Abstract
BackgroundQuality improvement (QI) methods are widely used in surgery in an effort to improve care, often using techniques such as Plan-Do-Study-Act cycles to implement specific interventions. Explicit definition of both the QI method and quality intervention is necessary to enable the accurate replication of effective interventions in practice, facilitate cumulative learning, reduce research waste and optimise benefits to patients. This systematic review aims to assess quality of reporting of QI methods and quality interventions in perioperative care.MethodsStudies reporting on quality interventions implemented in perioperative care settings will be identified. Searches will be conducted in the Ovid SP version of Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organisation of Care database and the related articles function of PubMed. The journal BMJ Quality will be searched separately. Search strategy terms will relate to (i) surgery, (ii) QI and (iii) evaluation methods. Explicit exclusion and inclusion criteria will be applied. Data from studies will be extracted using a data extraction form. The Template for Intervention Description and Replication (TIDieR) checklist will be used to evaluate quality of reporting, together with additional items aimed at assessing QI methods specifically.Systematic review registrationPROSPERO http://CRD42014012845
Highlights
Quality improvement (QI) methods are widely used in surgery in an effort to improve care, often using techniques such as Plan-Do-Study-Act cycles to implement specific interventions
Systematic review has evaluated data generated by QI methods across cardiothoracic, colorectal [14], vascular, hepatobiliary and upper gastrointestinal specialties [2,15,16] and has reported measureable improvements across the whole perioperative journey including the preoperative period, intraoperative period and postoperative period Yet the QI literature in surgery has been found to suffer from a range of problems including lack of explicit rationale, poor detail and overlapping components in the published descriptions of QI methods [2,19] and quality interventions [20]
This review has a number of strengths and limitations. It will be the first review assessing how well QI methods and quality interventions are described across diverse settings in perioperative care
Summary
Design We will undertake a review of the published qualitative and quantitative surgical literature on QI. All surgical specialities Adult surgical services Elective and emergency (trauma) surgery Primary and secondary care, because hospital stay is just one aspect of the surgical patient's whole pathway [23] Studies using both validated and unvalidated measures Studies meeting the criteria within the QI taxonomy generated by Shojania et al [24] (Table 1) All epubs ahead of print which are indexed in one of the selected databases by the end date specified for the review QI papers reporting upon a deliberate effort to produce change in perioperative care This may be in the form of a QI report, or a study of a QI method or quality intervention. Qualitative papers reporting exclusively on staff or patient experience of using QI methods
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