Use of risk-adjusted CUSUM and RSPRTcharts for monitoring in medical contexts

Grigg, O. A.; Farewell, Vern T.; Spiegelhalter, D

doi:10.1177/096228020301200205

Cited by 269 publications

(208 citation statements)

References 20 publications

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“…This approach has also been suggested when the lower boundary line is breached as if the cusum is allowed to continue to fall, a run with an unacceptably high failure rate may go unnoticed. 38 In fact, reaching a steady state on the graph may be enough assurance to conclude that the learning curve has settled down. 18 There are several problems with using cusum analysis to assess performance in procedural skills.…”

Section: Discussionmentioning

confidence: 99%

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Starkie

Drake

2013

Can J Anesth/J Can Anesth

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Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum) É valuation de la formation en habiletés techniques et de la performance en anesthésie au moyen de l'analyse des sommes cumulées (cusum) Abstract Purpose The current methods (work based assessments and logbooks) used to assess procedural competency and performance have well-documented deficiencies. Cumulative sum analysis (cusum), a statistical method that generates performance graphs over time, is an alternative tool that is not currently widely used. The purpose of this review is to investigate its current role in anesthetic procedural skills training and performance.Tim

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Section: Discussionmentioning

confidence: 99%

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Starkie

Drake

2013

Can J Anesth/J Can Anesth

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“…The CUSUM methodology allows detection of small changes in outcomes over time, much earlier than they would be detectable by using standard process control methods. 21 We chose this methodology given the infrequent nature of isolated skull fractures and our desire to rapidly assess the effectiveness of our interventions.…”

Section: Provider Surveymentioning

confidence: 99%

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Lyons¹,

Stack²,

Monuteaux³

et al. 2016

Pediatrics

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BACKGROUND AND OBJECTIVE: Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. METHODS: We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. RESULTS: We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5–16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%–77%) and decreased to 46% (34/72, 95% confidence interval, 35%–60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. CONCLUSIONS: We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions.

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“…The concept has subsequently been used in many fields, with surgery, and especially heart surgery, being the driver for the introduction of the term in the medical literature [2,3]. The experience acquired from performing a technical procedure differs among different individuals; and that the number of procedures completed alone is an inadequate marker of competency [4,5]. Nevertheless, despite this variation, learning curves are often similar for many individuals for specific procedures, and knowledge of the learning curve for an individual for a specific procedure can help guide the training of subsequent practitioners.…”

Section: Introductionmentioning

confidence: 99%

Learning curve of vessel cannulation in rats using cumulative sum analysis

Christakis

Georgiou

Minnion

et al. 2015

Journal of Surgical Research

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Extensive experience in rodent surgery and training junior surgeons Cover LetterDear Ms/Mr, We would be grateful if you would consider our manuscript entitled "Learning curve of cannulation of jugular and femoral vein in rats using Cumulative Summation Analysis" for publication in The Journal of Surgical Research. Our study investigates the learning curve required for competency and proficiency at blood vessel cannulation in rodents.Vessel cannulation in rats, such as of the femoral and jugular vein, is a technically challenging procedure even for an experienced surgeon. In this study we analyse the results of 200 cannulations of the femoral and jugular vein in rats performed within one year by a single surgeon. The use of Cumulative Summation analysis allows calculating the required experience to most effectively cannulate the jugular and femoral vein, which is approximately 50 and 100 cases, respectively.These results highlight the difficulty involved in performing such micro-surgical operations in rodents. The knowledge of the average time taken to cannulate these vessels allows experiments to be optimally planned, avoiding unexpected time over-runs. Furthermore, our results bring into the spotlight the need for training and direct supervision for the inexperienced researchers, as there is an ongoing need to reduce animal use in research through minimising adverse events.To the authors' knowledge this is the first study to report the learning curve for mastering the technique of catheterisation of the femoral and jugular vein in rats. We feel it will be of interest to readers of The Journal of Surgical Research, and particularly those using rodent microsurgery. Subject category: ResearchAuthors' contributions I.C., J.C., R.S. carried out the design and coordinated the study, participated in all of the experiments and prepared the manuscript. J.M., P.G., V.C., F.P., K.M., S.B.provided assistance in the design of the study, coordinated and carried out most of the experiments and participated in manuscript preparation. T.T., F.P., K.M. and S.B.approved the final version of the manuscript. All authors have read and approved the content of the manuscript.-3 - AbstractBackground:

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Use of risk-adjusted CUSUM and RSPRTcharts for monitoring in medical contexts

Cited by 269 publications

References 20 publications

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Learning curve of vessel cannulation in rats using cumulative sum analysis

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