Video Analysis for Ensuring Safer Diffusion of New Procedures New surgical procedures are introduced continuously into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into divers practice settings is often suboptimal. The uneven mastery of new techniques implied by these innovations may contribute to wide variations in outcomes and effectiveness across providers. Strategies for identifying best techniques and disseminating them would have clear benefits, but practical, scalable strategies have been elusive. Whether video analysis can be used for this purpose has not been explored. In this proposal, we will build on our recent work, published in NEJM, which uses vide analysis to assess surgical skill. Leveraging this prior work in the Michigan Bariatric Surgery Collaborative (MBSC), we will study sleeve gastrectomy, which was recently approved by the Center for Medicare and Medicaid Services (CMS). We have the following Specific Aims:
Aim 1 : To use surgical video analysis to examine variations in surgical technique. We will collect videos from all Michigan surgeons who perform sleeve gastrectomy. Using a standardized instrument, we will have peer reviewers assess each other's technique. The peer review instrument includes aspects of technique that relate to both short-term and long-term outcomes.
Aim 2. To examine the relationship between surgical technique and patient outcomes. We will link these details on technique from video analysis to patient outcome data from the MBSC clinical registry. After adjusting for all potential confounders, we will assess the relationship between surgical technique and short-term safety outcomes and long-term effectiveness outcomes.
Aim 3. To implement best technical practices and evaluate the impact on patient outcomes. . We will design and implement an intervention in a stepped wedge cluster randomized trial using the MBSC platform. The intervention will include a checklist of best practices, videos demonstrating the best practices, and coaching sessions by surgeons with expertise in these techniques. The most immediate impact of this work will be for patients undergoing sleeve gastrectomy in Michigan and beyond. However, the use of video analysis to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.
Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into diverse practice settings is often suboptimal. Thi proposal develops and tests a method for using surgical video analysis to accelerate the improvement of surgical technique for a common bariatric surgical procedure, sleeve gastrectomy, across a community of practicing surgeons in Michigan. The use of video analysis could be a powerful new paradigm for improving the quality of surgery and medical procedures.
|Shubeck, Sarah P; Kanters, Arielle E; Sandhu, Gurjit et al. (2018) Dynamics within peer-to-peer surgical coaching relationships: Early evidence from the Michigan Bariatric Surgical Collaborative. Surgery 164:185-188|
|Kanters, Arielle E; Shubeck, Sarah P; Sandhu, Gurjit et al. (2018) Justifying our decisions about surgical technique: Evidence from coaching conversations. Surgery 164:561-565|
|Ibrahim, Andrew M; Dimick, Justin B; Joseph, Anjali (2017) Building a Better Operating Room: Views from Surgery and Architecture. Ann Surg 265:34-36|
|Scally, Christopher P; Varban, Oliver A; Carlin, Arthur M et al. (2016) Video Ratings of Surgical Skill and Late Outcomes of Bariatric Surgery. JAMA Surg 151:e160428|
|Pradarelli, Jason C; Varban, Oliver A; Dimick, Justin B (2016) Hospital variation in rates of acid-reducing medication use after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 12:1382-1389|
|Varban, Oliver A; Greenberg, Caprice C; Schram, Jon et al. (2016) Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another? Surgery 160:1172-1181|
|Pradarelli, Jason C; Jaffe, Gregory A; Lemak, Christy Harris et al. (2016) A leadership development program for surgeons: First-year participant evaluation. Surgery 160:255-63|
|Ghaferi, A A; Dimick, J B (2016) Importance of teamwork, communication and culture on failure-to-rescue in the elderly. Br J Surg 103:e47-51|