PMID- 36669834
OWN - NLM
STAT- MEDLINE
DCOM- 20230124
LR  - 20231124
IS  - 2399-6641 (Electronic)
IS  - 2399-6641 (Linking)
VI  - 12
IP  - 1
DP  - 2023 Jan
TI  - Multicentre positive deviance to reduce adverse events and length of stay after 
      pulmonary resection.
LID - 10.1136/bmjoq-2022-001997 [doi]
LID - e001997
AB  - BACKGROUND: Postoperative adverse events (AEs) following pulmonary resection 
      enormously impact patient well-being, length of stay (LOS) and healthcare costs. 
      Standardised AE data collection can be used to identify positive outliers 
      demonstrating positive deviance (PD) who may be helpful to inform the best 
      practice. Here, we describe our initial experience of a novel quality improvement 
      process using PD to reduce LOS and AEs. METHODS: AE rates and LOS were collected 
      from four centres (2014-2020) using a common dictionary. Surgeons repeatedly 
      participated in 60 to 90 min seminars consisting of the following process: 
      identify outcome and procedure targeted, review relevant best evidence 
      literature, view all data anonymised by surgeon or centre (if multicentre), 
      choose and reveal identity of best performance PD outliers, who discuss their 
      management principles while all receive self-evaluation reports, followed by 
      collegial discussion to generate consensus recommendations, voted by all. We 
      assessed overall impact on AEs and LOS using aggregate data in a before/after 
      analysis. RESULTS: A total of 131 surgeons (average 12/seminar) participated in 
      11 PD seminars (8 local and 3 multicentre), yielding 85 consensus recommendation 
      (average 8/seminar). Median LOS following lobectomy decreased from 4.0 to 3.0 
      days (p=0.04) following local PD seminars and from 4.0 to 3.5 days (p=0.11) 
      following multicentre seminars. Trends for reductions in multiple AE rates were 
      also observed. CONCLUSION: While limited by the longitudinal design, these 
      findings provide preliminary support for this data-driven, collegial and 
      actionable quality improvement process to help standardise and improve patient 
      care, and merits further more rigorous investigation.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Seely, Andrew J E
AU  - Seely AJE
AD  - Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada 
      aseely@ohri.ca.
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - Ahmadzai, Zubair
AU  - Ahmadzai Z
AUID- ORCID: 0000-0003-2399-2834
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - French, Daniel G
AU  - French DG
AD  - Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
FAU - Gingrich, Molly
AU  - Gingrich M
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - Jones, Daniel
AU  - Jones D
AD  - Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
FAU - Anstee, Caitlin
AU  - Anstee C
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - Safieddine, Najib
AU  - Safieddine N
AD  - Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
FAU - Waddell, Thomas K
AU  - Waddell TK
AD  - Toronto General Hospital, Toronto, Ontario, Canada.
FAU - Malthaner, Richard
AU  - Malthaner R
AD  - Western University, London, Ontario, Canada.
FAU - Ferri, Lorenzo
AU  - Ferri L
AD  - McGill University, Montreal, Quebec, Canada.
FAU - Finley, Christian
AU  - Finley C
AD  - Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
FAU - Darling, Gail
AU  - Darling G
AD  - Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - BMJ Open Qual
JT  - BMJ open quality
JID - 101710381
SB  - IM
MH  - Humans
MH  - Length of Stay
MH  - *Surgeons
MH  - Quality Improvement
MH  - Health Care Costs
MH  - Data Collection
PMC - PMC9872471
OTO - NOTNLM
OT  - Adverse events, epidemiology and detection
OT  - Continuous quality improvement
OT  - Postoperative Care
OT  - Quality improvement methodologies
OT  - Surgery
COIS- Competing interests: None declared.
EDAT- 2023/01/21 06:00
MHDA- 2023/01/25 06:00
PMCR- 2023/01/20
CRDT- 2023/01/20 21:03
PHST- 2022/05/26 00:00 [received]
PHST- 2023/01/06 00:00 [accepted]
PHST- 2023/01/20 21:03 [entrez]
PHST- 2023/01/21 06:00 [pubmed]
PHST- 2023/01/25 06:00 [medline]
PHST- 2023/01/20 00:00 [pmc-release]
AID - bmjoq-2022-001997 [pii]
AID - 10.1136/bmjoq-2022-001997 [doi]
PST - ppublish
SO  - BMJ Open Qual. 2023 Jan;12(1):e001997. doi: 10.1136/bmjoq-2022-001997.