Initiating statistical process control to improve quality outcomes in colorectal surgery

Area of Science:

• Colorectal Surgery
• Healthcare Quality Improvement
• Statistical Process Control

Background:

• Unexpected variations in postoperative length of stay (LOS) negatively impact hospital resources and patient outcomes.
• Statistical process control (SPC) is a methodology for monitoring performance and driving process improvement.

Purpose of the Study:

• To initiate SPC for identifying length of stay (LOS) outliers in colorectal surgery.
• To evaluate the feasibility of SPC in improving surgical outcomes.

Main Methods:

• A prospective database of colorectal procedures was reviewed.
• Patients were stratified by elective/emergent and open/laparoscopic approaches.
• SPC was applied to identify LOS outliers and analyze associated characteristics within each group.

Main Results:

• 1294 cases were analyzed; 83% elective, 17% emergent.
• LOS outliers ranged from 8.6% to 10.8% across surgical groups.
• Outliers exhibited higher ASA scores, longer operating times, ICU needs, and increased complication/readmission rates.

Conclusions:

• SPC is a feasible and promising tool for enhancing colorectal surgery outcomes.
• SPC effectively identified patient and process factors contributing to increased LOS.
• This methodology supports real-time outlier identification and outcome reevaluation for quality improvement.