title: Raising the quality of hernia care: Is there a need?
abstract: BACKGROUND
  With a focus on raising the quality of hernia care through creation of educational programs, SAGES formed the Hernia Task Force (HTF). This study used needs assessment survey to target opportunities for improving surgical training and thus patient outcomes and experience.
  
  
  METHODS
  This qualitative study included structured interviews and online surveys of key stakeholders: HTF members, surgeons, nurses, patients, hospital administrators, healthcare payers and medical suppliers. Questions included perceptions of recurrence and complication rates, their etiologies, perceived deficits in current hernia care and the most effective and training modalities.
  
  
  RESULTS
  A total of 841 participants included 665 surgeons, 66 patient care team members, 12 hospital administrators and 14 medical supply providers. Assessment of technical approach revealed that nearly 26 % of surgeons apply the same, limited range of techniques to all patients without evaluation of patient-specific factors. The majority (71 %) of surgeon respondents related hernia recurrence rates nearing 25 % or more. HTF members implicated surgeon factors (deficits in knowledge/technique, etc.) as primary determinants of recurrences, whereas nurses, medical supply providers and hospital administrators implicated patient health factors. Surgeons preferred attending conferences (82 %), reading periodicals/publications (71 %), watching videos (59 %) and communicating with peers (57 %) for learning and skill improvement. Topics of the greatest interest were advanced techniques for hernia repairs (71 %), preoperative and intraoperative decision making (56 %) and patient outcomes (64 %). Eighty-six percent of nurses felt that there was room for improvement in hernia patient safety and teamwork in the OR. Only 24 % believed that the patients had adequate preoperative education.
  
  
  CONCLUSIONS
  Major reported deficits in hernia care include: lack of standardization in training and care, "one size fits all" technical approach and inadequate patient follow-up/outcome measures. There is a need for a comprehensive, flexible and tailored educational program to equip surgeons and their teams to raise the quality of hernia care and bring greater value to their patients.
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway Dr., 1st Floor, Annapolis, MD, 21401, USA, apark@aahs.org.
authors.forename: Adrian E
authors.initials: AE
authors.lastname: Park
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Zahiri
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.forename: Guy
authors.initials: G
authors.lastname: Voeller
mesh_terms: D019985:Benchmarking; D046449:Hernia, Abdominal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards; D020380:Needs Assessment; D010348:Patient Care Team; D011183:Postoperative Complications; D012008:Recurrence; D011795:Surveys and Questionnaires; D014481:United States