Preface
Approximately a decade following the publication of the first edition of this manual, the world of surgery continues to dramatically change. The focus on the quality of care provided by surgeons, the safety of the patients we treat, and the clinical outcomes we see as a result of our care, by both the surgical community and the public, has never been stronger. SAGES remains committed to leading in these areas, and the work and expertise presented in this manual will hopefully serve as a comprehensive resource to all of our SAGES members, as well as to the broader surgical community. This manual covers a wide range of critical topics, from the language and basics of quality, outcomes, and patient safety to education, mentorship, new technologies, and different approaches to care. It is crucial for the care of their patients that surgeons understand all of the elements of how quality is measured, how care outcomes are reviewed, and what the best practices available to them are on how to provide that care. On behalf of the SAGES Quality, Outcomes, and Patient Safety Committee, I am indebted to the time and efforts of the committee members and authors who have helped to create this manual. I also wish to thank my co-editors, John Romanelli, Rebecca Kowalski, and Prashant Sinha, as well as to Erin Schwarz, who has provided all of the administrative support to this endeavor, for all of their hard work in producing this second edition. I hope that you find it to be informative, comprehensive, and useful.
Falls Church, VA, USA
Jonathan M. Dort, MD
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B.
Anjali A. Gresens and Jacob A. Tatum
Samuel M. Miller and John M. Morton
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Buğra Tugertimur and Bruce Ramshaw
Michael R. Keating and Benjamin E. Schneider
Brenda M. Zosa and Anne O. Lidor
Teresa L. LaMasters, Jamie P. Loggins, and Teresa Fraker
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Ingrid S. Schmiederer and James N. Lau
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14 Developing Patient-Centered Outcomes Metrics for Abdominal
Part III Surgical Safety
21 Quality, Safety, and the Electronic Health Record (EHR)
Eunice Y. Huang and Gretchen Purcell Jackson
22 Checklists, Surgical Timeout, Briefing, and Debriefing: Safety in the Operating Room .
Amelia T. Collings and Dimitrios Stefanidis
23 Creating Effective Communication and Teamwork for Patient Safety .
Pascal Fuchshuber and William Greif
Timothy Fokken and Sharon Bachman
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Stacy M. Ranson and Jonathan M. Dort 26 Culture
Eileen R. Smith and Shaina R. Eckhouse
27 Learning New Operations and Introduction into Practice
Ugoeze J. Nwokedi, Lee Morris, and Nabil Tariq
Jaisa Olasky and Daniel B. Jones
30 Debriefing After Simulation
Brandon W. Smith and Neal E. Seymour
31 Using Simulation for Disclosure of Bad
Limaris Barrios
32 Teleproctoring in Surgery .
Julio Santiago Perez and Shawn Tsuda
33 Training for Quality: Fundamentals Program . . .
Sofa Valanci and Gerald M. Fried
34 Training to Proficiency .
Madhuri B. Nagaraj and Daniel J. Scott
35 The Critical View of Safety: Creating Procedural Safety Benchmarks .
William C. Sherrill III and L. Michael Brunt
36 Mentorship and Quality in Surgery .
Dina Tabello and Jonathan M. Dort
Part V Threats to Surgical Quality, Outcomes, and Safety
37 Disparities in Healthcare: The Effect on Surgical Quality .
Valeria S. M. Valbuena and Dana A. Telem
38 Surgeon Wellness: Scope of the Problem and Strategies to Avoid Burnout
John R. Romanelli
39 The Disruptive Surgeon .
M. Shane Dawson and Rebecca B. Kowalski
40 The Surgeon as Collateral Damage: The Second Victim Phenomenon.
Rebecca Gates and Charles Paget
41 The Surgeon in Decline: Can We Assess and Train a Surgeon as Their Skills Deteriorate?
Arthur Rawlings
42 Fatigue in Surgery: Managing an Unrealistic Work Burden
V. Prasad Poola, Adam Reid, and John D. Mellinger
43 Training New Surgeons: Maintaining Quality in the Era of Work Hour Regulations .
Ingrid S. Schmiederer and James R. Korndorffer Jr
44 Maintaining Surgical Quality in the Setting of a Crisis . .
John R. Romanelli
45 Ergonomic Considerations for Surgeon Physical Wellness . .
Marinda Scrushy and Diana L. Diesen
Part VI Surgical Controversies That Impact Quality
46 Hernia Repair: Robot or No Robot? .
Matthew Madion and Rana M. Higgins
47 The Consistent Operating Room Team . .
Leena Khaitan and Joseph Youssef
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48 Prevention of Common Bile Duct Injury: What Are we as Surgeons Doing to Prevent Injury . . . . . . 923
