Key result
An improved implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information immediately leads to quicker detection of surgical process deterioration.
An improved implementation of the risk-adjusted Bernoulli CUSUM chart allows for earlier detection of surgical performance deterioration by incorporating outcomes immediately.
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May facilitate earlier responses to declining surgical performance; extends CUSUM methods but leaves open prospective validation.
METHODOLOGY ISSUE: The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. PROPOSED SOLUTION: We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. EVALUATION: A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. ADVICE TO PRACTITIONERS: Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems.
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Keefe et al. (2017) studied Surgical outcome quality monitoring. Improved implementation of the risk-adjusted Bernoulli CUSUM chart vs. Traditional implementation of the risk-adjusted Bernoulli CUSUM chart was evaluated on Detection of process deterioration. An improved implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information immediately leads to quicker detection of surgical process deterioration.
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