RT Journal Article
SR Electronic
T1 Multicentre positive deviance to reduce adverse events and length of stay after pulmonary resection
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e001997
DO 10.1136/bmjoq-2022-001997
VO 12
IS 1
A1 Andrew J E Seely
A1 Zubair Ahmadzai
A1 Daniel G French
A1 Molly Gingrich
A1 Daniel Jones
A1 Caitlin Anstee
A1 Najib Safieddine
A1 Thomas K Waddell
A1 Richard Malthaner
A1 Lorenzo Ferri
A1 Christian Finley
A1 Gail Darling
YR 2023
UL http://bmjopenquality.bmj.com/content/12/1/e001997.abstract
AB Background Postoperative adverse events (AEs) following pulmonary resection enormously impact patient well-being, length of stay (LOS) and healthcare costs. Standardised AE data collection can be used to identify positive outliers demonstrating positive deviance (PD) who may be helpful to inform the best practice. Here, we describe our initial experience of a novel quality improvement process using PD to reduce LOS and AEs.Methods AE rates and LOS were collected from four centres (2014–2020) using a common dictionary. Surgeons repeatedly participated in 60 to 90 min seminars consisting of the following process: identify outcome and procedure targeted, review relevant best evidence literature, view all data anonymised by surgeon or centre (if multicentre), choose and reveal identity of best performance PD outliers, who discuss their management principles while all receive self-evaluation reports, followed by collegial discussion to generate consensus recommendations, voted by all. We assessed overall impact on AEs and LOS using aggregate data in a before/after analysis.Results A total of 131 surgeons (average 12/seminar) participated in 11 PD seminars (8 local and 3 multicentre), yielding 85 consensus recommendation (average 8/seminar). Median LOS following lobectomy decreased from 4.0 to 3.0 days (p=0.04) following local PD seminars and from 4.0 to 3.5 days (p=0.11) following multicentre seminars. Trends for reductions in multiple AE rates were also observed.Conclusion While limited by the longitudinal design, these findings provide preliminary support for this data-driven, collegial and actionable quality improvement process to help standardise and improve patient care, and merits further more rigorous investigation.All data relevant to the study are included in the article or uploaded as online supplemental information. All data relevant to the findings of this study are contained within the text and online supplemental information. Additional lower level data are available on reasonable request.