Improved Implementation Of The Risk-Adjusted Bernoulli Cusum Chart To Monitor Surgical Outcome Quality

Methodology issue: The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information.Proposed solution: We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery.Evaluation: A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration.Advice to practitioners: Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems.