Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.
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.
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.
A C
AC
Wei
Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON.
K S
KS
Devitt
Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON.
M
M
Wiebe
Department of Surgery and Oncology, University of Calgary, Calgary, AB.
O F
OF
Bathe
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. ; Division of General Surgery, Mount Sinai Hospital, Department of Surgery, University of Toronto, Toronto, ON.
R S
RS
McLeod
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.
D R
DR
Urbach
Quality improvement; cancer surgery; clinical pathways; knowledge translation; patient safety; perioperative care