Nabajit Choudhury, Manoj Kumar Choudhury, and Rebecca B. Kowalski
49 OR Attire: Does it Impact Quality? . .
Yasmin Essaji, Kelly Mahuron, and Adnan Alseidi
50 Learning When Not to Operate: From Patient Selection to Withdraw of Care
Carolyn Judge, Kim Gerling, and Tiffany C. Cox
51 The Changing Paradigm in Acute Care Surgery: Who Is the Best to Offer the Care? .
Freeman Condon and Robert Lim
52 Super-subspecialization of General Surgery: Is This Better for Patients? . .
Joseph A. Sujka and Christopher G. DuCoin
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53 What Is the Connection Between Physician Relationships with Industry and Patient Care? . . . . . 993
Caroline E. Reinke, Peter M. Denk, Erin Schwarz, and Phillip P. Shadduck
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Contributors
Gina Adrales Johns Hopkins University School of Medicine, Baltimore, MD, USA
Thomas A. Aloia University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adnan Alseidi Department of Surgery, University of California San Francisco, San Francisco, CA, USA
Sharon Bachman Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
Limaris Barrios Dr. Kiran C. Patel College of Allopathic Medicine (NSU MD), Nova Southeastern University in Florida, Fort Lauderdale, FL, USA
Marylise Boutros Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
L. Michael Brunt Department of Surgery and Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
Stephanie Calcasola Hartford HealthCare, Hartford, CT, USA
Manoj Kumar Choudhury Senior Consultant, GI and MIS, Nemcare Superspecialty Hospital, Assam, India
Nabajit Choudhury The University of Tennessee Health Science Center, Memphis, TN, USA
Freeman Condon Tripler Army Medical Center, Honolulu, HI, USA
Tiffany C. Cox Department of Surgery, Uniformed Services University of Health Sciences & Walter Reed National Military Medical Center, Bethesda, MD, USA
M. Shane Dawson Northwell Health at Lenox Hill Hospital, New York, NY, USA
Peter M. Denk GI Surgical Specialists, Fort Myers, FL, USA
Diana L. Diesen Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
Justin B. Dimick Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Jonathan M. Dort Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
Christopher G. DuCoin Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
Shaina R. Eckhouse Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
Yasmin Essaji Division of HPB Surgery, Virginia Mason Medical Center, Seattle, WA, USA
Liane S. Feldman Department of Surgery, McGill University, Montreal, QC, Canada
Julio F. Fiore Department of Surgery, McGill University, Montreal, QC, Canada
Benjamin J. Flink Stony Brook University Department of Surgery, Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook, NY, USA
Timothy Fokken Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA Contributors
Teresa Fraker Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), Division of Research and Optimal Patient Care (DROPC), American College of Surgeons (ACS), Chicago, IL, USA
Gerald M. Fried Professor of Surgery and Associate Dean for Education Technology and Innovation, Montreal, QC, Canada
Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
Director, Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
Pascal Fuchshuber Sutter East Bay Medical Group, UCSFEast Bay, Oakland, CA, USA
Rebecca Gates Virginia Tech Carilion School of Medicine and Carilion Clinic, Roanoke, VA, USA
Kim Gerling Department of Surgery, Uniformed Services University of Health Sciences & Walter Reed National Military Medical Center, Bethesda, MD, USA
Michael Ghio Tulane University School of Medicine & Tulane Medical Center, New Orleans, LA, USA
William Greif The Permanente Medical Group, Kaiser Walnut Creek Medical Center, Walnut Creek, CA, USA
Anjali A. Gresens Bariatric Surgery, Sentara Medical Group, Norfolk, VA, USA
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Rana M. Higgins Medical College of Wisconsin, Milwaukee, WI, USA
Ryan Howard Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Eunice Y. Huang Departments of General and Thoracic Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Contributors
Gretchen Purcell Jackson Departments of General and Thoracic Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Intuitive Surgical, Sunnyvale, CA, USA
Daniel B. Jones Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
Carolyn Judge Department of Surgery, Uniformed Services University of Health Sciences & Walter Reed National Military Medical Center, Bethesda, MD, USA
Michael R. Keating University of Texas Southwestern, Dallas, TX, USA
Deborah S. Keller Division of Colorectal Surgery, Department of Surgery, University of California at Davis, Sacramento, CA, USA
Leena Khaitan University Hospitals, Department of Surgery, Cleveland, OH, USA
James R. Korndorffer Jr Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
Anai N. Kothari Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
Rebecca B. Kowalski Northwell Health at Lenox Hill Hospital, New York, NY, USA
Danuel Laan Tulane University School of Medicine & Tulane Medical Center, New Orleans, LA, USA
