Evidence map›Paper›PMID 29368672›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie2018

Process mapping as a framework for performance improvement in emergency general surgery.

Kristin DeGirolamo, Karan D'Souza, William Hall, Emilie Joos, Naisan Garraway, Chad Kim Sing, Patrick McLaughlin, Morad Hameed

Open access · bronzeAbstract read
PubMed Full text at PMC
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Process mapping in healthcare: a systematic review.BMC health services research · 2021
    Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Kristin DeGirolamoFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Karan D'SouzaFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
William HallFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Emilie JoosFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Naisan GarrawayFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Chad Kim SingFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Patrick McLaughlinFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Morad HameedFrom the Division of Trauma and Acute Care Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (DeGirolamo, Joos, Garraway, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, D'Souza, Joos, Garraway, Sing, McLaughlin, Hameed); the Centre for Clinical Epidemiology and Evaluation, School of Population and Public Health, University of British Columbia, Vancouver, BC (Hall); the Department of Emergency Medicine, University of British Columbia, Vancouver, BC (Sing); and the Department of Radiology, University of British Columbia, Vancouver, BC (McLaughlin).
Centre for Advancing Health Outcomes · CAUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement.

methodsWe used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge.

resultsEighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access.

conclusionVariability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

Indexed as

AdultAgedAged, 80 and overBritish ColumbiaEmergency MedicineFemaleGeneral SurgeryHumansIntestinal ObstructionIntestine, SmallMaleMiddle AgedProcess Assessment, Health CareQuality ImprovementSurgical Procedures, OperativeTrauma Centers

Identifiers

PMID29368672
PMCPMC5785284
OpenAlexW2743391646

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.