Lovrics Peter, Hodgson Nicole, O'Brien Mary Ann, Thabane Lehana, Cornacchi Sylvie, Coates Angela, Heller Barbara, Reid Susan, Sanders Kenneth, Simunovic Marko
Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada.
Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
Am J Surg. 2014 Jul;208(1):50-7. doi: 10.1016/j.amjsurg.2013.08.032. Epub 2013 Nov 8.
The investigators designed a sustained, surgeon-directed, iterative project to improve the quality of breast cancer surgery in south central Ontario.
The strategy included audit and feedback of surgeon-selected quality indicators, workshops, and tailoring interviews. Workshops were held to discuss quality improvement strategies, select quality indicators, review audited results, and select interventions for subsequent implementation. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All presentations and results were disseminated to all surgeons performing breast surgery in the study region.
Forty-four surgeons performing breast surgery across 12 hospitals are involved in the project. Five workshops have been held since 2005. Surgeons' enthusiasm and involvement in the project have been positive. Interim results demonstrated that over 4 audit cycles (2006-2010), the preoperative core biopsy rate increased from 73% to 92%. The tailoring interviews indicated that 18 of 21 surgeons performed preoperative core biopsies.
This project highlights the feasibility of a surgeon-directed, iterative quality improvement strategy in breast cancer surgery. Interim results demonstrate consistent improvements in a key selected quality indicator.
研究人员设计了一个由外科医生主导的持续迭代项目，以提高安大略省中南部乳腺癌手术的质量。
该策略包括对外科医生选定的质量指标进行审核与反馈、举办研讨会以及进行针对性访谈。举办研讨会以讨论质量改进策略、选定质量指标、审查审核结果，并选择后续实施的干预措施。进行半结构化的针对性访谈，以确定提高质量的促进因素和障碍。所有的报告和结果都传达给了研究区域内所有进行乳腺癌手术的外科医生。
来自12家医院的44名进行乳腺癌手术的外科医生参与了该项目。自2005年以来已举办了5次研讨会。外科医生对该项目的热情和参与度很高。中期结果表明，在4个审核周期（2006 - 2010年）中，术前核心活检率从73%提高到了92%。针对性访谈表明，21名外科医生中有18名进行了术前核心活检。
该项目凸显了在乳腺癌手术中由外科医生主导的迭代质量改进策略的可行性。中期结果表明，在一个选定的关键质量指标上有持续的改进。
