title: Systematic methods for measuring outcomes: How they may be used to improve outcomes after Radical cystectomy.
abstract: In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.
authors.affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Khurram M
authors.initials: KM
authors.lastname: Siddiqui
authors.affiliation: Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
keywords: (RA-)CUSUM, (risk-adjusted) cumulative summation; Charts; Cumulative summation; M&M, mortality and morbidity; POSSUM, (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity; Quality assurance; RC, radical cystectomy; RCA, root-cause analysis; Systematic methods; VLAD, variable life-adjusted display