576911
olaryngology–Head and Neck SurgeryKrouse 2015© The Author(s) 2010
OTOXXX10.1177/0194599815576911Ot
Reprints and permission: sagepub.com/journalsPermissions.nav
Highlights
Highlights from the Current Issue: May 2015 John H. Krouse, MD, PhD, MBA1
I
t is my privilege to present to you highlights from the May 2015 issue of Otolaryngology–Head and Neck Surgery. This month we are going to be showcasing the critical topic of patient safety and quality improvement (PS/QI) in otolaryngology–head and neck surgery. With an appreciation for the role of individual and systematic factors in determining the successful outcome of medical interventions, physicians and health care providers in all specialties increasingly need to focus their efforts on decreasing adverse patient events and enhancing the quality and safety of their medical and surgical treatments. Please examine the commentaries and articles that explore this important issue in our field. To focus attention on the importance of teaching PS/QI in residency programs in otolaryngology–head and neck surgery, McCormick and colleagues examine the recent emphasis of the Accreditation Council for Graduate Medical Education (ACGME) in driving resident education this area.1 The authors stress that curricula must be developed and implemented across all residency programs to educate our young physicians in patient safety and quality. Using both didactic and experiential methods, traditional teaching conferences can become vibrant learning laboratories for instilling this critical knowledge base. McCormick and colleagues discuss both the nature of these curricula and the challenges for training programs in their establishment and operation. In our second article, Dahl and colleagues2 further look at an issue relevant to quality as they examine whether routine computed tomography (CT) imaging is necessary in children diagnosed with DFNB1 sensorineural hearing loss (SNHL). They compared 21 patients with DFNB1-related SNHL to matched control groups of 33 children with SNHL unrelated to DFNB1 and 33 children with conductive hearing loss, measuring cochleovestibular structures on high-resolution CT scans of the temporal bone. Dahl and colleagues did not find any significant differences in 16 specific CT measurements. They concluded that patients with DFNB1 do not have statistically significant differences in these cochleovestibular structures from other children with hearing loss and recommend against routine CT imaging in these individuals. In the next article, Wilson and associates3 examine the use of ecological momentary assessment of tinnitus among patients using smartphone technology. In this study, the authors sent text messages to subjects 4 times daily via their smartphone devices, asking them to rate the level of their tinnitus at that time. These 20 patients with moderate to severe tinnitus also recorded their
Otolaryngology– Head and Neck Surgery 2015, V ol. 152(5) 774–775 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815576911 http://otojournal.org
activity at that time, their stress level, and their location. Of the 1120 surveys sent out by this method, subjects responded to 79.4% of these individual queries at a median response time of 7 minutes. The authors describe the use of this methodology as a valuable technique for timely recording of instantaneous patientcentered data among individuals with tinnitus. This technique would have potential applicability in measuring patient symptoms in a wide range of illnesses. In another article, Mulvey and colleagues4 address the relationship between the volume of head and neck cancer surgery (HNCA) performed at individual institutions and the mortality rates accompanying those procedures. The authors used discharge data from nearly 160,000 patients who underwent head and neck cancer surgery at over 8500 hospitals in the United States between 2001 and 2010 and examined both the complication rates for surgery at those institutions as well as the mortality rates among those surgical cases. They then looked at low-volume institutions (mean HNCA cases, 6 annually), intermediate-volume institutions (mean HNCA cases, 37 annually), and high-volume institutions (mean HNCA cases, 131 annually) and noted that while the complication rates at institutions with these 3 case volumes did not differ significantly, mortality rates from these complications were significantly less at high-volume institutions than at facilities with lower HNCA volumes. Mortality rate from complications in these high-volume centers was 44% less than in low-volume institutions. Mulvey and colleagues present these decreased mortality rates as a failure to rescue patients from serious perioperative complications at low-volume hospitals. The authors discuss the implications of their thought-provoking findings for surgical care of patients with head and neck cancer. Finally, Misono and colleagues5 report on survival differences among patients with T1 glottic carcinomas as a function of comorbidities, sociodemographics, and facility characteristics. Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, the authors examined records of 2338 patients with T1 glottic squamous cell carcinomas treated between 1991 and 2009. In addition to looking at these factors, type of treatment was assessed, with patients 1
