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[A method for quality assurance of surgical urologic training. Decentralized registration with centralized statistical processing].

https://arctichealth.org/en/permalink/ahliterature201910
Source
Ugeskr Laeger. 1999 Apr 5;161(14):2086-9
Publication Type
Article
Date
Apr-5-1999

[A quality study at a department of emergency surgery. The level of competence doesn't effect the quality].

https://arctichealth.org/en/permalink/ahliterature216904
Source
Lakartidningen. 1994 Nov 9;91(45):4110-4
Publication Type
Article
Date
Nov-9-1994
Author
D. Sevonius
U. Sjöblom
H. Forssell
Author Affiliation
Samtliga vid kirurgiska kliniken, Centrallasarettet i Karlskrona.
Source
Lakartidningen. 1994 Nov 9;91(45):4110-4
Date
Nov-9-1994
Language
Swedish
Publication Type
Article
Keywords
Clinical Competence
Emergency Service, Hospital - standards
Humans
Patient satisfaction
Quality Assurance, Health Care
Questionnaires
Surgery Department, Hospital - standards
Sweden
PubMed ID
7808110 View in PubMed
Less detail

Are complication rates for elective primary total hip arthroplasty in Ontario related to surgeon and hospital volumes? A preliminary investigation.

https://arctichealth.org/en/permalink/ahliterature203630
Source
Can J Surg. 1998 Dec;41(6):431-7
Publication Type
Article
Date
Dec-1998
Author
H J Kreder
J I Williams
S. Jaglal
R. Hu
T. Axcell
D. Stephen
Author Affiliation
Division of Orthopedic Surgery, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Ont. hans@ices.on.ca
Source
Can J Surg. 1998 Dec;41(6):431-7
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - statistics & numerical data - utilization
Cohort Studies
Comorbidity
Databases, Factual
Diagnosis-Related Groups
Female
Humans
Length of Stay
Male
Mortality
Ontario - epidemiology
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology - etiology - mortality
Quality of Health Care - statistics & numerical data
Sex Factors
Surgery Department, Hospital - standards - statistics & numerical data - utilization
Surgical Procedures, Elective - standards - statistics & numerical data - utilization
Abstract
To test the hypothesis that complication rates for elective total hip replacement operations are related to surgeon and hospital volumes.
Retrospective population cohort study. STUDY COHORT: Patients who had undergone elective total hip replacement in Ontario during 1992 as captured in the Canadian Institute for Health Information database.
In-hospital complications, 1- and 3-year revision rates, 1- and 3-year infection rates, length of hospital stay, and 3-month and 1-year death rates.
Surgeons with patient volumes above the 80th percentile (more than 27 hip replacements annually) discharged patients approximately 2.4 days earlier (p 0.05).
There is no evidence to support regionalization of elective hip replacement surgery in Ontario based on adverse clinical outcomes. Surgeons who perform a large number of total hip replacements are discharging patients earlier than less experienced surgeons, without any-demonstrable increase in complications leading to hospital readmission. The explanation for this observation remains unknown and will require further study.
PubMed ID
9854532 View in PubMed
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Are in-hospital deaths and long stay markers for errors in surgery?

https://arctichealth.org/en/permalink/ahliterature37909
Source
Qual Assur Health Care. 1990;2(2):149-59
Publication Type
Article
Date
1990
Author
T. Troëng
L. Janzon
Author Affiliation
Department of Surgery, Central Hospital, Karlskrona, Sweden.
Source
Qual Assur Health Care. 1990;2(2):149-59
Date
1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Diagnostic Errors
Female
Humans
Infant
Infant, Newborn
Intraoperative Complications
Length of Stay - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Surgery Department, Hospital - standards
Surgical Procedures, Operative - mortality
Surgical Wound Infection - mortality
Sweden - epidemiology
Abstract
To test the feasibility of using a system for classification of surgical errors and of in-hospital deaths and long hospital stay as markers for errors in surgery we reviewed the hospital records of 273 patients with 285 admissions. During the one year study period there were in all 3767 patients admitted for surgical care. From these we selected the 131 who died in the department during the year, the 100 who had the longest stay (greater than 33 days) and the 91 patients were referred to the departments of internal medicine, infectious diseases or orthopedic surgery. Errors were classified as error of omission or commission, in diagnosis or in therapy. Possible or definitive errors were found in the care of 23% of the patients who died and in 10% of the ones with a long hospital stay. Only 3% of patients referred to other departments experienced errors. It is concluded, that "in-hospital death and "long hospital stay" can be used as markers to identify errors in surgery.
PubMed ID
2103881 View in PubMed
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[A report on quality of surgical treatment: no evidence of the fact that bigger hospitals are better than small ones].

