Enhancing surgical performance outcomes through process-driven care: a systematic review
Author(s)
Pucher, Philip H
Aggarwal, Rajesh
Singh, Pritam
Darzi, Ara
Type
Journal Article
Abstract
Background
Recent evidence has demonstrated the variability in quality of postoperative care, as measured by rates of failure to rescue (FTR). The identification of structure- and process-related factors affecting the quality of postoperative care is the first step towards understanding and improving outcomes. The aim of this review is to review current evidence for structure and process factors affecting postoperative care.
Methods
A systematic review was conducted. Studies were selected that examined structure or process variables affecting FTR rates and postoperative outcomes. Quality analysis with Jadad and Newcastle–Ottawa scales was conducted and poor-quality studies were excluded.
Results
Thirty-seven studies were included in final analysis. Of these, 23 were related to enhanced recovery protocols in seven surgical specialties. Twenty-one of these 23 studies reported decreases in length of stay. Six studies also reported decreases in morbidity. No studies reported increases in stay duration or morbidity. Of the 16 studies that examined other structural and process factors, the strongest evidence was for the association between nursing ratios and FTR rates. The effects of hospital size, resources, and subspecialist care processes were less clear.
Conclusion
Process-led care represents a clear, evidence-based approach that can be integrated on a local scale, without necessitating major structural or organisational change, to improve outcomes and may also be cost effective. To foster success, process improvement must be driven on a local level and backed up by appropriate understanding, education, and multidisciplinary involvement.
Recent evidence has demonstrated the variability in quality of postoperative care, as measured by rates of failure to rescue (FTR). The identification of structure- and process-related factors affecting the quality of postoperative care is the first step towards understanding and improving outcomes. The aim of this review is to review current evidence for structure and process factors affecting postoperative care.
Methods
A systematic review was conducted. Studies were selected that examined structure or process variables affecting FTR rates and postoperative outcomes. Quality analysis with Jadad and Newcastle–Ottawa scales was conducted and poor-quality studies were excluded.
Results
Thirty-seven studies were included in final analysis. Of these, 23 were related to enhanced recovery protocols in seven surgical specialties. Twenty-one of these 23 studies reported decreases in length of stay. Six studies also reported decreases in morbidity. No studies reported increases in stay duration or morbidity. Of the 16 studies that examined other structural and process factors, the strongest evidence was for the association between nursing ratios and FTR rates. The effects of hospital size, resources, and subspecialist care processes were less clear.
Conclusion
Process-led care represents a clear, evidence-based approach that can be integrated on a local scale, without necessitating major structural or organisational change, to improve outcomes and may also be cost effective. To foster success, process improvement must be driven on a local level and backed up by appropriate understanding, education, and multidisciplinary involvement.
Date Issued
2014-06-01
Date Acceptance
2013-12-01
Citation
World Journal of Surgery, 2014, 38 (6), pp.1362-1373
ISSN
1432-2323
Publisher
Springer Verlag
Start Page
1362
End Page
1373
Journal / Book Title
World Journal of Surgery
Volume
38
Issue
6
Copyright Statement
© Société Internationale de Chirurgie 2013.
Sponsor
National Institute for Health Research
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000335750100015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
NF-SI-0510-10186
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
RANDOMIZED-CLINICAL-TRIAL
FAST-TRACK SURGERY
LAPAROSCOPIC RADICAL PROSTATECTOMY
IMPROVES POSTOPERATIVE RECOVERY
QUALITY-OF-CARE
COLORECTAL SURGERY
PATIENT MORTALITY
COLONIC SURGERY
INPATIENT SURGERY
VOLUME HOSPITALS
Publication Status
Published
Date Publish Online
2013-12-23