Evidence map›Paper›PMID 33900420›Full record

ArticleWorld journal of surgery2021

Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru.

Katherine R Iverson, Lina Roa, Sebastian Shu, Milagros Wong, Shayna Rubenstein, Paloma Zavala, Luke Caddell, Cole Graham, Jorge Colina, Segundo R Leon and 2 more

Abstract read
PubMed Publisher
In one paragraph

Article in World journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.5field-weighted citation impact, top 35% 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

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Review
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

12 authors at 6 institutions in 3 countries.

Katherine R IversonDepartment of Surgery, Medical Center, University of California, Davis, 2335 Stockton Blvd, North Addition 5th floor, Sacramento, CA, 95817, USA. katie.r.iverson@gmail.com.ORCID 0000-0002-5261-8027
Lina RoaProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Sebastian ShuProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Milagros WongSocios En Salud, Lima, Peru.
Shayna RubensteinTufts University School of Medicine, Boston, MA, USA.
Paloma ZavalaSocios En Salud, Lima, Peru.
Luke CaddellProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Cole GrahamSocios En Salud, Lima, Peru.
Jorge ColinaDepartment of Surgery, Sergio E. Bernales National Hospital, Lima, Peru.
Segundo R LeonSocios En Salud, Lima, Peru.
Leonid LeccaSocios En Salud, Lima, Peru.
Gita N ModyDivision of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
EsSALUD · PEHarvard University · USTufts University · USUniversidad Privada San Juan Bautista · PEUniversidad Privada Sergio Bernales · PEUniversity of North Carolina at Chapel Hill · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn resource-limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru.

methodsDuring the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the surgery waitlist included up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank-sum test.

resultsAt the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre-existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre- and post-intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant.

conclusionThe process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy-in from all participants and disruptions in surgical services from bed shortages.

Indexed as

Cost of IllnessQuality ImprovementElective Surgical ProceduresHospitals, PublicHumansPeru

Identifiers

PMID33900420
OpenAlexW3157622021

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.