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Surgical quality indicators in low-resource settings: A new evidence-based tool
Isabelle Citron1, Saurabh Saluja2, Julia Amundson1
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.
Surgery
|August 5, 2018
Summary
A new tool measures surgical care quality in low-resource settings. This evidence-based framework includes 15 indicators for safe, effective, patient-centered, timely, efficient, and equitable surgical care.
Area of Science:
- Global Health
- Surgical Quality Improvement
- Health Systems Research
Background:
- Improving surgical care access globally requires concurrent quality enhancements.
- Measuring surgical quality is crucial but challenging, especially in low-resource environments.
- This report introduces a novel, evidence-based tool designed to assess surgical care quality in resource-limited settings.
Purpose of the Study:
- To develop a comprehensive, multidimensional conceptual framework for surgical quality.
- To evaluate existing quality metrics for suitability in low-resource contexts.
- To create new, evidence-based indicators to form a complete quality assessment tool.
Main Methods:
- Defined a widely applicable, multidimensional conceptual framework for surgical quality.
- Assessed the applicability of current quality metrics in low-resource settings.
- Developed and validated new indicators to complement the framework, condensing them into practical collection tools.
Main Results:
- A set of 15 final evidence-based indicators was defined, covering structure, process, and outcome domains.
- Indicators include: morbidity and mortality conference, safe surgery checklist use, perioperative mortality rate, Clavien-Dindo complications, provider density, procedure rates, C-section rates, informed consent, patient satisfaction, travel time, emergency surgery time, follow-up plans, OR usage, income disparity, and catastrophic expenditure.
- The metrics were organized into four distinct collection sources and tools.
Conclusions:
- The developed tool offers an evidence-based conceptual framework for evaluating surgical care quality.
- This tool is applicable across diverse low-resource settings.
- It provides a standardized method for assessing and improving surgical care quality where resources are limited.
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