Best Practices For Measuring Surgical Outcomes

As the field of outcomes research has developed in the last decade, surgeons and hospitals have become aware that post-operative adverse events are common. These events contribute greatly to the increasing and already significant cost of healthcare [1].

In order to improve healthcare and assess the effectiveness of a surgery or program, hospitals must measure post-operative outcomes. Often this information justifies the existence or funding for certain procedures.

A new approach to medical documentation, synoptic reporting, allows surgeons and clinicians to both gather and analyze data in a standardized way, ensuring a smoother method for tracking surgical outcomes.

Current issues with measuring surgical outcomes

Outcomes research is picking up momentum in surgical fields, but several issues complicate measuring outcomes[2], such as:

  • Intervention efficacy is often not immediately apparent.
  • Post-surgical complications can be delayed.
  • Patient follow-up is limited and/or difficult.
  • Significant differences in surgical specialties means there is no ‘one size fits all’ approach appropriate to every surgical field.
  • Determining what, and how, to measure.

Indeed, the last issue could be the most difficult to grapple with, as research supports that surgeries and hospitals that do measure outcomes may be influenced by the agenda of researchers or service payers. This means they not be focused on improving the quality of care from the perspective of patients[3].

Clinical outcomes versus patient-reported outcomes

In hospitals that do consistently measure surgical outcomes, these are typically limited to very basic areas, such as survival. Clinical outcomes are the traditional way of measuring success, but the medical industry is quickly learning that these are not enough.

In studies that ask patients to report on their post-surgical outcomes, patients report much more varied responses. Patient-reported outcomes (PROs) are vital because they provide a patient-led assessment of health and health-related quality of life.

Patients that had surgery to remove their cervical cancer, for instance, may report on post-surgery incontinence, their return to work, and their sexual energy and performance.

This data, beyond simply post-operative survival or similar clinical outcomes, could become the bedrock for whether patients opt for surgery. Using PROs on a regular basis can help align the surgeon’s and the patient’s view of post-operative reality[4]. Hospitals can also use PROs to focus funding and improvement efforts.

The pros and cons of clinical documentation

Today the majority of electronic medical documentation is a wide-open data field into which surgeons enter relevant information which is typically typed, narrated, or transcribed. Surgeons are meticulous, and we can often rely on their clinical documentation to be consistent from patient to patient.

The issue, then, is the consistency from surgeon to surgeon: imagine that one surgeon may report on a young man who is obese, while a different surgeon may report that he is 25-years old with a BMI of 31. While this provides good patient background in a casual, narrative way, there’s no easy way to collect data consistently from clinical documentation.

To gather and analyze outcomes from clinical notes, administrative staff or interns typically spend hours poring over this narrated information in attempts to find trackable, standardized data.

Improving medical documentation and patient care with synoptic reporting

Surgeons and clinicians are starting to adopt synoptic reporting, a new clinical documentation method, to begin or enhance measuring post-operative outcomes. This method changes from the open text field common to most electronic health records (EHR) systems to a structured and standardized method of capturing clinical data [5].

Structured checklists, like those developed from the College of American Pathologists (CAP) Cancer Protocols and Cancer Checklists, prompt surgeons to report on data that is relevant but may otherwise not be top-of-mind. These checklists are coded and discrete, prompting for clarifying details while hiding irrelevant details.

Synoptic reporting means clinical reporting is faster to produce than narrative medical transcription. The synoptic reports capture data that is consistent and easy to interpret, thereby making clinical research and quality assurance easier to perform. Surgeons and clinicians can customize the templates. Importantly, surgeons and clinics who use synoptic reporting for medical documentation report streamlined workflows [6].

Synoptic reporting is a better for medical documentation because it produces results that can be measured and analyzed, which leads to the improved quality and safety of patient care and the decreased cost of healthcare.

References:

  1. Maggard-Gibbons, M. The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program. BMJ Quality & Safety. 2014; 2397); 589-599.
  2. Measuring surgical outcomes. Royal College of Surgeons Web site. https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/measuring-surgical-outcomes/ Accessed February 16, 2017.
  3. Nelson, EC, Eftimovska E, Lind C, Hager A, Wasson JH, Lindblad Staffan. Patient report outcome measures in practice. BMJ.  2015; 350: g7818
  4. Barry, Michael J., Edgman-Levitan, Susan. Shared decision making – the pinnacle of patient-centered care. The New England Journal of Medicine. 2012; 366; 7801-781.
  5. Synoptic reporting. Canada Health Infoway Web site. https://www.infoway-inforoute.ca/en/solutions/clinicians-e-services/synoptic-reporting Accessed February 16, 2017.
  6. Temple WJ, Francis WP, Tamano E, Dabbs K, Mack LA, Fields A; Cancer Surgery Alberta. Synoptic surgical reporting for breast cancer surgery: an innovation in knowledge translation. American Journal of Surgery. 2010; 199(6); 770-775.