PT  - JOURNAL ARTICLE
AU  - Kristin DeGirolamo
AU  - Karan D’Souza
AU  - William Hall
AU  - Emilie Joos
AU  - Naisan Garraway
AU  - Chad Kim Sing
AU  - Patrick McLaughlin
AU  - Morad Hameed
TI  - Process mapping as a framework for performance improvement in emergency general surgery
AID  - 10.1503/cjs.004417
DP  - 2018 Feb 01
TA  - Canadian Journal of Surgery
PG  - 13--18
VI  - 61
IP  - 1
4099  - http://canjsurg.ca/content/61/1/13.short
4100  - http://canjsurg.ca/content/61/1/13.full
SO  - CAN J SURG2018 Feb 01; 61
AB  - Background: Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement.Methods: We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge.Results: Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access.Conclusion: Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.