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Changing Outcomes 

C-SATS recently worked with a large multi-hospital health system on the West Coast to evaluate the impact of its surgeons' technical performance on patient and system-level outcomes.  C-SATS worked with the Chief Medical Officer, Chief of Staff and the OB/GYN Division to establish a process for intra-operative video review.  Customized surgeon dashboards were created to provide meaningful and actionable post-appraisal feedback.  

  • C-SATS assembled 1,000 independent reviewers in hours
  • Generated over 11,000 data points
  • Average review time of 2.5 hours per video 
 

results:

The outcomes of 4 of 6 surgeons, including the top and bottom performers, correlated directly with their technical skills as measured by C-SATS.

  Indicators of Success = Average surgeon rank for case volume, patient length of stay, cut-to-close time, patient in-to-out time, complications, 30 day readmissions, transfusion rate, supply cost and total direct cost.

 

Indicators of Success = Average surgeon rank for case volume, patient length of stay, cut-to-close time, patient in-to-out time, complications, 30 day readmissions, transfusion rate, supply cost and total direct cost.


Users of C-SATS receive detailed feedback and recommendations to improve their skills.

Feedback provides the means for continuous improvement.  In a study from UCLA and the University of Michigan, Dr. Carter and team determined video-based peer feedback was associated with “better simulation scores for the intervention group than for controls” and “greater comfort level with the robotic surgery and greater learning satisfaction than controls.”  (Annals of Surgery, May 2015)

Actual comments provided by C-SATS reviewers:

Progress through the dissection in a fluid and efficient manner. Judicious use of cautery. Uses the fourth arm well to facilitate dissection.”
— C-SATS reviewer
Exposure is helped by the left instrument and the movements are precise with the mono polar and bipolar. Often doing something with both hands at the same time.”
— C-SATS reviewer
This surgeon is obviously very good, however perhaps for the sake of speed, he/she may be sacrificing adequate caution. First the placement of the two most lateral sutures did not actually incorporate the angles of the vagina. When placing the last suture in the midline the operator should have left the needle attached and used it to help with the knot tying. Instead, the needle was quickly cut off and dropped. Fortunately it was found, but a lost needle is a significant avoidable complication. Speed is great but not at the cost of safety.”
— C-SATS reviewer

Healthcare systems realize significant cost savings when their practitioners use proper technique, procedure and protocol. Failures of care delivery, which include “poor execution or lack of widespread adoption of best practices," account for $154 billion in wasteful healthcare spending. (JAMA, April 2012)