Surgeons and Quality Improvement: Individuals in an Evolving Process

Abstract

Volume 9 Issue 2 presents an interesting series of articles that illustrate approaches to some of the many complications that occur following complex reconstructive procedures. These include a creative approach to the reconstruction of the quadriceps tendon in a diabetic patient and a new pharmacologic prophylaxis against heterotopic ossification. Morrison and his coauthors provide a thorough review of the increased risk of periprosthetic infection in patients with inflammatory arthropathy and address prevention, diagnosis, and treatment when this devastating complication occurs. I am particularly interested in the report by Dr. Klatt and colleagues which examined the blood utilization experience following total joint arthroplasty in a large hospital network. We live and work in an era of reform. It seems that most aspects of our practice are now subject to review with the aim that standardized practice should supplant the variability of the judgment and experience of the individual practitioner. Dr. Klatt’s report is a valuable lesson for those of us who debate these changes in practice. They found that blood utilization was conservative for most of the practitioners on their service and that the over use of blood transfusion could be attributed to two outliers. Over utilization of blood products is an obvious quality concern. Surgeons respond most often to evidence and data as well as to peer pressure. It will be interesting to note if these two outliers have modified their practice after review of the data regarding the use of transfusion by their colleagues on the service as a whole. At Hospital for Special Surgery, we have found peer review to be a valuable technique in the quest for quality improvement. Understanding how your own performance compares to your colleagues can provide useful insight that prompts a change for the better in your practice. I hope you enjoy reading these interesting articles. I also eagerly encourage you to consider the HSS Journal as a valuable forum for the publication of your future work.