Siddiqui Khurram M, Izawa Jonathan I
Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
Arab J Urol. 2015 Jun;13(2):122-7. doi: 10.1016/j.aju.2015.02.008. Epub 2015 Mar 29.
In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.
在管理式医疗时代，衡量和报告手术结果是一项普遍要求。应及时监测和报告结果。衡量手术结果的方法应具有连续性、无偏差，并能适应患者因素的差异。传统的手术审计方法是定期的，资源密集型的，而且存在偏差的可能性。这些审计通常是每年进行一次，因此在采取任何有效的补救措施之前会有很长的时间延迟。为了减少这种延迟，制造业长期以来一直使用统计控制图监测系统，因为它们提供持续监测，更适合系统地、及时地监测结果。医疗行业现在也在采用这种系统方法。根治性膀胱切除术（RC）是最复杂的外科手术之一。测量RC术后结果的系统方法可以持续识别改进领域，可用于及时采取纠正措施。我们回顾了可用的改善结果的方法。累积求和图有可能成为一种强大的方法，能够发出早期预警，从而启动根本原因分析。这种早期预警系统可能有助于迅速解决问题，而无需等待年度审计报告。该系统对于监测个人的学习曲线也很有帮助，无论是在培训期间还是在学习新技术时。
