Evidence map›Paper›PMID 30154219›Full record

ArticleCMAJ open

Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study.

Timothy Jackson, David Schramm, Husein Moloo, Lee Fairclough, Azusa Maeda, Tricia Beath, Avery Nathens

Abstract read
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. 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

7 authors.

Timothy JacksonDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont. timothy.jackson@uhn.ca.
David SchrammDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
Husein MolooDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
Lee FaircloughDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
Azusa MaedaDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
Tricia BeathDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
Avery NathensDepartment of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals.

methodsAll Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools. Outcome measures included the level of quality-improvement capacity, collaborative-wide aggregate data on postoperative complications, and self-reported rates of surgical site and urinary tract infections.

resultsEighteen hospitals that enrolled in the ON-SQIN in 2015 reported an increase in their capacity for quality improvement after 18 months. Analysis of the collaborative-wide aggregate data in a 6-month period (14 748 surgical cases) revealed a substantial reduction of acute renal failure (relative risk 0.48, 95% confidence interval 0.25-0.95) and urinary tract infection (relative risk 0.77, 95% confidence interval 0.61-0.97). Most hospitals that targeted prevention of surgical site infection and urinary tract infection reported reduction of these occurrences during a 1-year period.

interpretationThe ON-SQIN supported the uptake of the NSQIP in Ontario hospitals and promoted targeted surgical quality-improvement initiatives, resulting in increased quality-improvement capacity and development of the community of practice. Furthermore, our early experience suggests that improvements in surgical care are being realized.

Identifiers

PMID30154219
PMCPMC6182121

What OpenQuestion holds

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Registered trials

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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.