Correspondence
Comment on ‘Why do we do the same things so differently?’ doi:10.1111/codi.12672
Dear Sir, We read with interest the recent editorial ‘Why do we do the same things so differently?’ [1]. We agree with the points raised and wanted to add a further few. As the article states, for a wide variety of surgical conditions and situations there is no clear evidence for performing one particular surgical technique over another. This in itself, however, does not mean that we should avoid standardization. Having a variety of different techniques for one situation within an individual organization may not be a good thing and can lead to more safety issues with associated increased costs. The aviation industry has made huge progress over the last 30 years in reducing air crashes. One of the main methods for this has been to establish standard operating procedures (SOPs) for as many situations as possible, even where no convincing evidence exists as to which is better. The high-profile emergency landing on the Hudson River is an excellent example of this. The copilot and pilot had never met each other until the morning of the flight (which is a common situation in commercial flying) but as they had clear SOPs they were able to react knowing exactly what the other would do and safely land their plane on the Hudson without any loss of life [2]. Surgery is vastly more complex that commercial flying but there are still many areas of surgery that could have SOPs; for example, the anastomotic technique for a standard right hemicolectomy. No convincing evidence exists for any particular technique and consequently many different methods are used within each hospital [3]. Across the UK, multiple techniques are used with a variety of suturing or stapling techniques. This creates problems for procurement in terms of stock and increases the complexity of ensuring the equipment is ready for each case. More important is the impact on training. The majority of bowel anastomoses are performed by trainees under consultant supervision [4]. The technique they use will depend on the consultant with whom they are working at the time and so they often perform each technique (with its own peculiarities) rarely. Surely it would make sense to settle on one SOP for ileo-colic anastomosis? Standardization will reduce costs, simplify training and save lives.
642
R. Bethune* and R. Longman*† *University Hospitals Bristol NHS Trust, Bristol, UK and †School of Surgery, Severn Deanery, Bristol, UK E-mail: [email protected] Received 16 April 2014; accepted 23 April 2014; Accepted Article online 22 May 2014
References 1 Wille-Jorgensen P. Why do we do the same things so differently? Colorectal Dis 2014; 16: 155. 2 National Transportation Safety Board. Loss of thrust in both engines after encountering a flock of birds and subsequent ditching of the Hudson river. 2009. http://www.ntsb.gov/ investigations/summary/AAR1003.html (accessed 1 April 2014). 3 Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis. JAMA Surg 2013; 148: 190–201. 4 Tottrup A. Surveillance of surgical training by detailed electronic registration of logical components. Postgrad Med J 2002; 78: 607–11.
Response to Mroczkowski (2014): Lost in translation, or overestimating administrative data for outcome control in colorectal surgery doi:10.1111/codi.12655
Dear Sir, We sincerely thank the Editors for offering us the opportunity to reply to the editorial related to our manuscript [1]. We will attempt to respond to the many comments raised. The Global Comparators (GC) initiative represents an international collaboration of institutions that have elected to share their administrative data for the purposes of quality improvement (QI). The initiative is much broader than just colorectal surgery and has already achieved significant success in QI through the sharing of best clinical practice amongst international participants. The purpose of this collaboration is not, and never was, intended for outcome performancereporting to the general public. Rather, its development was for internal use amongst the participating group to promote learning and to direct QI efforts through understanding the processes employed by highly performing units. The translation of coding systems was an essential step in this process so that comparisons could
Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 640–647
Comment on ‘Why do we do the same things so differently?’ doi:10.1111/codi.12672
Dear Sir, We read with interest the recent editorial ‘Why do we do the same things so differently?’ [1]. We agree with the points raised and wanted to add a further few. As the article states, for a wide variety of surgical conditions and situations there is no clear evidence for performing one particular surgical technique over another. This in itself, however, does not mean that we should avoid standardization. Having a variety of different techniques for one situation within an individual organization may not be a good thing and can lead to more safety issues with associated increased costs. The aviation industry has made huge progress over the last 30 years in reducing air crashes. One of the main methods for this has been to establish standard operating procedures (SOPs) for as many situations as possible, even where no convincing evidence exists as to which is better. The high-profile emergency landing on the Hudson River is an excellent example of this. The copilot and pilot had never met each other until the morning of the flight (which is a common situation in commercial flying) but as they had clear SOPs they were able to react knowing exactly what the other would do and safely land their plane on the Hudson without any loss of life [2]. Surgery is vastly more complex that commercial flying but there are still many areas of surgery that could have SOPs; for example, the anastomotic technique for a standard right hemicolectomy. No convincing evidence exists for any particular technique and consequently many different methods are used within each hospital [3]. Across the UK, multiple techniques are used with a variety of suturing or stapling techniques. This creates problems for procurement in terms of stock and increases the complexity of ensuring the equipment is ready for each case. More important is the impact on training. The majority of bowel anastomoses are performed by trainees under consultant supervision [4]. The technique they use will depend on the consultant with whom they are working at the time and so they often perform each technique (with its own peculiarities) rarely. Surely it would make sense to settle on one SOP for ileo-colic anastomosis? Standardization will reduce costs, simplify training and save lives.
642
R. Bethune* and R. Longman*† *University Hospitals Bristol NHS Trust, Bristol, UK and †School of Surgery, Severn Deanery, Bristol, UK E-mail: [email protected] Received 16 April 2014; accepted 23 April 2014; Accepted Article online 22 May 2014
References 1 Wille-Jorgensen P. Why do we do the same things so differently? Colorectal Dis 2014; 16: 155. 2 National Transportation Safety Board. Loss of thrust in both engines after encountering a flock of birds and subsequent ditching of the Hudson river. 2009. http://www.ntsb.gov/ investigations/summary/AAR1003.html (accessed 1 April 2014). 3 Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis. JAMA Surg 2013; 148: 190–201. 4 Tottrup A. Surveillance of surgical training by detailed electronic registration of logical components. Postgrad Med J 2002; 78: 607–11.
Response to Mroczkowski (2014): Lost in translation, or overestimating administrative data for outcome control in colorectal surgery doi:10.1111/codi.12655
Dear Sir, We sincerely thank the Editors for offering us the opportunity to reply to the editorial related to our manuscript [1]. We will attempt to respond to the many comments raised. The Global Comparators (GC) initiative represents an international collaboration of institutions that have elected to share their administrative data for the purposes of quality improvement (QI). The initiative is much broader than just colorectal surgery and has already achieved significant success in QI through the sharing of best clinical practice amongst international participants. The purpose of this collaboration is not, and never was, intended for outcome performancereporting to the general public. Rather, its development was for internal use amongst the participating group to promote learning and to direct QI efforts through understanding the processes employed by highly performing units. The translation of coding systems was an essential step in this process so that comparisons could
Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 640–647
