feasible to collect and synthesize information from surgical instruments and clinical workflows to drive surgical performance. Akin to the black box in aviation, the digital trail records everything (video, conversations, data, images, etc.). Through analyzing such data, surgeons can find the root causes for the complications that put a patient and hospital at risk.