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- Title
A new risk‐adjusted EWMA control chart based on survival time for monitoring surgical outcome quality.
- Authors
Ding, Ning; He, Zhen; Shi, Liangxing; Qu, Liang
- Abstract
Monitoring surgical outcome quality by risk‐adjusted control charts has attracted wide attention. The hidden medical errors may cause increasing of adverse events such as infection, rehospitalization, and even death. Quickly and timely detecting abnormal changes of surgical performance helps reduce the probability of adverse events and improve health care quality. Most existing monitoring schemes focus on the binary surgical outcomes. However, continuous survival times of patients should be considered for more accurate monitoring. In this paper, a new exponentially weighted moving average (EWMA) control chart is proposed for monitoring continuous surgical outcomes. To describe surgical performance, a patient's actual survival time and predicted mortality are combined in an illustrative and interpretable way. Performance of the proposed chart is evaluated with different chart parameters under different shifts by a simulation study. We compare our chart with the risk‐adjusted survival time cumulative sum chart, and the simulation results demonstrate that the proposed monitoring scheme has better efficiency. The implementation of the proposed chart is illustrated by a real example. Besides an analysis of the entire dataset, the surgical performance of each surgeon is monitored, because each of them has patients with different risk levels.
- Subjects
QUALITY control charts; SURVIVAL analysis (Biometry); MEDICAL quality control; ADVERSE health care events; MOVING average process; MEDICAL errors
- Publication
Quality & Reliability Engineering International, 2021, Vol 37, Issue 4, p1650
- ISSN
0748-8017
- Publication type
Article
- DOI
10.1002/qre.2818