手术流程改进工具：确定胃肠道癌症手术中的质量差距和优先领域。
Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.
机构信息
Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON.
出版信息
Curr Oncol. 2014 Apr;21(2):e195-202. doi: 10.3747/co.21.1733.
BACKGROUND
Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits.
METHODS
The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes.
RESULTS
The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures.
CONCLUSIONS
Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.
背景
手术是癌症治疗的基石，但已有报道称手术质量存在显著差异。手术流程改进工具（spits）通过改变护理流程来实现质量改进（qi）。我们有兴趣在胃肠道（gi）癌症手术领域开发 spits。我们报告了一个专家小组的建议，该小组旨在确定质量差距并确定将受益于 spits 的优先领域。
方法
本研究使用知识转化周期作为框架。加拿大 qi 和 gi 癌症手术方面的专家在一次名义小组研讨会上进行了集合。参与者评估了 spits 的优点，描述了当前知识的差距，并确定和对受益于 qi 的护理流程进行了排名。使用修改后的扎根理论方法对研讨会的讨论进行了定性分析，确定了主要主题。
结果
专家小组由 22 名参与者组成。专家们确认 spits 是 qi 的重要策略。评价最高的 spits 包括临床路径、电子信息技术和患者安全工具。spits 的首选使用场景包括术前和术中场景以及多学科环境。感兴趣的结果包括癌症相关结果、流程和手术措施的技术质量。
结论
手术流程改进工具被确认为一种重要策略。专家小组的建议将用于指导未来在 gi 癌症手术中开展 spits 的研究工作。
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