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. 2022 May;36(5):3610-3618.
doi: 10.1007/s00464-021-08614-8. Epub 2021 Jul 14.

Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details

Lia D Delaney  1   2 , Kerry M Lindquist  2 , Ryan Howard  2   3 , Anne P Ehlers  2   3 , C Ann Vitous  2 , Michael Englesbe  3   4 , Justin B Dimick  2   3   5 , Dana A Telem  6   7   8
Affiliations

Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details

Lia D Delaney et al. Surg Endosc. 2022 May.

Abstract

Background: Variable approaches to intraoperative communication impede our understanding of surgical decision-making and best practices. This is critical among hernia repairs, where improved outcomes are reliant on understanding the impact of different patient characteristics and surgical approaches. In this context, a hernia-specific synoptic operative note was piloted as part of an effort to create a statewide hernia registry. We aimed to understand the impact of the synoptic operative note on variable missingness and evaluate barriers and facilitators to improved intraoperative communication and note adoption.

Methods: In January 2020, the Michigan Surgical Quality Collaborative (MSQC) registry was expanded to capture hernia-specific intraoperative variables. A synoptic operative note for hernia repair was piloted at 8 hospitals. The primary outcome was change in hernia variable communication, measured by missingness. Using a sequential explanatory mixed-methods design, we performed semi-structured interviews with data abstractors (n = 4) and surgeons (n = 4) at 5 pilot sites to assess barriers and facilitators of implementation. Interviews were iteratively analyzed using content analysis with both deductive and inductive approaches.

Results: From January to June 2020, 870 hernia repairs were performed across 8 pilot and 53 control sites. Pilot sites had significantly less missingness for all hernia-specific variables. At pilot sites, 46% of notes were fully complete in regard to hernia variables, compared to 21% at control sites (p value < 0.001). While collection of intraoperative variables improved after synoptic note implementation, low note adoption was reported. Facilitators of improved variable collection were (1) communication with data abstractors and (2) stakeholder acknowledgment of widespread benefit, while barriers included (1) surgeon resistance to practice change, (2) EMR/technology, and (3) interruptions to communication and implementation.

Conclusion: This mixed-methods evaluation of a synoptic operative note implementation suggests that sustained communication, particularly with abstractors, was the most impactful intervention. Future implementation efforts may have improved effectiveness with interventions supplementary to surgeon-level direction.

Keywords: Abdominal hernia repair; Intraoperative communication; Synoptic operative note; Variable registry.

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Conflict of interest statement

Ryan Howard receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). Michael Englesbe receives unrelated funding from the Michigan Department of Health and Human Services, and the National Institute on Drug Abuse. Justin Dimick receives Grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases, and is a cofounder of ArborMetrix, Inc. Dana Telem receives funding from AHRQ K08HS025778-01A1 and receives consulting fees from Medtronic. Anne P. Ehlers, Kerry Lindquist, Lia D. Delaney, and C. Ann Vitous have no conflicts of interest or financial ties to disclose. The Michigan Surgical Quality Collaborative is funded as part of the Blue Cross Blue Shield of Michigan Value Partnership program. The content of this study is solely the responsibility of the authors and does not necessarily reflect the official views of Blue Cross Blue Shield of Michigan. No funder or sponsor had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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