https://arctichealth.org/en/permalink/ahliterature214124
Source
Lakartidningen. 1995 Oct 4;92(40):3646
Publication Type
Article
Date
Oct-4-1995

Centralization, certification, and monitoring. Readmissions and complications after surgery.

https://arctichealth.org/en/permalink/ahliterature236350
Source
Med Care. 1986 Nov;24(11):1044-66
Publication Type
Article
Date
Nov-1986
Author
L L Roos
S M Cageorge
N P Roos
R. Danzinger
Source
Med Care. 1986 Nov;24(11):1044-66
Date
Nov-1986
Language
English
Publication Type
Article
Keywords
Cholecystectomy
Female
Follow-Up Studies
Hospital Departments - standards
Humans
Hysterectomy
Male
Manitoba
Medical Staff Privileges
Outcome and Process Assessment (Health Care) - methods
Patient Readmission
Postoperative Complications
Prostatectomy
Quality of Health Care
Registries
Statistics as Topic
Surgery Department, Hospital - standards
Surgical Procedures, Operative - standards
Abstract
Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.
PubMed ID
3773578 View in PubMed
Less detail

Clinical audit of surgery in a large teaching hospital.

https://arctichealth.org/en/permalink/ahliterature245803
Source
Can J Surg. 1980 May;23(3):278-82
Publication Type
Article
Date
May-1980
Author
R J Blanchard
A R Downs
Source
Can J Surg. 1980 May;23(3):278-82
Date
May-1980
Language
English
Publication Type
Article
Keywords
Canada
Hospital Departments - standards
Hospitals, Teaching - standards
Humans
Medical Audit - methods
Morbidity
Mortality
Postoperative Complications - epidemiology - mortality
Quality of Health Care
Surgery Department, Hospital - standards
Surgical Procedures, Operative - utilization
Utilization Review - methods
Abstract
Practical peer review by means of a clinical audit requires complete documentation, critical assessment and open discussion of difficulties or errors in patient management. The quality of care in a large surgical department was monitored using weekly on-the-ward capture of complications and immediate feedback to involved surgeons. Retrospective peer review of surgical deaths judged the process of patient care in three categories--treatment, investigation and documentation; feedback was also provided. Seven of the 10 surgical services each collected morbidity data for at least 40 weeks in 1976 and 44 weeks in 1977. In 1978, 8 of the 10 services collected data for 50 weeks or more. The number of patients reviewed was 3520 in 1978. Of these, 822 (23%) had complications in 1976, 703 (16%) in 1977 and 918 (17%) in 1978. In 1976, 260 patients died; the quality of care was considered to have been adequate in 67%. In 1977, 278 patients died; in 76% the management was considered adequate. In 1978, 231 patients died; in 68% management was satisfactory. This clinical audit system is suitable for computer programming and can provide a complete and accurate report of the entire spectrum of complications.
PubMed ID
7378962 View in PubMed
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[Communication between general practitioners and hospitals].

https://arctichealth.org/en/permalink/ahliterature199252
Source
Ugeskr Laeger. 2000 Jan 31;162(5):648-53
Publication Type
Article
Date
Jan-31-2000
Author
S L Rubak
J. Mainz
Author Affiliation
Aarhus Universitet, Institut for Almen Medicin.
Source
Ugeskr Laeger. 2000 Jan 31;162(5):648-53
Date
Jan-31-2000
Language
Danish
Publication Type
Article
Keywords
Communication
Denmark
Family Practice
Hospitals
Humans
Internal Medicine - standards
Interprofessional Relations
Medical Records
Patient Discharge
Referral and Consultation
Retrospective Studies
Surgery Department, Hospital - standards
Abstract
The study was partly based on a retrospective analysis of 408 hospital referrals and 261 discharge summary letters and partly on interviews with chief physicians/surgeons and general practitioners. The level of information in hospital referrals: patient history 87%, objective findings 94%, social medicine 31%, plan/expectations 21%. The diagnostic applicability of patient history/objective findings was 95% and social medicine 70%. The discharge summary letter was received 2-3 days after hospital discharge in 17% cases. In the discharge letters information about medication was described in 41%, information given to patient/relatives in 9%. When discharge summary letters from departments of internal medicine and surgery were compared the level of informations from departments of internal medicine to departments of surgery was superior e.g. descriptions of medication (62% against 26%), date of control (34% against 24%) and information to patient/relatives (12% against 5%). The conclusion was that the level of information and the diagnostic applicability showed variation with regard to quality. General practitioners and hospitals must develop guidelines for hospital referrals and discharge summary letters in order to improve the patient's course.
PubMed ID
10707597 View in PubMed
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Completeness and accuracy of voluntary reporting to a national case registry of laparoscopic cholecystectomy.

