From the Health Data Department, Hospices Civils de Lyon, Université de Lyon 1.
Brigham and Women's Hospital-Harvard Medical School, Center for Surgery and Public Health, Boston, Massachusetts.
J Patient Saf. 2023 Mar 1;19(2):110-116. doi: 10.1097/PTS.0000000000001103. Epub 2023 Jan 6.
The control chart is a graphical tool for data interpretation that detects aberrant variations in specific metrics, ideally leading to the identification of special causes that can be resolved. A clear assessment of control chart utilization and its potential impact in surgery is required to justify recommendations for its dissemination. This review aims to describe how performance monitoring using control charts was used over time in surgery.
A systematic search of PubMed regarding statistical process control in surgery from its inception until December 2019 was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Information extracted from selected publications included study aim and population setting, monitored indicators, control charts methodological parameters, and implementation strategy.
One hundred thirteen studies met the selection criteria with a median of 1916 monitored patients. Overall, 57.5% of studies focused on control chart methodology, 24.8% aimed at evaluating performance changes using control charts retrospectively, and 17.7% implemented control charts for continuous quality improvement prospectively. Although there was a great diversity of used indicators and charting tools, the evaluation of patient safety (72.6%) or efficiency (15.9%) metrics based on Shewhart control chart (33.6%) or cumulative sum chart (54.9%) were common. To foster control charts implementation, 14 studies promoted their periodic review, but only three assessed their impact on patient outcomes.
The scientific literature supports the feasibility and utility of control chart to improve patient safety in multiple surgical settings. Additional studies are necessary to reveal the optimal manner in which to implement this affordable tool in surgical practice.
控制图是一种用于数据分析的图形工具，可用于检测特定指标中的异常变化，理想情况下可以识别出可以解决的特殊原因。为了证明推广控制图使用的合理性，需要对控制图的使用情况及其在外科手术中的潜在影响进行明确评估。本综述旨在描述控制图在外科手术中的使用情况随时间的变化。
根据系统综述和荟萃分析首选报告项目的指南，对从一开始到 2019 年 12 月期间在 PubMed 上发表的关于外科手术中统计过程控制的研究进行了系统搜索。从选定的出版物中提取的信息包括研究目的和人群设置、监测指标、控制图方法参数和实施策略。
符合选择标准的研究有 113 项，中位数为 1916 例监测患者。总体而言，57.5%的研究关注控制图方法，24.8%旨在使用控制图回顾性评估绩效变化，17.7%前瞻性地为持续质量改进实施控制图。尽管使用的指标和图表工具种类繁多，但基于休哈特控制图（33.6%）或累积和图（54.9%）评估患者安全性（72.6%）或效率（15.9%）指标较为常见。为了促进控制图的实施，有 14 项研究促进了其定期审查，但只有三项研究评估了其对患者结局的影响。
科学文献支持控制图在多种外科环境中提高患者安全性的可行性和实用性。需要进一步的研究来揭示在外科实践中实施这种经济实惠的工具的最佳方式。