Kathleen Lak Bariatric and Minimally Invasive Gastrointestinal Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Teresa L. LaMasters Iowa Methodist Medical Center Unity Point Clinic, University of Iowa, Des Moines, IA, USA
Contributors
James N. Lau Loyola University Medical Center, Department of Surgery, Maywood, IL, USA
Shauna Levy Tulane University School of Medicine & Tulane Medical Center, New Orleans, LA, USA
Anne O. Lidor Department of Surgery, Johns Hopkins University SOM, Baltimore, MD, USA
Cara A. Liebert Department of Surgery, Stanford University School of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
Robert Lim University of Oklahoma School of Medicine Tulsa, Tulsa, OK, USA
Jamie P. Loggins Mission Weight Management Center, Asheville, NC, USA
Matthew Madion Medical College of Wisconsin, Milwaukee, WI, USA
Kelly Mahuron Department of Surgery, University of California San Francisco, San Francisco, CA, USA
John D. Mellinger Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA
Samuel M. Miller Department of Surgery, Yale School of Medicine, New Haven, CT, USA
Jeongyoon Moon Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
Lee Morris Department of Surgery, The Houston Methodist Hospital, Houston, TX, USA
John M. Morton Department of Surgery, Yale School of Medicine, New Haven, CT, USA
Madhuri B. Nagaraj University of Texas Southwestern, Department of Surgery, Dallas, TX, USA
Brian J. Nasca Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Ugoeze J. Nwokedi Department of Surgery, The Houston Methodist Hospital, Houston, TX, USA
Jaisa Olasky Mount Auburn Hospital, Harvard Medical School, Boston, MA, USA
Rocco Orlando III Hartford HealthCare, Hartford, CT, USA
University of Connecticut School of Medicine, Hartford, CT, USA
Charles Paget Virginia Tech Carilion School of Medicine and Carilion Clinic, Roanoke, VA, USA
John T. Paige Department of Surgery, MedicineLouisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
Julio Santiago Perez Valley Health System General Surgery Department, Las Vegas, NV, USA
V. Prasad Poola Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA
Aurora D. Pryor Stony Brook University Department of Surgery, Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook, NY, USA
Fateme Rajabiyazdi Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
Bruce Ramshaw Managing Partner, CQInsights PBC, Knoxville, TN, USA
Stacy M. Ranson Inova Fairfax Medical Campus, Falls Church, VA, USA
Arthur Rawlings General Surgery, University of Missouri, One Hospital Drive, Columbia, MO, USA
Swathi Reddy Johns Hopkins University School of Medicine, Baltimore, MD, USA
Contributors
Adam Reid Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA
Caroline E. Reinke Department of Surgery, Atrium Health, Charlotte, NC, USA
Amelia T. Collings Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
John R. Romanelli Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA
Ingrid S. Schmiederer Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
New York Presbyterian-Queens, Department of Surgery, Flushing, NY, USA
Benjamin E. Schneider University of Texas Southwestern, Dallas, TX, USA
Erin Schwarz SAGES, Los Angeles, CA, USA
Daniel J. Scott University of Texas Southwestern, Department of Surgery and Simulation Center, Dallas, TX, USA
Marinda Scrushy Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
Neal E. Seymour Baystate Medical Center, Department of Surgery, Springfield, MA, USA
Phillip P. Shadduck Duke University, Durham, NC, USA
William C. Sherrill III Department of Surgery and Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
Prashant Sinha Department of Surgery, NYU Langone Medical Center, Brooklyn, NY, USA
Brandon W. Smith Baystate Medical Center, Department of Surgery, Springfield, MA, USA
Contributors
Eileen R. Smith Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
Dimitrios Stefanidis Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
Jonah J. Stulberg The University of Texas Health Science Center at Houston, Houston, TX, USA
Joseph A. Sujka Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
Dina Tabello Inova Fairfax Medical Campus, Falls Church, VA, USA
Nabil Tariq Department of Surgery, The Houston Methodist Hospital, Houston, TX, USA
Jacob A. Tatum Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
Dana A. Telem National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
Shawn Tsuda Valley Health System General Surgery Department, Las Vegas, NV, USA
Bu ğ ra Tugertimur General Surgery Resident, PGY 5, Department of Surgery, Lenox Hill Hospital, Northwell Health, New York City, NY, USA
Sofia Valanci Doctoral student in Experimental Surgery, Education Concentration, McGill University, Montreal, QC, Canada
Valeria S. M. Valbuena University of Michigan, Department of Surgery, Ann Arbor, MI, USA
Sherry M. Wren Department of Surgery, Center for Innovation and Global Health, Stanford University School of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
Contributors
Tonia M. Young-Fadok Division of Colon and Rectal Surgery, Mayo Clinic, Phoenix, AZ, USA
Joseph Youssef University Hospitals, Department of Surgery, Cleveland, OH, USA
Brenda M. Zosa Department of Surgery, Johns Hopkins University SOM, Baltimore, MD, USA
