Uptake and impact of synoptic reporting in a community care setting

Synoptic report: Interests of structured standardized operative report in renal surgery

The synoptic operative report (SOR) is a model with several advantages but still not enough adopted. We studied the performance of a SOR template (FileMaker Pro®, FMP) versus the usual narrative operative report (NOR) template on DxCare® software (DXC) of the urology department at the Georges-Pompidou European Hospital by comparing the number of completed data, the completeness rate, the writing time, and the writing speed and by analyzing the learning curve. Over an 11-week period between March and June 2021, 118 case-control OR for 59 laparoscopic or open, partial or total nephrectomy procedures, for all indications were prospectively created. The number of completed data was higher on FMP (113, IQR: 92-122 vs. 59, IQR: 54-70). SOR done on FMP were more complete (95.1%±4.1 vs. 85.5%±6.1; P<0.001). Creation time was longer on FMP (9.07±2.94 vs. 7.66±2.88min; P=0.008). However, FMP generated a database and an OR faster than NOR (9.07±2.94 vs. 12.9±3.2min; P<0.001). The speed of data-filling was higher on FMP (12.9±3.5 vs. 9.2±3.7 data/min; P<0.001). There was a progressive improvement in SOR creation with a Pearson correlation coefficient of -0.313 (P=0.044) independent of the writer. The use of the SOR FMP template seems to be more efficient on data recording but an improvement of the template to make it faster to use should be sought through recommendations from a panel of experts. LEVEL OF EVIDENCE: 3.

Technical Standards for Cancer Surgery: Improving Patient Care through Synoptic Operative Reporting

The Operative Standards for Cancer Surgery manuals define critical elements of optimal cancer surgery based on data and expert opinion. These key aspects of commonly performed cancer operations define technical standards that can be used as a quality assurance tool for practicing surgical oncologists and as an educational tool for trainees. This article provides background on these operative standards and their subsequent integration into synoptic operative report templates. With the goal of codifying the most important aspects of surgical oncology care to elevate and harmonize cancer care, the American College of Surgeons Cancer Programs has developed comprehensive synoptic operative reports. Synoptic operative reports are structured so that key data elements are recorded in a standardized format with prespecified terminology. In contrast to the narrative or structured operative reports frequently used by surgeons, these synoptic operative reports improve semantic clarity, provide uniform fields for abstraction, and facilitate passive data collection and real-time analytics while delivering key information for downstream multidisciplinary patient care. In this way, the synoptic operative report is a key component of a comprehensive effort to elevate the quality of cancer care nationally.

European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma

BACKGROUND

Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care.

OBJECTIVE

In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma.

METHODS

QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs.

RESULTS

Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.

Orde ab Chao Method for Disruptive Innovations Creation (With COVID-19 Pandemic Case Application)

This paper introduces a novel method for the creation of ideas for disruptive innovations. It provides an application of innovation management techniques to specifics of disruptive technologies, which stand behind the Industry 4.0 (and Society 4.0) changes that are taking place at present. Centered around the Ordo ab Chao technique, the paper presents how contemporary disruptive technologies can attain reflections in the complex creative process that has to lead to disruptive ideas and innovations. Quite some innovative thinking techniques already exist. However, they fail to place emphasis on creation of ideas that are tied to emerging disruptive technologies so as to further deploy them in a focused, yet innovative manner. Hence, this paper presents an effective technique that facilitates creation of disruptive ideas with a focused potential for real-life implementations. Practical application of the method related to challenges in higher education processes amid the COVID-19 pandemic is also demonstrated. Based on the understanding of existing disruptive technologies, the technique is used for the adaptation and improvements of distance-learning processes to further add value for students and our society in general. In brief, the Ordo ab Chao technique is a promising tool for systematic development of disruptive solutions, representing a creative synergy between cutting-edge technologies and innovation management approaches.

