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BMC Surgery
Published in: BMC Surgery 1/2014

Open Access 01-12-2014 | Research article

Improving quality through process change: a scoping review of process improvement tools in cancer surgery

Authors: Alice C Wei, David R Urbach, Katharine S Devitt, Meagan Wiebe, Oliver F Bathe, Robin S McLeod, Erin D Kennedy, Nancy N Baxter

Published in: BMC Surgery | Issue 1/2014

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Abstract

Background

Surgery is a cornerstone of treatment for malignancy. However, significant variation has been reported in patterns and quality of cancer care for important health outcomes, including perioperative mortality. Surgical process improvement tools (SPITs) have been developed that focus on enhancing the processes of care at the point of care, as a means of quality improvement. This study describes SPITs and develops a conceptual framework by synthesizing the available literature on these novel quality improvement tools.

Methods

A scoping review was conducted based on instruments developed for quality improvement in surgery. The search was executed on electronically indexed sources (MEDLINE, EMBASE, and the Cochrane library) from January 1990 to March 2011. Data were extracted, tabulated and reported thematically using a narrative synthesis approach. These results were used to develop a conceptual framework that describes and classifies SPITs.

Results

232 articles were reviewed for data extraction and analysis. SPITs identified were classified into 3 groups: clinical mapping tools, structure communication tools and error reduction instruments. The dominant instrument reported were clinical mapping tools, including: clinical pathways (113, 48%), fast track (46, 20%) and enhanced recovery after surgery protocols (36, 15%). Outcomes reported included: length of stay (174, 75%), readmission rates (116, 50%), morbidity (116, 50%), mortality (104, 45%), and economic (60, 26%). Many gaps in the literature were recognized.

Conclusion

We have developed a conceptual framework of SPITs and identified gaps in current knowledge. These results will guide the design and development of new quality instruments in surgery.
Appendix
Available only for authorised users
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Metadata
Title
Improving quality through process change: a scoping review of process improvement tools in cancer surgery
Authors
Alice C Wei
David R Urbach
Katharine S Devitt
Meagan Wiebe
Oliver F Bathe
Robin S McLeod
Erin D Kennedy
Nancy N Baxter
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2014
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-14-45

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