Using an Electronic Perioperative Documentation Tool to Identify Returns to Operating Room (ROR) in a Tertiary Care Academic Medical Center
The metric “Unplanned returns to operating room (ROR)” is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR...
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Veröffentlicht in: | Joint Commission journal on quality and patient safety 2017-03, Vol.43 (3), p.138-145 |
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Zusammenfassung: | The metric “Unplanned returns to operating room (ROR)” is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers.
A real-time electronic tool was used to identify all RORs—planned and unplanned—in a high-volume, high-complexity academic surgical practice at Mayo Clinic–Rochester within 45 days of the index operation. Analysis by ROR type and indication was performed.
During the analysis period (June 2014–February 2015) 44,031 operations were performed, with 5,552 subsequent RORs (13%). Of all RORs, 51% (n = 2,818) were planned staged returns, 29% (n = 1,589) were unrelated, 15% (n = 830) were unplanned and 6% (n = 315) were planned because of previous complications. Overall, unplanned reoperations were uncommon (n = 830, 2% of all operations). The most common indications for unplanned RORs included “other” (32%, n = 266), bleeding related (24%, n = 198) and wound complications (20%, n = 166).
In a high-volume, high-complexity academic surgical practice, RORs occurred after 13% of cases. Unplanned returns were infrequent and usually were associated with complications; most RORs were planned staged or unrelated returns. A simple ROR metric that does not consider planned/unrelated returns is likely not a valid surgical quality measure. Electronic tools designed specifically to identify in real-time RORs, associated indication, and clinical validation should provide more reliable data for public reporting and quality improvement efforts. |
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ISSN: | 1553-7250 1938-131X |
DOI: | 10.1016/j.jcjq.2016.11.003 |