AIMS: To apply cumulative sum (CUSUM) in monitoring performance of surgeons in cataract surgery and to evaluate the response of performance to intervention. METHOD: A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees' CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries. RESULTS: CUSUM charts of the trainees demonstrated an initial upward followed by flattening trend. This reflects learning curves in their process of acquiring competency in phacoemulsification. In contrast, the consultant showed a flat curve indicating an ongoing maintenance of competence. CONCLUSION: The CUSUM analysis is able to monitor and promptly detect adverse events and trends of unacceptable outcomes in cataract surgery. This objective and dynamic monitoring makes CUSUM a useful audit tool for individual surgeons, but more so for busy consultants who need to supervise trainees.
AIMS: To apply cumulative sum (CUSUM) in monitoring performance of surgeons in cataract surgery and to evaluate the response of performance to intervention. METHOD: A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees' CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries. RESULTS: CUSUM charts of the trainees demonstrated an initial upward followed by flattening trend. This reflects learning curves in their process of acquiring competency in phacoemulsification. In contrast, the consultant showed a flat curve indicating an ongoing maintenance of competence. CONCLUSION: The CUSUM analysis is able to monitor and promptly detect adverse events and trends of unacceptable outcomes in cataract surgery. This objective and dynamic monitoring makes CUSUM a useful audit tool for individual surgeons, but more so for busy consultants who need to supervise trainees.
Authors: Gustavo Vedana; Filipe G Cardoso; Alexandre S Marcon; Licio E K Araújo; Matheus Zanon; Daniella C Birriel; Guilherme Watte; Albert S Jun Journal: Int J Ophthalmol Date: 2017-07-18 Impact factor: 1.779
Authors: Sachin Wani; Samuel Han; Violette Simon; Matthew Hall; Dayna Early; Eva Aagaard; Wasif M Abidi; Subhas Banerjee; Todd H Baron; Michael Bartel; Erik Bowman; Brian C Brauer; Jonathan M Buscaglia; Linda Carlin; Amitabh Chak; Hemant Chatrath; Abhishek Choudhary; Bradley Confer; Gregory A Coté; Koushik K Das; Christopher J DiMaio; Andrew M Dries; Steven A Edmundowicz; Abdul Hamid El Chafic; Ihab El Hajj; Swan Ellert; Jason Ferreira; Anthony Gamboa; Ian S Gan; Lisa Gangarosa; Bhargava Gannavarapu; Stuart R Gordon; Nalini M Guda; Hazem T Hammad; Cynthia Harris; Sujai Jalaj; Paul Jowell; Sana Kenshil; Jason Klapman; Michael L Kochman; Sri Komanduri; Gabriel Lang; Linda S Lee; David E Loren; Frank J Lukens; Daniel Mullady; Raman V Muthusamy; Andrew S Nett; Mojtaba S Olyaee; Kavous Pakseresht; Pranith Perera; Patrick Pfau; Cyrus Piraka; John M Poneros; Amit Rastogi; Anthony Razzak; Brian Riff; Shreyas Saligram; James M Scheiman; Isaiah Schuster; Raj J Shah; Rishi Sharma; Joshua P Spaete; Ajaypal Singh; Muhammad Sohail; Jayaprakash Sreenarasimhaiah; Tyler Stevens; James H Tabibian; Demetrios Tzimas; Dushant S Uppal; Shiro Urayama; Domenico Vitterbo; Andrew Y Wang; Wahid Wassef; Patrick Yachimski; Sergio Zepeda-Gomez; Tobias Zuchelli; Rajesh N Keswani Journal: Gastrointest Endosc Date: 2019-02-07 Impact factor: 9.427
Authors: Rena Yadlapati; Rajesh N Keswani; Jody D Ciolino; David P Grande; Zoe I Listernick; Dustin A Carlson; Donald O Castell; Kerry B Dunbar; Andrew J Gawron; C Prakash Gyawali; Philip O Katz; David Katzka; Brian E Lacy; Stuart J Spechler; Roger Tatum; Marcelo F Vela; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2016-07-27 Impact factor: 11.382
Authors: Sachin Wani; Matthew Hall; Rajesh N Keswani; Harry R Aslanian; Brenna Casey; Rebecca Burbridge; Amitabh Chak; Ann M Chen; Gregory Cote; Steven A Edmundowicz; Ashley L Faulx; Thomas G Hollander; Linda S Lee; Daniel Mullady; Faris Murad; V Raman Muthusamy; Patrick R Pfau; James M Scheiman; Jeffrey Tokar; Mihir S Wagh; Rabindra Watson; Dayna Early Journal: Clin Gastroenterol Hepatol Date: 2014-11-14 Impact factor: 11.382