TY - JOUR
T1 - Novel assessments of technical and nontechnical cardiac surgery quality
T2 - Protocol for a mixed methods study
AU - Likosky, Donald
AU - Yule, Steven J.
AU - Mathis, Michael R.
AU - Dias, Roger D.
AU - Corso, Jason J.
AU - Zhang, Min
AU - Krein, Sarah L.
AU - Caldwell, Matthew D.
AU - Louis, Nathan
AU - Janda, Allison M.
AU - Shah, Nirav J.
AU - Pagani, Francis D.
AU - Stakich-Alpirez, Korana
AU - Manojlovich, Milisa M.
N1 - Publisher Copyright:
© Donald Likosky, Steven J Yule, Michael R Mathis, Roger D Dias, Jason J Corso, Min Zhang, Sarah L Krein, Matthew D Caldwell, Nathan Louis, Allison M Janda, Nirav J Shah, Francis D Pagani, Korana Stakich-Alpirez, Milisa M Manojlovich
PY - 2021/1
Y1 - 2021/1
N2 - Background: Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Objective: The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. Methods: This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. Results: The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. Conclusions: We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon's technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/22536.
AB - Background: Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Objective: The objectives of this study are to (1) investigate the relationship between peer assessments of intraoperative technical skills and nontechnical practices with risk-adjusted complication rates and (2) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and nontechnical practices. Methods: This multicenter study will use video recording, established peer assessment tools, electronic health record data, registry data, and a high-dimensional computer vision approach to (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based nontechnical practices and variability in risk-adjusted patient adverse events; and (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven, computer-based assessments to automate the measurement of important intraoperative determinants of risk-adjusted patient adverse events. Results: The project has been funded by the National Heart, Lung and Blood Institute in 2019 (R01HL146619). Preliminary Institutional Review Board review has been completed at the University of Michigan by the Institutional Review Boards of the University of Michigan Medical School. Conclusions: We anticipate that this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon's technical skills and operating room team member nontechnical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/22536.
KW - Cardiac surgery
KW - Complications
KW - Coronary artery bypass grafting surgery
KW - Improvement
KW - Intraoperative
KW - Patient risk
KW - Protocol
KW - Quality
KW - Study
KW - Variation
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U2 - 10.2196/22536
DO - 10.2196/22536
M3 - Article
AN - SCOPUS:85099173236
VL - 10
JO - JMIR Research Protocols
JF - JMIR Research Protocols
IS - 1
M1 - e22536
ER -