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<a target="_blank" rel="noopener" href="https://fatcat.wiki/container/vumuxnjohndezob4p7wrnzf3ce" style="color: black;">Canadian journal of surgery</a>
Emergency general surgery conditions are often thought of as being too acute and unpredictable for the development of standardized approaches to quality improvement (QI). However, process mapping, a concept that has been applied extensively in manufacturing, has been used to understand opportunities for improvement in complex health care processes. This study uses process mapping to deconstruct the surgical care of patients presenting to emergency general surgery (EGS) services with acute small<span class="external-identifiers"> <a target="_blank" rel="external noopener noreferrer" href="https://doi.org/10.1503/cjs.005617">doi:10.1503/cjs.005617</a> <a target="_blank" rel="external noopener" href="https://fatcat.wiki/release/th6qr2nyvngnjokgkce53mncc4">fatcat:th6qr2nyvngnjokgkce53mncc4</a> </span>
more »... bowel obstruction (SBO). Methods: The American College of Surgeons Emergency General Surgery Quality Improvement Program (EQIP) pilot database was used to identify patients presenting to a single, large teaching hospital over a 1-year period (Mar. 1, 2015, to Mar. 1, 2016) for the nonoperative or operative management of SBO. The EQIP database and chart and electronic health records were used to create process maps for each patient. These maps were evaluated to identify important process issues and areas for improvement. Results: Eighty-seven patients with SBO (34 operative, 53 nonoperative) were identified. Three were excluded for not being admitting to general surgery. Operative SBO 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. Data visualization strategies were used to identify bottlenecks in care and demonstrated substantial variability in terms of operating room access. Conclusion: Complication rates in the operative care of SBO are high and represent an important QI opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures. At our centre, we are directing plan-do-study-act (PDSA) cycles and developing standardized orders and approaches based on process map inputs. Remote transatlantic mentored telemedical support during trauma resuscitation and prolonged field care.
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