Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy (original) (raw)
Related papers
The Journal of ambulatory care management
This study explores associations between patient outcomes (7- and 30-day hospitalization and mortality) and healthcare provider (physician and facility) volumes of outpatient colonoscopy, cataract removal, and upper gastrointestinal endoscopy performed in outpatient surgical settings in Florida. Findings indicate that patients treated by high-volume physicians or facilities had lower adjusted odds ratios for hospitalizations and mortality. When physician and facility volume were assessed simultaneously, physician volume accounted for larger effects than facility volume in hospitalization models. When assessing both physician and facility volume together for mortality, facility volume was a stronger predictor of mortality outcomes at 30 days. Further examinations of associations of outpatient physician and facility volumes and patient outcomes are suggested.
Variability in Reoperation Rates at 182 Hospitals: A Potential Target for Quality Improvement
2010
BACKGROUND: Reoperation rate has gained increasing attention as a potential indicator of surgical quality. Objectives of this study were to examine the feasibility of assessing reoperation rates at 182 hospitals to identify institutions with outlying performance, to examine potentially modifiable factors that are associated with reoperations, and to determine if a more parsimonious logistic regression model effectively predicts reoperations. STUDY DESIGN: Patients were identified who underwent colorectal procedures at 182 hospitals participating in the American College of Surgeon's National Surgical Quality Improvement Program in 2006Ϫ2007. Risk-adjusted regression models for reoperation were developed to identify hospitals that had ratios of observed-to-expected events that were substantial outliers. RESULTS: Of 23,098 patients identified, 1,320 (5.7%) required reoperations. Reoperation occurred significantly more often than expected in 16 hospitals and less often than expected in 7 hospitals (p Ͻ 0.05). Factors that were associated with an increased risk of reoperation were advanced American Society of Anesthesiologists class, male gender, contaminated wounds, surgical extent, surgical indication, smoking, poor functional status, disseminated cancer, COPD, steroid dependence, anemia, body mass index (calculated as kg/m 2) Ͼ35 or Յ18.5, and hypertension. Compared with the full logistic regression model, there was a high degree of correlation with the more parsimonious logistic model containing only the first six variables (r ϭ 0.996).
Cureus
Background Acute care surgery (ACS) models address high volumes of emergency general surgery and emergency room (ER) overcrowding. The impact of ACS service model implementation on the quality and efficiency of care (EOC) outcomes in acute appendicitis (AA) and acute cholecystitis (AC) cohorts was evaluated. Methods A retrospective chart review (N=1,229) of adult AA and AC patients admitted prior to (pre-ACS; n=507; three hospitals; 2007) and after regionalization (R-ACS; n=722; one hospital; 2011). Results R-ACS time to ER physician assessment was significantly longer for AA (3.4 ± 2.3 versus 2.4 ± 2.6 hr; p ≤ 0.001). Surgical response times (1.3 ± 1.2 vs 2.6 ± 4.3 hr for AA; 1.8 ± 1.5 vs 4.1 ± 5.0 hr for AC; p ≤ 0.0001) and acquisition of imaging (4.1 ± 4.1 vs 6.9 ± 9.9 hr for AA, p ≤ 0.0001; 7.8 ± 1.9 vs 13.2 ± 18.5 hr for AC, p ≤ 0.008) occurred significantly faster with R-ACS. R-ACS resulted in a significant increase in night-time appendectomies (21.7% vs 11.1%; p ≤ 0.002), perforated appendices (29.1 % vs 18.9 %; p ≤ 0.006), 30-day readmissions (4.56% vs 0.82%; p ≤ 0.01), and lower rate of intraoperative complications for AC patients (2.78% vs 7.69%; p ≤ 0.02). Conclusions Despite the increased volume of patients seen with the implementation of R-ACS, surgical assessments and diagnostic imaging were significantly more prompt. EOC measures were maintained. Worse AA outcomes highlight areas for improvement in delivering R-ACS.
