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Control charts to identify adverse outcomes in elective colon resection
Donald E Fry1, Michael Pine, Barbara L Jones
1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. dfry@consultmpa.com
American Journal of Surgery
|December 31, 2011
Summary
Control charts effectively measure surgical quality by identifying outliers in risk-adjusted postoperative length of stay (RApoLOS). These charts correlate with coded complications and hospital costs, aiding quality improvement initiatives.
Area of Science:
- Healthcare Quality Improvement
- Surgical Outcomes Analysis
- Statistical Process Control
Background:
- Control charts are established tools for monitoring quality in healthcare settings.
- Assessing surgical care quality requires robust measurement methods.
- Postoperative length of stay is a key indicator of surgical patient outcomes.
Purpose of the Study:
- To evaluate the utility of average moving range control charts for risk-adjusted postoperative length of stay (RApoLOS) in measuring surgical quality.
- To correlate RApoLOS outliers with coded complications (CCs) and hospital costs.
- To determine the validity of control charts for surgical quality assessment.
Main Methods:
- Utilized the 2005 National Inpatient Sample database for 181 hospitals.
- Constructed average moving range control charts for RApoLOS for patients undergoing elective colectomy.
- Correlated RApoLOS outliers (at 2.0σ, 2.5σ, 3.0σ) with CCs and hospital costs.
Main Results:
- A significant proportion of live discharges were identified as RApoLOS outliers across different control limits.
- A high percentage of RApoLOS outliers were associated with coded complications.
- Increased hospital costs were linked to RApoLOS outliers, though less strongly to CCs alone.
Conclusions:
- Average moving range control charts for RApoLOS are valid and effective tools for measuring surgical quality.
- These charts provide valuable insights into surgical care performance and associated costs.
- Control charts can aid in identifying areas for quality improvement in surgical procedures.
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