title: Quality Improvement Initiatives in Colorectal Surgery: Value of Physician Feedback.
abstract: BACKGROUND
  The impact of process improvement through surgeon feedback on outcomes is unclear.
  
  
  OBJECTIVE
  We sought to evaluate the effect of biannual surgeon-specific feedback on outcomes and adherence to departmental and Surgical Care Improvement Project process measures on colorectal surgery outcomes.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected 100% capture surgical quality improvement data.
  
  
  METHODS
  This study was conducted at the department of colorectal surgery at a tertiary care teaching hospital from January 2008 through December 2013.
  
  
  METHODS
  Each surgeon was provided with biannual feedback on process adherence and surgeon-specific outcomes of urinary tract infection, deep vein thrombosis, surgical site infection, anastomotic leak, 30-day readmission, reoperation, and mortality. We recorded adherence to Surgical Care Improvement Project process measures and departmentally implemented measures (ie, anastomotic leak testing) as well as surgeon-specific outcomes.
  
  
  RESULTS
  We abstracted 7975 operations. There was no difference in demographics, laparoscopy, or blood loss. Adherence to catheter removal increased from 73% to 100% (p < 0.0001), whereas urinary tract infection decreased 52% (p < 0.01). Adherence to thromboprophylaxis administration remained unchanged as did the deep vein thrombosis rate (p = not significant). Adherence to preoperative antibiotic administration increased from 72% to 100% (p < 0.0001), whereas surgical site infection did not change (7.6%-6.6%; p = 0.3). There were 2589 operative encounters with anastomoses. For right-sided anastomoses, the proportion of handsewn anastomoses declined from 19% to 1.5% (p < 0.001). For left-sided anastomoses, without diversion, anastomotic leak testing adherence increased from 88% to 95% (p < 0.01). Overall leak rate decreased from 5.2% to 2.9% (p < 0.05).
  
  
  CONCLUSIONS
  Concurrent process changes make isolation of the impact from individual process improvement changes challenging.
  
  
  CONCLUSIONS
  Nearly complete adherence to process measures for deep vein thrombosis and surgical site infection did not lead to measureable outcomes improvement. Process measure adherence was associated with decreased rate of anastomotic leak and urinary tract infection. Biannual surgeon-specific feedback of outcomes was associated with improved process measure adherence and improvement in surgical quality.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Waters
authors.forename: Todd
authors.initials: T
authors.lastname: Francone
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: Caitlin
authors.initials: C
authors.lastname: Stafford
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control; D019072:Antibiotic Prophylaxis; D003107:Colorectal Surgery / Q000592:standards*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012086:Reoperation; D012189:Retrospective Studies; D066231:Surgeons; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D062606:Tertiary Care Centers; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control