Influence of trends in hospital volume over time on patient outcomes for high-risk surgery
Research Square (Research Square), 2019
Background: The "practice makes perfect" concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods: We included all patients who underwent one of 10 digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. Results: Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients' mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g.
Management by Outcomes: Efficiency and Operational Success in the Ambulatory Surgery Center
Anesthesiology Clinics, 2010
Quality of care and service in health care can benefit from the use of algorithm-driven care (standard work) that integrates literature assessment and analysis of local outcome and process data to eliminate unnecessary variation that causes error and waste. 1-6 Effective management of an ambulatory surgery center requires that leadership emphasize constant improvement in the processes of care to achieve maximum patient safety and satisfaction, delivered with highest efficiency. Such work is only effective if staff and physicians understand the value of such improvement to patient and family experiences, and if they believe there is a gap between current operations and the ideal. Therefore, leadership needs a method to obtain, evaluate, and share process and outcome measurements in an open, objective, and clear manner. Measurement and explication of outcomes of operational workflow are of value in directing process improvement efforts in a variety of industries, including health care. 7-10 The seemingly ubiquitous increase in operational improvement models (Six Disclosure: Both authors are members of SAMBA, and DGM is a member of the Board of Directors for SAMBA and the AQI. Excel is a registered trademark of the Microsoft Corporation. Toyota Production System (TPS) is a registered trademark of the Toyota Motor Manufacturing Corporation. The Six Sigma Management System is a registered trademark of Motorola Inc.
Health Services Research, 2007
Research Objective. To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs). Data Sources. the state of Florida were assembled and analyzed. Study Design. We used a pooled, cross-sectional design. Logistic regressions with time fixed-effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk-adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses. Principal Findings. Although neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used.
Hospital operations and length of stay performance
International Journal of Operations & Production Management, 2007
Purpose -As hospital costs continue to rise, increasing attention is being paid to the way these organizations are and should be managed. This attention typically comes in the form of focus on costs of services, quality (often measured through mortality rates) and length of stay. Hospital management has a broad array of choices at their disposal to address these challenges. As service operations, hospitals present a significant opportunity to apply the many tools and techniques from the field of operations strategy to this important industry. The objective of this paper is to use the operations strategy framework to assess the relationship between a set of operational elements and hospital performance in terms of average length of stay (ALOS), so that hospital managers improve the effectiveness and efficiency of patient care of their hospitals. Design/methodology/approach -Using the structural and infrastructural operations strategy framework, this study examines the relationship between several strategic variables and hospital performance. To analyze these relationships the paper employs data from the population of hospitals in New York State. The performance measure is the ALOS for patients, adjusted for the mix and severity of cases in each hospital. Findings -The paper finds that a direct relationship exists between the dependent variable and location, capacity, and teaching status, and failed to find a direct relationship for capital expenditures, salary, and staffing levels. However, the paper did find significant interaction effects between capital expenses and both salary and staffing levels. Practical implications -There appear to be trade-offs between capital expenditures and workforce decisions that have significant implications in light of current and expected hospital staffing shortages. The findings indicate that reductions in staff may not be perfectly replaced by corresponding increases in capital expenditures. Originality/value -This paper further expands the body of research that addresses the important challenges hospitals face from an operations management perspective.
Jurnal Konseling Pendidikan Islam
The most important goal in health services is to produce patient health outcomes that benefit patients and continue to prioritize the quality of health services. The results of the interviews conducted found that referrals from insurance agents also decreased due to problems related to the variety of services that have an impact on increasing service costs. The purpose of this study was to determine the impact of implementing a clinical pathway as a tool for quality and cost control on length of stay, hospital costs, patient health outcomes in groups that implement and do not implement clinical pathways. This study took place at the EMC Pekayon Hospital with a population of all medical record files of patients who had a diagnosis of appendicitis with laparoscopic appendectomy surgery in the period 2021 to November 2022 who met the inclusion criteria, namely 69 patients. Clinical pathway is the independent variable and length of stay, hospital cost, patient health outcome is the depe...