Open AccessQuality monitoring in thyroid surgery using the Shewhart control chart
Author(s) -
Duclos A.,
Touzet S.,
Soardo P.,
Colin C.,
Peix J. L.,
Lifante J. C.
Publication year - 2009
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.6418
Subject(s) - medicine , control chart , chart , shewhart individuals control chart , quality (philosophy) , thyroid , medical physics , statistics , ewma chart , mathematics , philosophy , process (computing) , epistemology , computer science , operating system
Background: A control chart can help to interpret and reduce sources of variability in patient safety by continuously monitoring indicators. The aim of this study was to monitor the outcome of thyroid surgery using control charts. Methods: Patients who had thyroid surgery during 2006–2007 were included in the study. Safety was monitored based on postoperative complications of recurrent laryngeal nerve palsy and hypocalcaemia. Indicators were extracted prospectively from the hospital information system and plotted each month on a P‐control chart. Performance of the surgical team was also measured retrospectively for 2004–2005 (baseline period) to compare surgical outcomes before and after control chart implementation. Electromyographic monitoring of recurrent laryngeal nerves was not used, nor was calcium or vitamin D given routinely. Results: The outcomes of 1114 thyroid procedures were monitored. Although the proportion of patients with recurrent laryngeal nerve palsy was similar for baseline and monitored periods (6·4 and 7·2 per cent respectively), there was a 35·3 per cent decrease in hypocalcaemia after implementation of control charts ( P < 0·001). Complications almost doubled during a period when one surgeon was away and operating room renovations took place. Conclusion: Outcome monitoring in thyroid surgery using control charts is useful for identifying potential issues in patient safety. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.