https://arctichealth.org/en/permalink/ahliterature194861
Source
Int J Qual Health Care. 2001 Feb;13(1):51-5
Publication Type
Article
Date
Feb-2001
Author
E. Dreisler
L. Schou
S. Adamsen
Author Affiliation
The Danish National Regristry of Laparoscopic Cholecystectomy, Department of Surgery A, Hillerød Hospital. dreisler@dadlnet.dk
Source
Int J Qual Health Care. 2001 Feb;13(1):51-5
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Benchmarking
Cholecystectomy, Laparoscopic - adverse effects - utilization
Databases, Factual - standards
Denmark - epidemiology
Humans
Information Services
Medical Audit - methods
Postoperative Complications - epidemiology - prevention & control
Quality Assurance, Health Care - methods
Registries - standards
Reproducibility of Results
Risk Management - standards - statistics & numerical data
Surgery Department, Hospital - standards - utilization
Surgical Wound Infection - epidemiology
Abstract
To validate completeness and accuracy of registry data reported from three randomly chosen departments contributing to The Danish National Registry of Laparoscopic Cholecystectomy, covering all departments offering chole cystectomy.
A total of 431 case reports representing cases of laparoscopic cholecystectomy in a 2-year period in three surgical departments.
Comparison of case reports with reported data in The Danish National Registry of Laparoscopic Cholecystectomy.
Rates of discrepancies, comparison of complication rates for cases in the registry and cases not reported to the registry.
Completeness of registration was 69%, 80% and 99% respectively. A significantly higher degree of completeness was found in the only department with a formalized registration procedure. Inaccuracies were found in 28-49% of the cases, but none regarding serious complications such as bile duct injury or perioperative death.
The information in the national registry may be accurate if the present findings can be extrapolated to the remaining departments in the country. The number of non-reported cases should be minimized by introducing a formalized procedure of handling and forwarding information to the registry. Continuous validation through external visits by registry staff to contributing departments may also be advisable.
PubMed ID
11330444 View in PubMed
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Development of communities of practice to facilitate quality improvement initiatives in surgical oncology.

https://arctichealth.org/en/permalink/ahliterature157643
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Publication Type
Article
Author
Michael Fung-Kee-Fung
Elena Goubanova
Karen Sequeira
Arifa Abdulla
Rose Cook
Claire Crossley
Bernard Langer
Andrew J Smith
Hartley Stern
Author Affiliation
Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. MFUNG@Ottawahospital.on.ca
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Language
English
Publication Type
Article
Keywords
Humans
Models, organizational
Oncology Service, Hospital - standards
Ontario
Organizational Case Studies
Quality Assurance, Health Care - organization & administration
Surgery Department, Hospital - standards
Abstract
The process of developing clinical guidelines and standards for cancer treatment and screening is well established in the Ontario health care system; however, the dissemination and implementation of such guidelines and standards are more recent undertakings. Traditional implementation strategies to improve surgical practice and the delivery of cancer care have not been consistently effective. There is a recognized need to develop integrated models that offer direct support for implementation strategies. Such a model should be feasible, adaptable, and open to evaluation across diverse surgical settings.
Research suggests that successful implementation should consider tools and expertise from other disciplines. This article considers a community of practice (COP) model to provide a supportive infrastructure for quality improvements in cancer surgery. The COP model was adapted for cancer surgeons. It is supported by 5 enablers referred to as tools: communication system, project development support, access to data, access to evidence review, and accreditation with continued medical education and continued professional development. These tools need to be part of an infrastructure that is both provided and supported by a team of administrators and health care professionals, who have active roles and responsibilities. Therefore, the primary objective of this article is to describe our COP model in cancer surgery including the key success factors necessary for providing the infrastructure and tools. The secondary objective is to offer the integrated COP model as a basis for future research and the evaluation of various collaborative improvement projects.
Building on knowledge management concepts, we identified the 4 essential processes that should be targeted by implementation strategies. A common COP evaluation framework uses the outcomes of 4 knowledge conversion modes-organizational memory, social capital, innovation, and knowledge transfer-as proxies for actual provider and organizational behavior. Insights from different collaborative improvement projects described in a consistent way could inform future research and assist in the collation of systematic reviews on this topic.
PubMed ID
18425031 View in PubMed
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53 records – page 1 of 6.