Development of quality indicators to assess emergency general surgery

Editor's Note

Development of and adherence to quality indicators by providers may improve the quality of emergency general surgery, for which current outcomes are modifiable, finds this study.

Of 25 quality indicators developed and rated as valid, there were 13 for patient-level and 12 for hospital-level quality. Adherence with 18 indicators was assessed.

Compliance with:

• performing cholecystectomy for acute cholecystitis within 72 hours of symptoms onset ranged from 45% to 76%
• surgery start times within 3 hours from decision to operate for uncontained perforated viscus ranged from 20% to 100%
• exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of decision to operate was 0% to 88%.

None of the providers were compliant with three quality indicators:

• auditing 30-day planned readmissions/operations for patients managed nonoperatively
• monitoring time to source for intra-abdominal infections
• having protocols for bypass/transfer.

Developing indicators for providers to assess their performance provides a foundation for specific initiatives, the authors say.

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators.