PMID- 25038587 OWN - NLM STAT- MEDLINE DCOM- 20150414 LR - 20211021 IS - 1471-2482 (Electronic) IS - 1471-2482 (Linking) VI - 14 DP - 2014 Jul 19 TI - Improving quality through process change: a scoping review of process improvement tools in cancer surgery. PG - 45 LID - 10.1186/1471-2482-14-45 [doi] AB - BACKGROUND: Surgery is a cornerstone of treatment for malignancy. However, significant variation has been reported in patterns and quality of cancer care for important health outcomes, including perioperative mortality. Surgical process improvement tools (SPITs) have been developed that focus on enhancing the processes of care at the point of care, as a means of quality improvement. This study describes SPITs and develops a conceptual framework by synthesizing the available literature on these novel quality improvement tools. METHODS: A scoping review was conducted based on instruments developed for quality improvement in surgery. The search was executed on electronically indexed sources (MEDLINE, EMBASE, and the Cochrane library) from January 1990 to March 2011. Data were extracted, tabulated and reported thematically using a narrative synthesis approach. These results were used to develop a conceptual framework that describes and classifies SPITs. RESULTS: 232 articles were reviewed for data extraction and analysis. SPITs identified were classified into 3 groups: clinical mapping tools, structure communication tools and error reduction instruments. The dominant instrument reported were clinical mapping tools, including: clinical pathways (113, 48%), fast track (46, 20%) and enhanced recovery after surgery protocols (36, 15%). Outcomes reported included: length of stay (174, 75%), readmission rates (116, 50%), morbidity (116, 50%), mortality (104, 45%), and economic (60, 26%). Many gaps in the literature were recognized. CONCLUSION: We have developed a conceptual framework of SPITs and identified gaps in current knowledge. These results will guide the design and development of new quality instruments in surgery. FAU - Wei, Alice C AU - Wei AC AD - Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada. Alice.Wei@uhn.ca. FAU - Urbach, David R AU - Urbach DR FAU - Devitt, Katharine S AU - Devitt KS FAU - Wiebe, Meagan AU - Wiebe M FAU - Bathe, Oliver F AU - Bathe OF FAU - McLeod, Robin S AU - McLeod RS FAU - Kennedy, Erin D AU - Kennedy ED FAU - Baxter, Nancy N AU - Baxter NN LA - eng GR - KRS-103275/Canadian Institutes of Health Research/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20140719 PL - England TA - BMC Surg JT - BMC surgery JID - 100968567 SB - IM MH - Digestive System Surgical Procedures/*standards/trends MH - Global Health MH - Humans MH - Morbidity/trends MH - Neoplasms/epidemiology/*surgery MH - *Quality Improvement PMC - PMC4112620 EDAT- 2014/07/21 06:00 MHDA- 2015/04/15 06:00 PMCR- 2014/07/19 CRDT- 2014/07/21 06:00 PHST- 2013/07/17 00:00 [received] PHST- 2014/07/14 00:00 [accepted] PHST- 2014/07/21 06:00 [entrez] PHST- 2014/07/21 06:00 [pubmed] PHST- 2015/04/15 06:00 [medline] PHST- 2014/07/19 00:00 [pmc-release] AID - 1471-2482-14-45 [pii] AID - 10.1186/1471-2482-14-45 [doi] PST - epublish SO - BMC Surg. 2014 Jul 19;14:45. doi: 10.1186/1471-2482-14-45.