Temple University School of Medicine, Philadelphia, Pennsylvania, USA
Corresponding Author: John H. Krouse, Temple University School of Medicine, 3440 N. Broad St, Kresge West # 300, Philadelphia, PA 19140, USA. Email: [email protected]
Downloaded from oto.sagepub.com by guest on November 15, 2015
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Krouse receiving local surgery, radiation therapy, or a combination of the 2 treatment modalities. Results of the study demonstrated that black race and concurrent comorbidities were associated with decreased survival across treatments. Interestingly, when controlling for comorbidities, sociodemographics, and facility characteristics, survival differences were observed across treatment types, with those patients undergoing local surgery demonstrating better overall and cancer-specific survival. Misono and colleagues comment on these treatment differences and their implications for management of patients with T1 glottic carcinomas. Again, please explore these 5 articles, as well as the other interesting articles that you will find in this May 2015 issue. Please also enjoy our spotlight on patient safety and quality this month, beginning with the introductory editorial by our Deputy Editor, Cecelia Schmalbach, MD,6 and supported by both commentary and research. We plan to continue to emphasize this vital topic in future issues of the journal as well. John H. Krouse, MD, PhD, MBA Editor in Chief, Otolaryngology–Head and Neck Surgery Department of Otolaryngology/Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
References 1. McCormick ME, Stadler ME, Shah RK. Embedding quality and safety in otolaryngology–head and neck surgery education. Otolaryngol Head Neck Surg. 2015;152:778-782. 2. Dahl JP, Stadler ME, Huang BY, et al. Connexin-related (DFNB1) hearing loss: is routine computed tomography imaging necessary? Otolaryngol Head Neck Surg. 2015;152:889-896. 3. Wilson MB, Kallogjeri D, Joplin CN, et al. Ecological momentary assessment of tinnitus using smartphone technology: a pilot study. Otolaryngol Head Neck Surg. 2015;152:897-903. 4. Mulvey CL, Pronovost PJ, Gourin CG. Hospital volume and failure to rescue after head and neck cancer surgery. Otolaryngol Head Neck Surg. 2015;152:783-789. 5. Misono S, Marmor S, Yueh B, Virnig BA. T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment types? Otolaryngol Head Neck Surg. 2015;152:856-862. 6. Schmalbach CE. Patient safety/quality improvement (PS/QI): Florence Nightingale prevails. Otolaryngol Head Neck Surg. 2015;152:771-773.
Downloaded from oto.sagepub.com by guest on November 15, 2015
olaryngology–Head and Neck SurgeryKrouse 2015© The Author(s) 2010
OTOXXX10.1177/0194599815576911Ot
Reprints and permission: sagepub.com/journalsPermissions.nav
Highlights
Highlights from the Current Issue: May 2015 John H. Krouse, MD, PhD, MBA1
I
t is my privilege to present to you highlights from the May 2015 issue of Otolaryngology–Head and Neck Surgery. This month we are going to be showcasing the critical topic of patient safety and quality improvement (PS/QI) in otolaryngology–head and neck surgery. With an appreciation for the role of individual and systematic factors in determining the successful outcome of medical interventions, physicians and health care providers in all specialties increasingly need to focus their efforts on decreasing adverse patient events and enhancing the quality and safety of their medical and surgical treatments. Please examine the commentaries and articles that explore this important issue in our field. To focus attention on the importance of teaching PS/QI in residency programs in otolaryngology–head and neck surgery, McCormick and colleagues examine the recent emphasis of the Accreditation Council for Graduate Medical Education (ACGME) in driving resident education this area.1 The authors stress that curricula must be developed and implemented across all residency programs to educate our young physicians in patient safety and quality. Using both didactic and experiential methods, traditional teaching conferences can become vibrant learning laboratories for instilling this critical knowledge base. McCormick and colleagues discuss both the nature of these curricula and the challenges for training programs in their establishment and operation. In our second article, Dahl and colleagues2 further look at an issue relevant to quality as they examine whether routine computed tomography (CT) imaging is necessary in children diagnosed with DFNB1 sensorineural hearing loss (SNHL). They compared 21 patients with DFNB1-related SNHL to matched control groups of 33 children with SNHL unrelated to DFNB1 and 33 children with conductive hearing loss, measuring cochleovestibular structures on high-resolution CT scans of the temporal bone. Dahl and colleagues did not find any significant differences in 16 specific CT measurements. They concluded that patients with DFNB1 do not have statistically significant differences in these cochleovestibular structures from other children with hearing loss and recommend against routine CT imaging in these individuals. In the next article, Wilson and associates3 examine the use of ecological momentary assessment of tinnitus among patients using smartphone technology. In this study, the authors sent text messages to subjects 4 times daily via their smartphone devices, asking them to rate the level of their tinnitus at that time. These 20 patients with moderate to severe tinnitus also recorded their
