Debate: what is the best method to monitor surgical performance?

Stefan H. Steiner · William H. Woodall

18 citations0/0 files storedBMC Surgery

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Advanced Statistical Process Monitoring Healthcare Quality and Management Hospital Admissions and Outcomes

Abstract

BACKGROUND: There is considerable recent interest in the monitoring of individual surgeon or hospital surgical outcomes. If one aggregates data over time and assesses performance with a funnel plot, then the detection of any process deterioration or improvement could be delayed. The variable life adjusted display (VLAD) is widely used for monitoring on a case-by-case basis, but we show that use of the risk-adjusted Bernoulli cumulative sum (RA-CUSUM) chart leads to much better performance. DISCUSSION: We use simulation to illustrate that the RA-CUSUM chart has better performance than the VLAD in detecting changes in the rates of adverse events. We recommend the RA-CUSUM approach over the VLAD approach for monitoring surgical performance. If the VLAD is used, we recommend running the RA-CUSUM chart in the background to generate signals that the process performance has changed.

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References

1986Optimal Stopping Times for Detecting Changes in Distributions 2000Monitoring surgical performance using risk-adjusted cumulative sum charts 2015Dynamic probability control limits for risk-adjusted Bernoulli CUSUM charts 2005A Method for Detecting Runs of Good and Bad Clinical Outcomes on Variable Life-Adjusted Display (VLAD) Charts

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2018A simple signaling rule for variable life‐adjusted display derived from an equivalent risk‐adjusted CUSUM chart 2018Use of cumulative summation (CUSUM) as a tool for early feedback and monitoring in robot-assisted radical prostatectomy outcomes and performance 2020Statistical process monitoring to improve quality assurance of inpatient care 2024Risk-adjusted observed minus expected cumulative sum (RA O-E CUSUM) chart for visualisation and monitoring of surgical outcomes

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