Abstract
Background
This study was designed to investigate the effectiveness of intraoperative consultation (IOC) with regard to its feasibility for improving quality management. IOC comprises an assessment of major steps in the operative procedure by another surgeon requested by the operating surgeon to be present in the operating room in a consultative capacity during the operation.
Methods
Between January and June 2008, IOC was implemented in 1217 operations. Data on the frequency of the feasibility of IOC and on whether IOC led to decisions influencing the course of the procedure were measured.
Results
A total of 872 IOCs were performed: regular IOC in 708 cases (81%), and tactical IOC in 164 cases (19%). In 70 cases (8%), consultation resulted in minor changes, and in 59 cases (7%) major clinically relevant revision of the operative strategy was deemed necessary.
Conclusions
It was found that IOC can be performed in the majority of cases. In the case of tactical IOC in particular, a large number of treatment-relevant decisions are taken. This means that in the area of operative disciplines, IOC represents a potential preventive strategy within the framework of quality management.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ekkernkamp A, Haeske-Seeberg H (1999) Quality management in surgery. Chirurg 70:102–112
Jähne J (2006) Does internal quality control reduce mistakes and complications? A plea for structured surgical education and increased transparency in clinical day-to-day work. Zentralbl Chir 131:354–357
Catchpole KR, Giddings AE, Wilkinson M et al (2007) Improving patient safety by identifying latent failures in successful operations. Surgery 142:102–110
Gore DC (2006) National survey of surgical morbidity and mortality conferences. Am J Surg 191:708–714
Veen EJ, Janssen-Heijnen ML, Leenen LP et al (2005) The registration of complications in surgery: a learning curve. World J Surg 29:402–409
Riedl S (2002) Modern operations management in workflow operation. Spectrum of responsibilities and challenges for the future. Chirurg 73:105–110
Siess M (2003) Quality management in surgery–quo vadis? Chirurg 74:499–500
Giessling U, Petersen S, Freitag M et al (2002) Surgical management of severe peritonitis. Zentralbl Chir 127:594–597
Teichmann W, Herbig B (1994) Relaparotomie. In: Lierse W, Platzer W, Schreiber HW (eds) Chirurgische Operationslehre. Thieme, Stuttgart, pp 173–189
Maschuw K, Osei-Agyemang T, Weyers P et al (2008) The impact of self-belief on laparoscopic performance of novices and experienced surgeons. World J Surg 32:1911–1916
Hamdorf JM, Hall JC (2000) Acquiring surgical skills. Br J Surg 87:28–37
Alkov RA, Boroswsky MS, Williamson DW et al (1992) The effect of trans-cockpit authority gradient on Navy/Marine helicopter mishaps. Aviat Space Environ Med 63:659–661
Yule S, Flin R, Paterson-Brown S et al (2006) Non-technical skills for surgeons in the operating room: a review of the literature. Surgery 139:140–149
Heistermann HP, Tobusch A, Palmes D (2006) Prevention of bile duct injuries after laparoscopic cholecystectomy. “The critical view of safety”. Zentralbl Chir 131:460–465
Hall JC, Ellis C, Hamdorf J (2003) Surgeons and cognitive processes. Br J Surg 90:10–16
Dambier M, Hinkelbein J (2006) Analysis of 2004 German general aviation aircraft accidents according to the HFACS model. Air Med J 25:265–269
Müller M (2004) Risk and risk management in aviation. Z Arztl Fortbild Qualitatssich 98:559–565
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented in parts at the 125th Congress of the German Society of Surgery, Berlin, Germany, April 23, 2008.
Rights and permissions
About this article
Cite this article
Teichmann, W., Rost, W., Thieme, D. et al. Intraoperative Consultation as an Instrument of Quality Management. World J Surg 33, 6–11 (2009). https://doi.org/10.1007/s00268-008-9786-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9786-3