Otolaryngology– Head and Neck Surgery 2015, V ol. 152(5) 774–775 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815576911 http://otojournal.org
activity at that time, their stress level, and their location. Of the 1120 surveys sent out by this method, subjects responded to 79.4% of these individual queries at a median response time of 7 minutes. The authors describe the use of this methodology as a valuable technique for timely recording of instantaneous patientcentered data among individuals with tinnitus. This technique would have potential applicability in measuring patient symptoms in a wide range of illnesses. In another article, Mulvey and colleagues4 address the relationship between the volume of head and neck cancer surgery (HNCA) performed at individual institutions and the mortality rates accompanying those procedures. The authors used discharge data from nearly 160,000 patients who underwent head and neck cancer surgery at over 8500 hospitals in the United States between 2001 and 2010 and examined both the complication rates for surgery at those institutions as well as the mortality rates among those surgical cases. They then looked at low-volume institutions (mean HNCA cases, 6 annually), intermediate-volume institutions (mean HNCA cases, 37 annually), and high-volume institutions (mean HNCA cases, 131 annually) and noted that while the complication rates at institutions with these 3 case volumes did not differ significantly, mortality rates from these complications were significantly less at high-volume institutions than at facilities with lower HNCA volumes. Mortality rate from complications in these high-volume centers was 44% less than in low-volume institutions. Mulvey and colleagues present these decreased mortality rates as a failure to rescue patients from serious perioperative complications at low-volume hospitals. The authors discuss the implications of their thought-provoking findings for surgical care of patients with head and neck cancer. Finally, Misono and colleagues5 report on survival differences among patients with T1 glottic carcinomas as a function of comorbidities, sociodemographics, and facility characteristics. Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, the authors examined records of 2338 patients with T1 glottic squamous cell carcinomas treated between 1991 and 2009. In addition to looking at these factors, type of treatment was assessed, with patients 1
Temple University School of Medicine, Philadelphia, Pennsylvania, USA
Corresponding Author: John H. Krouse, Temple University School of Medicine, 3440 N. Broad St, Kresge West # 300, Philadelphia, PA 19140, USA. Email: [email protected]
Downloaded from oto.sagepub.com by guest on November 15, 2015
775
Krouse receiving local surgery, radiation therapy, or a combination of the 2 treatment modalities. Results of the study demonstrated that black race and concurrent comorbidities were associated with decreased survival across treatments. Interestingly, when controlling for comorbidities, sociodemographics, and facility characteristics, survival differences were observed across treatment types, with those patients undergoing local surgery demonstrating better overall and cancer-specific survival. Misono and colleagues comment on these treatment differences and their implications for management of patients with T1 glottic carcinomas. Again, please explore these 5 articles, as well as the other interesting articles that you will find in this May 2015 issue. Please also enjoy our spotlight on patient safety and quality this month, beginning with the introductory editorial by our Deputy Editor, Cecelia Schmalbach, MD,6 and supported by both commentary and research. We plan to continue to emphasize this vital topic in future issues of the journal as well. John H. Krouse, MD, PhD, MBA Editor in Chief, Otolaryngology–Head and Neck Surgery Department of Otolaryngology/Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
References 1. McCormick ME, Stadler ME, Shah RK. Embedding quality and safety in otolaryngology–head and neck surgery education. Otolaryngol Head Neck Surg. 2015;152:778-782. 2. Dahl JP, Stadler ME, Huang BY, et al. Connexin-related (DFNB1) hearing loss: is routine computed tomography imaging necessary? Otolaryngol Head Neck Surg. 2015;152:889-896. 3. Wilson MB, Kallogjeri D, Joplin CN, et al. Ecological momentary assessment of tinnitus using smartphone technology: a pilot study. Otolaryngol Head Neck Surg. 2015;152:897-903. 4. Mulvey CL, Pronovost PJ, Gourin CG. Hospital volume and failure to rescue after head and neck cancer surgery. Otolaryngol Head Neck Surg. 2015;152:783-789. 5. Misono S, Marmor S, Yueh B, Virnig BA. T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment types? Otolaryngol Head Neck Surg. 2015;152:856-862. 6. Schmalbach CE. Patient safety/quality improvement (PS/QI): Florence Nightingale prevails. Otolaryngol Head Neck Surg. 2015;152:771-773.
Downloaded from oto.sagepub.com by guest on November 15, 2015
