PMID- 29315152
OWN - NLM
STAT- MEDLINE
DCOM- 20190917
LR  - 20191210
IS  - 1945-1474 (Electronic)
IS  - 1062-2551 (Linking)
VI  - 40
IP  - 4
DP  - 2018 Jul/Aug
TI  - Impact of Surgeon Self-evaluation and Positive Deviance on Postoperative Adverse 
      Events After Non-cardiac Thoracic Surgery.
PG  - e62-e70
LID - 10.1097/JHQ.0000000000000130 [doi]
AB  - As an innovative approach to improve quality of surgical care, we combined 
      surgeon self-assessment and anonymized peer comparison with continuous quality 
      improvement seminars using positive deviance (CQI/PD) to identify surgeon(s) with 
      the lowest rates of adverse events (AEs) to guide group practice recommendations. 
      Our objective was to quantify the impact these interventions on postoperative AEs 
      rates after major non-cardiac chest operations. All postoperative AEs after all 
      thoracic operations (n = 1,084, March, 2013 to February, 2016, single-center) 
      were prospectively collected using the thoracic morbidity and mortality system, 
      based on Clavien-Dindo schema. Online software provided surgeons (n = 6) with 
      self-evaluation and peer comparison at all times. In addition, quarterly CQI/PD 
      seminars (n = 8, September, 2013 to December, 2015) focused on common impactful 
      AEs: atrial fibrillation (AFIB), prolonged alveolar air leak (PAAL), and 
      anastomotic leak (AL). Impact was analyzed using univariate statistics 6, 9, and 
      12 months before and after implementation. We observed reductions of 
      postoperative AEs after CQI/PD: a decrease (all time periods) in AFIB, greatest 
      at 6 months (10.1% vs. 6.7%; p = .36); a decrease (all time periods) in PAAL, 
      greatest at 12 months (18.9% vs. 11.7%; p < .05); and decrease (6 and 9 months) 
      in AL, greatest at 6 months (11.1% vs. 8.3%; p = .82). Improvements in AE rates 
      after individual surgeon self-evaluation and CQI/PD seminars provide encouraging 
      results that merit further investigation.
FAU - Ivanovic, Jelena
AU  - Ivanovic J
FAU - Mostofian, Fargol
AU  - Mostofian F
FAU - Anstee, Caitlin
AU  - Anstee C
FAU - Gilbert, Sebastien
AU  - Gilbert S
FAU - Maziak, Donna E
AU  - Maziak DE
FAU - Shamji, Farid M
AU  - Shamji FM
FAU - Sundaresan, Ramanadhan Sudhir
AU  - Sundaresan RS
FAU - Villeneuve, Patrick James
AU  - Villeneuve PJ
FAU - Seely, Andrew J E
AU  - Seely AJE
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Healthc Qual
JT  - Journal for healthcare quality : official publication of the National Association 
      for Healthcare Quality
JID - 9202994
MH  - Adult
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Outcome Assessment, Health Care
MH  - Postoperative Complications/*prevention & control/*psychology
MH  - Quality Improvement/*organization & administration
MH  - Self-Assessment
MH  - Surgeons/*psychology
MH  - Thoracic Surgical Procedures/*psychology/*standards
EDAT- 2018/01/10 06:00
MHDA- 2019/09/19 06:00
CRDT- 2018/01/10 06:00
PHST- 2018/01/10 06:00 [pubmed]
PHST- 2019/09/19 06:00 [medline]
PHST- 2018/01/10 06:00 [entrez]
AID - 10.1097/JHQ.0000000000000130 [doi]
PST - ppublish
SO  - J Healthc Qual. 2018 Jul/Aug;40(4):e62-e70. doi: 10.1097/JHQ.0000000000000130.