The 2008 Second Global Patient Safety Challenge sponsored by the World Health Organization articulated 10 “essential objectives for safe surgery”. One of these is to “establish routine surveillance of surgical capacity, volume, and results” at the hospital level. There can be little doubt that this recommendation was made in the expectation that longitudinal surveillance and analysis of surgical results could lead to quality improvements in care and improved patient outcomes.
In this linked study, Duclos and colleagues investigated a surveillance system the central feature of which was the use of Shewhart control charts. Originally developed to monitor industrial processes, control charts track variability in key process indicators over time and provide visual feedback on both positive and negative trends. This allows evaluation of the impact of process changes or, in the case of a negative trend, it triggers investigation into the causes and the formulation of appropriate responses.
They found that the implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements.