Kristin DeGirolamo1, Karan D'Souza1, William Hall1, Emilie Joos1, Naisan Garraway1, Chad Kim Sing1, Patrick McLaughlin1, Morad Hameed1. 1. From the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Abstract
BACKGROUND: Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. METHODS: We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. RESULTS: Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. CONCLUSION: Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.
BACKGROUND: Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. METHODS: We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. RESULTS: Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. CONCLUSION: Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.
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