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Review
. 2016 May;42(5):196-206.
doi: 10.1016/s1553-7250(16)42025-8.

How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

Emma L Jones  1 , Nicholas Lees, Graham Martin, Mary Dixon-Woods
Affiliations
Review

How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

Emma L Jones et al. Jt Comm J Qual Patient Saf. 2016 May.

Abstract

Background: Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care.

Methods: Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) check list, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e. g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI.

Results: The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles).

Conclusions: The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved.

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Figures

Figure 1
Figure 1. Flow Diagram of the Phases of the Systematic Review
This flow diagram provides the phases of article identification and selection, which resulted in the identification of 100 articles that were deemed eligible for inclusion. Prepared in accordance with Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol. 2009;62:1006–1012.
Figure 2
Figure 2. Range of Template for Intervention Description and Replication (TIDier) Scores Across 100 Perioperative Quality Improvement Articles
The distribution of TIDieR scores for the reporting of quality interventions across the 100 articles approximately followed a normal bell-shaped curve, with a slight skew toward higher ratings. The most common (modal) score was 7/11, and the average (arithmetic mean) score was 6.31/11.
Figure 3
Figure 3. Template for Intervention Description and Replication (TIDieR) Scores by Items 1–11 for the 100 Perioperative Quality Improvement Articles
The TIDieR items that were most usually fully reported were why (complete in 98% of articles), brief name of intervention (94%), where (77%), what (procedures; 69%), and who (52%).
Figure 4
Figure 4. Quality Improvement (QI) Technique Scores for the 100 Perioperative QI Articles
The most frequently complete QI technique items were: naming the QI technique (fully reported in 95% of the articles) and outcome measures (86%). The most common incomplete items were the description of missing data (incomplete in 83% of the articles) and the provision of a primary outcome measure (missing in 90% of the articles). PDSA, Plan-Do-Study-Act.
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