Current perspectives on video and audio recording inside the surgical operating room: results of a cross-disciplinary survey

The availability of intraoperative multimedia recording is increasing. Considering the growing call for physicians’ accountability, it is inevitable that multimedia will play an important role in aiding quality control by improving the adequacy of operative reporting. However, the perspectives of medical professionals on this matter are poorly known. In this cross-disciplinary survey, we aimed to investigate the current viewpoints concerning the use of multimedia recording in the operating room. We conducted an electronic survey among all affiliated members of the Association of Surgeons of the Netherlands, the Dutch Urological Association and the Dutch Society of Obstetrics and Gynecology containing questions regarding current use of intraoperative recording and the level of likelihood or objection for certain scenarios. The response rate was 27.8%. The survey encompasses 370 (54.5%) surgeons, 71 (10.5%) urologists, 80 (11.8%) gynecologists, and 158 (23.3%) residents in training. 52.4% of respondents feel that the currently used operative report is insufficient for future quality requirements. 58.5% think it is unlikely they would behave differently during surgery when intra-operative video recording is applied. 82.8% think it is unlikely that their surgical methods would be altered. 63.8% of respondents preferred only video registration when intraoperative recording is implemented. The majority of respondents agree that the current method of operative reporting is insufficient for future quality requirements. There is support for intraoperative video recording, however, legal transparency is needed before either intraoperative video or audio recording could be implemented to protect not only the patients, but also the healthcare providers.

Do surgeons convey all the details? A provincial assessment of operative reporting for breast cancer

INTRODUCTION

A breast cancer synoptic operative report was developed using a modified Delphi process METHODS: Data from the British Columbia Cancer Breast Cancer Outcomes Unit (BCOU) was used to analyze the association between the completion of a synoptic operative report and reporting of operative details and The American Society of Breast Surgeons quality indicators.

RESULTS

3662 patients had surgery for breast cancer by 185 surgeons. 2281 reports were narrative and 1007 synoptic. Requested surgical details were more commonly reported with synoptic reports for both posterior (96 vs 58%, p < 0.0001) and anterior margins (96 vs 5%, p < 0.0001). This was true for high and low volume surgeons. Quality Indicators were higher in those cases with an associated synoptic report for high and low volume surgeons.

CONCLUSION

Communication of operative details is improved with synoptic reporting. Investment in platforms to facilitate synoptic reporting could improve patient care through improved multidisciplinary communication.

Completeness of operative reports for rectal cancer surgery

INTRODUCTION

Synoptic operative reporting has been shown to improve completeness and consistency in surgical documentation. We sought to determine whether operative reports contain the key elements recommended by the National Accreditation Program for Rectal Cancer.

METHODS

Rectal cancer operative reports from June-December 2018 were submitted from ten hospitals in Michigan. These reports were analyzed to identify key elements in the synoptic operative template and assessed for completeness.

RESULTS

In total, 110 operative reports were reviewed. Thirty-one (28%) reports contained all 24 elements; all of these reports used a synoptic template. Overall, 62 (56%) reports used a synoptic template and 48 (44%) did not. Using a synoptic template significantly improved documentation, as these reports contained 92% of required elements, compared to 39% for narrative reports (p < 0.001).

CONCLUSIONS/DISCUSSION

Narrative operative reports inconsistently document rectal cancer resection. This study provides evidence that synoptic reporting will improve quality of documentation for rectal cancer surgery.

Synoptic reporting in Mohs micrographic surgery

There is currently no standardised reporting format for Mohs surgery with its operation reports mostly written in a narrative form making them prone to unintentional errors and omission of necessary data. Synoptic histology reporting is used to describe excised skin cancers such as melanomas and, more recently, squamous cell and basal cell carcinomas. Since Mohs surgery is utilised as the gold standard treatment for locally invasive squamous and basal cell carcinomas, we propose the use of our model of synoptic reporting to ensure the completeness and consistency of Mohs surgery operation reports.