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ABSTRACT: Most hospital work can be seen as linked processes. Designed to examine process performance, control charts allow distinction between two types of variation. While processes that exhibit special cause variation are unstable and should be improved by eliminating special causes, processes exhibiting only common cause variation are predictable and should be improved by fundamental redesign. Control charts are also key tools to monitor such intended changes. This paper provides an overview of the most common types of control charts and the most important interpretation rules.
Ugeskrift for laeger 04/2009; 171(11):895-8.
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ABSTRACT: Predictors of a poor surgical outcome are numerous, of which some are well-defined. We aimed to assess risk factors predictive of poor surgical outcome across different gastrointestinal operations related to the patient, the disease, the treatment, and the organization of care.
Data from 5,255 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 was prospectively recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and complexity, and the surgeon's training. Variables predictive of mortality and complications occurring within 30 days after surgery were assessed by multiple logistic regression analysis.
After elective operation, the 30-day mortality was 2.8% and major complications occurred in 11.5% of the patients. The corresponding figures in emergency surgery were 13.8% and 30.1%. Independent of elective or emergency surgery, dependent functional status, and type of operation were associated with postoperative mortality. Comorbidity, type of operation, blood loss, and reoperation were predictors of complications regardless of elective or emergency operation. In elective surgery, predictors of poor surgical outcome were high age, comorbidity, malignancy, and the surgeons training, whereas abnormal vital signs values and peritonitis were predictors of poor outcome after emergency surgery.
Premorbid factors, characteristics of the disease, the patients' preoperative condition, operative factors, and the surgeon's training are all associated with surgical outcome across different gastrointestinal operations and should be assessed when auditing surgical outcome.
Journal of Gastrointestinal Surgery 08/2007; 11(7):903-10. · 2.83 Impact Factor
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ABSTRACT: Surgical site infections and disruption of sutured tissue are frequent complications following surgery. We aimed to assess risk factors predictive of tissue and wound complications in open gastrointestinal surgery.
Data from 4855 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 were recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and severity, and the surgeon's training. Variables predictive of surgical site infection and dehiscence of sutured tissue within 30 days after surgery were assessed by multiple logistic regression analysis.
Following elective operation, the incidence of tissue and wound complications was 6% compared with 16% in emergency surgery (P < 0.001). These complications resulted in prolonged hospitalization in 50% of the patients and a 3-fold higher risk of reoperation but not increased mortality. Factors associated with complications following elective operations were smoking, comorbidity, and perioperative blood loss. Following emergency operations, male gender, peritonitis, and multiple operations were predictors of complications. Irrespective of elective or emergency surgery, the type of operation was a predictor of complications.
Factors known to affect the process of tissue and wound healing are independently associated with tissue and wound complications following gastrointestinal surgery.
Annals of Surgery 04/2005; 241(4):654-8. · 7.49 Impact Factor
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Ugeskrift for laeger 06/2004; 166(19):1787-91.
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Ugeskrift for laeger 06/2004; 166(19):1779-83.
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Ugeskrift for laeger 06/2004; 166(19):1784-7.
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Ugeskrift for laeger 12/2002; 164(46):5406; author reply 5406-7.
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ABSTRACT: This review states the work which has been done in Denmark on clinical indicators and large databases containing clinical data with nationwide coverage. The aim of the work was to obtain valid and reliable information on clinical quality to be used by clinicians, leaders, and the public. Nationally we have: 1) The needed experience related to identification and development of clinical indicators and construction of databases. 2) The necessary partners (scientific societies, hospital owners, primary care sector, and health authorities) are motivated and involved in a collaborative organisation. Nationally we lack: 1) Experience with implementation and use of clinical indicators. 2) An overview of the needed investments to ensure coverage of all important diseases, continuity in patient care, and improvement of the existing databases. 3) Fully integrated information systems.
Ugeskrift for laeger 10/2002; 164(38):4392-8.
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ABSTRACT: Generally, the use of clinical databases for quality development in the hospital sector has not been satisfactory. A substantial problem attaches to the IT systems used hitherto. This article describes a number of requirements which the National Indicator Project has specified for a forthcoming second generation of clinical database system. Besides, the second generation system Clinical Performance Measurements which is used in the Copenhagen Hospital Corporation for several disease areas and for The Danish Vascular Registry is described. This experience emphasizes the need for central management of development initiatives within clinical quality databases. The management must allow for coordination, rational management and experience-based further development of IT systems for the clinical databases and integration with present and forthcoming systems including electronic patient record systems. The management should also allow for the decisive interaction between clinical quality development and medical informatics.
Ugeskrift for laeger 10/2002; 164(38):4398-405.
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ABSTRACT: Studies of connective tissue from patients with inguinal hernia have shown that smoking may be associated with hernia formation due to a defective connective tissue metabolism. Whether smoking is a risk factor for recurrence, too, was examined in this study. From December 1990 through December 1995, 649 patients underwent hernia repair as open sutured repair (Cooper ligament or abdominal ring repair) or as open mesh repair. Five hundred forty-four eligible patients were evaluated for recurrence 2 years postoperatively. Association between recurrence and 17 patient-, disease-, and intraoperative variables were analyzed by multiple logistic regression. The results showed that smoking was significantly and independently associated with recurrence compared to nonsmoking [odds ratio (OR = 2.22; 95% confidence interval (95% CI) = 1.19-4.15)]. Open sutured repair compared to open mesh repair was the most significant predictor for recurrence (OR = 7.23; 95% CI = 3.01-17.37). Surprisingly, local anesthesia was associated with a higher risk of recurrence compared to general anesthesia (OR = 2.44; 95% CI = 1.19-5.09). Potential confounders and other risk factors for hernia recurrence such as age, alcohol consumption, previous surgery, and anatomical characteristics of the hernia were adjusted for in the analysis. In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.
World Journal of Surgery 05/2002; 26(4):397-400. · 2.36 Impact Factor
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ABSTRACT: The operative courses of 294 elective consecutive colorectal resections were reviewed in order to evaluate the morbidity and
mortality of postoperative thromboembolic complications. All patients received low-dose heparin prophylaxis. Fifty-seven patients
were screened for deep venous thrombosis with the fibrinogen uptake test, and treatment of thromboembolism was started if
the diagnosis was established by venography and/or pulmonary scintigraphy. Neither the morbidity nor mortality from clinical
thromboembolic complications was lowered in the group of patients who were screened. Rectal surgery seems to carry a higher
risk of postoperative thromboembolic complications than colon surgery, and thromboembolic complications are responsible for
about half of the postoperative deaths following elective colorectal surgery.
Diseases of the Colon & Rectum 04/1988; 31(5):384-386. · 3.13 Impact Factor
