Resources for Optimal Care of Emergency Surgery by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030493639
Publisher: Springer International Publishing

Sam Huddart

Email: [email protected]

Keywords

Quality improvementEmergency surgeryDataStructureProcess and outcomeCollaborationRisk prediction

10.1 Quality Improvement

Batalden and Davidoff defined quality improvement in healthcare as “the combined efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)” (Batalden and Davidoff [1]).

Deming WE (1900–1993) is considered by many to be the father of quality improvement science. He is credited with transforming quality in industrial manufacturing in the USA during World War II, in post-war Japan, and at the Ford Motor company in the 1980s. He adapted statistical control methods originally developed by Walter Shewhart (a statistician at Bell laboratories). Shewhart developed control charts that allowed the monitoring of a system and identified common- and special-cause variation. Deming developed a theory of “profound knowledge”. For profound knowledge of a particular system we must have: an appreciation of the system; knowledge of the variation within that system; a theory of knowledge (including its concepts and limitations) and knowledge of psychology. Deming theorised that profound knowledge is a pre-requisite to improvement within a system. He also described the PDSA cycle (plan, do, study, act), a cornerstone of Quality Improvement methodology, which is described below.

Quality in healthcare is not a new concept. Avedis Donabedian described the evaluation of quality in medical healthcare [2]. He described quality in healthcare in terms of three distinct domains: structure, process and outcome. Outcome measures are often the mainstay of assessing the quality of a healthcare service. Donabedian discussed the necessity and limitations of outcome measures as an evaluation of quality. Some outcome measures (e.g. mortality) are concrete, unambiguous and relatively easy to measure, others (e.g. patient-reported outcomes or morbidity) are less well-defined. Outcomes give an aggregate assessment of a hospital performance in a given area. However, they lack specificity for the quality of underlying care, do not give an assessment of the processes of care, nor the underlying healthcare structures that lead to the outcomes. For example, all high-risk emergency surgical cases are at risk of adverse outcomes (morbidity or mortality). Therefore, the rate of adverse outcome alone cannot be used as a measure of the quality of care in an institution. To assess quality of care key processes must be identified. Compliance to key care measures must be studied alongside outcome measures.

Examining the process and structure-drivers of a particular outcome is a useful method in identifying areas for improvement. This approach allows the construction of driver diagrams that define the primary and secondary drivers of the desired outcome, thereby providing a structure for focusing on areas for quality improvement. An example of a driver diagram is shown in Fig. 10.1.

Fig. 10.1Example of a driver diagram for improving time between the decision for operation to arrival in the operating theatre for emergency surgical patients (EWS—Early Warning Score)

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