title: An audit and feedback system for effective quality improvement in head and neck surgery: Can we become better surgeons?
abstract: BACKGROUND
  An evaluation system was established for measuring physician performance. This study was designed to determine whether an initial evaluation with surgeon feedback improved subsequent performance.
  
  
  METHODS
  After an evaluation of an initial cohort of procedures (2004-2008), surgeons were given risk-adjusted individual feedback. Procedures in a postfeedback cohort (2009-2010) were then assessed. Both groups were further stratified into high-acuity procedure (HAP) and low-acuity procedure (LAP) groups. Negative performance measures included the length of the perioperative stay (2 days or longer for LAPs and 11 days or longer for HAPs); perioperative blood transfusions; a return to the operating room within 7 days; and readmission, surgical site infections, and mortality within 30 days.
  
  
  RESULTS
  There were 2618 procedures in the initial cohort and 1389 procedures in the postfeedback cohort. Factors affecting performance included the surgeon, the procedure's acuity, and patient comorbidities. There were no significant differences in the proportions of LAPs and HAPs or in the prevalence of patient comorbidities between the 2 assessment periods. The mean length of stay significantly decreased for LAPs from 2.1 to 1.5 days (P = .005) and for HAPs from 10.5 to 7 days (P = .003). The incidence of 1 or more negative performance indicators decreased significantly for LAPs from 39.1% to 28.6% (P < .001) and trended downward for HAPs from 60.9% to 53.5% (P = .081).
  
  
  CONCLUSIONS
  Periodic assessments of performance and outcomes are essential for continual quality improvement. Significant decreases in the length of stay and negative performance indicators were seen after feedback. Therefore, an audit and feedback system may be an effective means of improving quality of care and reducing practice variability within a surgical department.
authors: Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Carol M
authors: CM
authors: Lewis
authors: Marcus M
authors: MM
authors: Monroe
authors: Dianna B
authors: DB
authors: Roberts
authors: Amy C
authors: AC
authors: Hessel
authors: Stephen Y
authors: SY
authors: Lai
authors: Randal S
authors: RS
authors: Weber
mesh_terms: D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D002173:Cancer Care Facilities; D030141:Feedback, Psychological; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D016730:Program Development; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D066231:Surgeons / Q000592:standards / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology
keywords: audit; feedback; head neck cancer; head neck surgery; performance improvement; quality improvement
references: Med Teach. 2011;33(2):e113-20
references: 21275533
references: Arch Otolaryngol Head Neck Surg. 2010 Dec;136(12):1212-8
references: 21173370
references: J Am Coll Cardiol. 2012 Jun 19;59(25):2378-82
references: 22698492
references: J Eval Clin Pract. 2013 Apr;19(2):230-4
references: 22128773
references: BMJ. 2013;346:f3795
references: 23757757
references: J Public Health (Oxf). 2014 Jun;36(2):251-8
references: 23929885
references: Arch Surg. 2002 Jan;137(1):20-7
references: 11772210
references: Ann Thorac Surg. 1994 Dec;58(6):1852-7
references: 7979781
references: JAMA. 1995 Sep 6;274(9):700-5
references: 7650822
references: CMAJ. 1995 Nov 15;153(10):1423-31
references: 7585368
references: Ann Surg. 1998 Oct;228(4):491-507
references: 9790339
references: Surgery. 2005 Nov;138(5):837-43
references: 16291383
references: BMC Med Res Methodol. 2007;7:30
references: 17608932
references: Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1188-92
references: 18086958
references: Cochrane Database Syst Rev. 2012;6:CD000259
references: 22696318