Implementation of a Synoptic Operative Report for Rectal Cancer: A Mixed-Methods Study.

糖心传媒

Abstract

The National Accreditation Program for Rectal Cancer is a collaborative effort to improve the quality of rectal cancer care, including multidisciplinary assessment, treatment planning, and documentation using synoptic radiology, pathology, and operative reports.The purpose of this study was to examine the implementation and use of a synoptic operative report for rectal cancer.This was a convergent mixed-methods implementation study of electronic medical record data, surveys, and qualitative interviews.The study was conducted at US medical centers.Colorectal surgeons were included.After development, the synoptic operative report was iteratively revised and ultimately approved by the American Society of Colon and Rectal Surgeons Executive Council and the National Accreditation Program for Rectal Cancer and then implemented into participants' institutional electronic medical record systems.Change in fidelity to documentation of 19 critical items after implementation of synoptic reports and in-depth details and perspectives about the synoptic operative report were measured.Thirty-seven surgeons from 14 institutions submitted preimplementation operative reports (n = 180); 32 of 37 surgeons submitted postimplementation reports (n = 118). The operation type, approach, and formation of a stoma were present in >70% of preimplementation reports; however, the location of the tumor, the type of reconstruction, and the distal margin were reported in <50%. Each item was present in =89% of postimplementation reports. Twenty eight of 37 participants completed the survey, and 21 of 37 participants completed qualitative interviews. Emergent themes included concerns for additional burden and time constraints using the synoptic report themselves, as well as errors or absent information in traditional narrative operative reports of other surgeons.The study was limited by its sample size, cross-sectional nature, specialized centers, and inclusion of colorectal surgeons only.Although fidelity to the 19 items substantially increased after implementation of the synoptic report, reactions to the synoptic report varied among surgeons. Many indicated concerns that it would hinder workflow or add extra time burden. Others felt the synoptic report could indirectly improve rectal cancer quality of care and provide useful data for quality improvement and 糖心传媒. More work is needed to update and improve the synoptic operative report and streamline the workflow. See Video Abstract at http://links.lww.com/DCR/B100. IMPLEMENTACI脫N DE UN INFORME OPERATIVO SIN脫PTICO PARA EL C脕NCER DE RECTO: UN ESTUDIO UTILIZANDO M脡TODOS MIXTOS: El Programa Nacional de Acreditaci贸n para el C谩ncer Rectal es una iniciativa de colaboraci贸n para mejorar la calidad de la atenci贸n del c谩ncer rectal, utilizando evaluaci贸n multidisciplinaria, planificaci贸n del tratamiento y documentaci贸n mediante radiolog铆a sin贸ptica, patolog铆a e informes quir煤rgicos.Examinar la implementaci贸n y el uso de un informe operativo sin贸ptico para el c谩ncer de recto.Estudio de implementaci贸n de m茅todos mixtos convergentes de datos de registros m茅dicos electr贸nicos, encuestas y entrevistas cualitativas.Centros m茅dicos de los Estados Unidos.Cirujanos colorrectales.Despu茅s de su formulaci贸n, el informe operativo sin贸ptico fue revisado de forma iterativa y finalmente aprobado por el Consejo Ejecutivo de la Sociedad Americana de Cirujanos de Colon y Rectal y el Programa Nacional de Acreditaci贸n para el C谩ncer Rectal. Posteriormente, se implement贸 en los sistemas de registros m茅dicos electr贸nicos institucionales de los participantes.Cambios en la precisi贸n de documentaci贸n de 19 铆tems cr铆ticos despu茅s de la implementaci贸n de informes sin贸pticos; Revisi贸n de detalles y perspectivas en a profundidad sobre el informe operativo sin贸ptico.Treinta y siete cirujanos de 14 instituciones presentaron informes operativos previos a la implementaci贸n (n = 180); 32/37 cirujanos presentaron informes posteriores a la implementaci贸n (n = 118). El tipo de operaci贸n, el enfoque y la formaci贸n de un estoma estuvieron presentes en > 70% de los informes previos a la implementaci贸n; sin embargo, la ubicaci贸n del tumor, el tipo de reconstrucci贸n y el margen distal se informaron en <50%. Cada 铆tem estuvo presente en > 89% de los informes posteriores a la implementaci贸n. 28/37 participantes completaron la encuesta y 21/37 participantes completaron entrevistas cualitativas. Los temas emergentes incluyeron preocupaciones por la carga adicional y las limitaciones de tiempo usando el informe sin贸ptico en s铆, y errores o informaci贸n ausente en los informes operativos narrativos tradicionales de otros cirujanos.Tama帽o de la muestra, estudio transversal, centros especializados, cirujanos colorrectales solamente.Aunque la fidelidad a los 19 铆tems aument贸 sustancialmente despu茅s de la implementaci贸n del informe sin贸ptico, las reacciones al informe sin贸ptico variaron entre los cirujanos. Muchos indicaron preocupaciones de que obstaculizar铆a el flujo de trabajo o agregar铆a una carga de tiempo adicional. Otros consideraron que el informe sin贸ptico podr铆a mejorar indirectamente la calidad de la atenci贸n del c谩ncer de recto y proporcionar datos 煤tiles para la mejora de la calidad y la investigaci贸n. Se necesita m谩s trabajo para actualizar y mejorar el informe operativo sin贸ptico y agilizar el flujo de trabajo. Consulte Video Resumen en http://links.lww.com/DCR/B100. (Traducci贸n-Dr. Adrian E. Ortega).

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