A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes

BACKGROUND

The current healthcare system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality healthcare processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among healthcare providers may not be valid OBJECTIVE: To develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator STUDY DESIGN: This is a prospective international multicenter implementation study. A web-based application (.www.qusum.org) was developed with three main goals: to measure the surgeon's performance using three primary outcomes (blood loss, operative time, and complications); to provide immediate individual feedback using cumulative Observed-minus-Expected graphs; and to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter, a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale.

RESULTS

A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100±39 minutes, blood loss 127±163ml, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5±13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance.

CONCLUSIONS

We report the development and test of a real-time, dynamic quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures.