Using Video Analysis to Improve Outcomes of Laparoscopic Colectomy Abstract: New surgical procedures are continuously introduced into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into diverse practice settings is often suboptimal. Strategies for accelerating the surgical learning curve would have clear benefits, but practical, scalable approaches have been elusive. Video analysis may help fill this void. There several important unanswered questions in this emerging area of performance improvement. First, it is unclear whether surgical technique (the details of how the case is done) or skill (how well the case was done) is the driver of better outcomes for laparoscopic colectomy. Second, although there is emerging evidence that the effectiveness of coaching varies (i.e., some coaches are better than others), whether this translates into differential clinical outcomes of coachees is unknown. Third, the technical pathways by which surgeons improve in response to coaching are entirely unexplored. We have the unique opportunity to leverage the existing surgeon relationships and registry data in the Michigan Surgical Quality Collaborative (MSQC) to implement this program. Building on our preliminary data using video analysis in laparoscopic bariatric surgery, we propose the following Specific Aims:
Aim 1. To examine the relationship between surgeon video ratings and patient outcomes. After adjusting for all potential differences in patient risk factors, we will assess the relationship between surgeon technique (how they do operation) and surgeon skill (how well they do operation) on patient outcomes (e.g., mortality, complications, reoperations.
Aim 2. To implement a video-based coaching intervention and evaluate the impact on outcomes. We will design and implement a coaching intervention in a stepped wedge cluster randomized trial using the MSQC platform. We will evaluate the impact of the intervention on patient outcomes using the detailed outcomes from the MSQC clinical registry.
Aim 3. To evaluate the relationship between coaching effectiveness and patient outcomes. We will audio record and transcribe all coaching conversations. Based on these data, we will evaluate the quality of the conversation using a validated instrument that scores coaching effectiveness (from a scale of 1 to 5, across four domains). We will also conduct a qualitative evaluation of coaching conversations and exit interviews to explore the pathways by which surgeons improve (i.e., what changes do they make) and also what the barriers and facilitators are to broader adoption. This study will have immediate and direct impact. For patients in Michigan and beyond, this study will accelerate the implementation of best technical practices for laparoscopic colon surgery and improve their outcomes. The use of video analysis and video-based coaching to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.
In the setting of the Michigan Surgical Quality Collaborative (MSQC), we propose a systematic evaluation of the relationship between surgeon technical skill and outcomes for laparoscopic colectomy. We will obtain videos from surgeons across the collaborative and have them rated using a standardized instrument for assessing skill and technique. We will then use data from MSQC to assess the correlation between these ratings and risk-adjusted outcomes and implement best practices using a peer coaching intervention. To evaluate the relationship between coach effectiveness and improvement in outcomes, we will evaluate the quality of the coaching using a standardized instrument. Finally, we will conduct a qualitative evaluation of the coaching sessions and semi-structured interviews of participants to understand pathways of improvement (i.e., what surgeons changed) and to better appreciate barriers and facilitators to broader adoption of surgical coaching programs.
