Currently submitted to: JMIR Research Protocols
Date Submitted: Jul 22, 2020
Open Peer Review Period: Jul 22, 2020 - Sep 16, 2020
(currently open for review)
Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality: Protocol for a Mixed Methods Study
Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative approach explain only 2% of hospital variation in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement.
The objectives of this study are to: (i) investigate the relationship between peer assessments of intraoperative technical skills and non-technical practices with risk-adjusted complication rates and (ii) evaluate the feasibility of using computer-based metrics to automate the assessment of important intraoperative technical skills and non-technical practices.
This multi-center study will use video-recording, established peer assessment tools, electronic health record data, registry data and a high-dimensional computer vision approach to: (1) investigate the relationship between peer assessments of surgeon technical skills and variability in risk-adjusted patient adverse events; (2) investigate the relationship between peer assessments of intraoperative team-based non-technical practices and variability in risk-adjusted patient adverse events; (3) use quantitative and qualitative methods to explore the feasibility of using objective, data-driven computer-based assessments to automate the measurement of significant, intraoperative determinants of risk-adjusted patient adverse events.
The project was funded by the National Heart, Lung and Blood Institute in 2019 and enrollment for the overall project is expected to begin in 2020.
We anticipate this project will substantially increase our ability to assess determinants of variation in complication rates by specifically studying a surgeon’s technical skills and operating room team member non-technical practices. These findings may provide effective targets for future trials or quality improvement initiatives to enhance the quality and safety of cardiac surgical patient care. Clinical Trial: -
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