Debate: should we use variable adjusted life displays (VLAD) to identify variations in performance in general surgery?
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Key result
Variable life adjusted displays (VLAD) provide a simple and continuous method for monitoring surgical performance in real-time, despite limitations in detecting certain variations in performance.
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Implication
VLAD may support real-time surgical monitoring; leaves open need for validation of detection limits before wider use.
Structured PICO
I
Intervention
Variable life adjusted display (VLAD)
The variable life adjusted display (VLAD) offers a simple method for continuous real-time monitoring of surgical performance, though its limitations in detecting sudden performance changes must be understood.
Limitations
- A good run of results may mask a subsequent poor run, requiring an excess of mortalities to cross the control limit and trigger a review.
- The VLAD lacks formal control limits, making it difficult to assess the possible contribution of random variation to performance.
- Risk adjustment models must be accurate and regularly updated, as outdated or flawed models can lead to inaccurate impressions of performance.
- Good runs may mask subsequent poor runs
- Lacks inherent control limits
- Risk models can rapidly become out of date
Cite This Study
́Neill et al. (2015) conducted an editorial in Surgical performance monitoring. Variable life adjusted displays (VLAD) vs. Conventional retrospective assessment was evaluated. Variable life adjusted displays (VLAD) provide a simple and continuous method for monitoring surgical performance in real-time, despite limitations in detecting certain variations in performance.
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