RT Journal Article
SR Electronic
T1 Early Experience with a Hepatobiliary and Pancreatic Quality Improvement Program
JF BMJ Quality Improvement Reports
JO BMJ Qual Improv Report
FD British Medical Journal Publishing Group
SP u201158.w721
DO 10.1136/bmjquality.u201158.w721
VO 2
IS 2
A1 Derek O'Reilly
A1 Rachel Edmiston
A1 Pooja Bijoor
A1 Rahul Deshpande
A1 Nicola de'Liguori Carino
A1 Basil Ammori
A1 David J. Sherlock
YR 2013
UL http://bmjopenquality.bmj.com/content/2/2/u201158.w721.abstract
AB This project aims to assess the impact of the introduction of a hepatobiliary and pancreatic (HPB) Quality Improvement Program (QIP) on postoperative complications following liver, biliary and pancreatic surgery. A prospective analysis of postoperative complications over a six month period was performed. Complications were analysed and graded according to internationally agreed definitions. Justification was sought and errors identified. Weekly meetings were performed to review each complication enabling an action plan to be created to prevent future recurrence. Rates were compared with previously audited and published results, using the chi-square test. A total of 326 procedures were performed over the six months including 30 pancreatectomies, 45 liver resections and 251 other procedures. 37 patients developed complications (11.3%) with 47 complications in total including two deaths. Using the ISGPS grading, eight complications were identified; two grade A, four grade B and two grade C. There were three grade A ISGLS complications and one grade B. 30 complications were justified as unavoidable, 16 as avoidable and one as indeterminate. Action plans included continued monitoring (n=41), formulation of new policy (n=3), individual counselling (n=4), educational offering (n=4). When compared with 2010 complication rates, 114 complications occurred in 233 liver operations during the baseline period, compared with 17 complications in 45 liver operations during the QIP period, OR=0.63 (95% CI: 0.33 to 1.22), p=0.17 and 86 complications occurred in 99 pancreatic resections during the baseline period, compared with 20 complications in 30 pancreatic resections during the QIP period OR=0.30 (95% CI: 0.12 to 0.79), p=0.01 The HPB QIP is a rigorous approach to grade every complication and death. A statistically significant reduction in pancreas related complications has already been obtained. Further work is required to determine the persistence and magnitude of this quality improvement.