International journal of health care quality assurance · 2009
Maximising safety of cataract surgery training: improving patient safety by reducing cataract surgery complication rates.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Goh E-Shawn
Аннотация
PURPOSE: Cataract surgery is a highly successful, high-volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost-effective, high-quality services that meet the needs of patients. This paper aims to describe 18-month results of a sustainable program to maximize the safety of cataract surgery training.
DESIGN/METHODOLOGY/APPROACH: Modifications to the comprehensive cataract-training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.
FINDINGS: Prior to intervention, PCR rates for trainee-surgeons averaged 3.34 per cent cf international published figures of 4.6-10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p < 0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow-up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p < 0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p < 0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.
RESEARCH LIMITATIONS/IMPLICATIONS: Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.
PRACTICAL IMPLICATIONS: Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.
ORIGINALITY/VALUE: This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.
DESIGN/METHODOLOGY/APPROACH: Modifications to the comprehensive cataract-training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.
FINDINGS: Prior to intervention, PCR rates for trainee-surgeons averaged 3.34 per cent cf international published figures of 4.6-10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p < 0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow-up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p < 0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p < 0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.
RESEARCH LIMITATIONS/IMPLICATIONS: Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.
PRACTICAL IMPLICATIONS: Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.
ORIGINALITY/VALUE: This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.