Controversies In Obstetrics and Gynaecology Berlin 2003 A

Controversies In Obstetrics and Gynaecology Berlin 2003 A Quality Guide for Surgery Restaurants & Hotels Can we ? - Should we ? Why Not Suggestions Philippe R. Koninckx

The Principles of hotel/restaurants ‘Guides’ l Voluntary – Accept unannounced visits ‘by experts’ – Accept to be scored for…. – Accept to be listed with a scoring l Scoring – – l Quality of food/room Quality of service Environment/location ‘hors catégorie’ -Used by consumers -Incentive for providers Listing accessible to consumers

Controversies In Obstetrics and Gynaecology Berlin 2003 A Quality Guide for Surgery Restaurants & Hotels Can we ? - Should we ? Can we ? – Should Why Not Suggestions we ?

A Quality Guide for surgery l Can we define quality ? – Not a virtuosity contest – Not a race to be the best – Judgment of peers l Skills – Learning curves – Measurable l Experience

The Rabbit Nephrectomy Model l The surgical dilemma – Go slow & safe – Too fast l Task – As fast as possible – But safe

The Rabbit Nephrectomy Model l As fast as possible But safe

Training to prevent accidents ? § Yes § Rabbit nephrectomy model § All series on number of procedures § Series on ‘experience’ § No § Accidents are accidental § Predisposing circomstances § The dangerous surgeon § Vision

A Quality Guide for surgery l Skills & learning curves – Well established for a range of procedures – Is there a minimum to do surgery ? l Endoscopic surgery – Does not take off as expected ? – More difficult than anticipated – Not for everybody : slow becomes too slow l Can we define quality -Yes we can -……………….

Controversies In Obstetrics and Gynaecology Berlin 2003 A Quality Guide for Surgery Restaurants & Hotels Can we ? - Should we ? Why Not Suggestions Why not ?

Historical & political dogma’s § All MD’s are equal § Clearly not true § All patients have acces to similar quality § Clearly not true

Who will be the Judge ? § Professionals - Peers § For Indication of surgery § Criteria of good surgery § § Impossible § Power structures § Difficult to find Unanimity § Examples

Reporting in the literature l Data are not always easy to find – Depth of infiltration reported in 1998 depth n

Who will be the Judge ? § The Judges : medicolegal § Same experts § Same difficulty of criteria § Too late : harm is done § Bad § Conflict model § Very costly for medicine § Does not help the patient

Controversies In Obstetrics and Gynaecology Berlin 2003 A Quality Guide for Surgery Restaurants & Hotels Can we ? - Should we ? Why Not Suggestions

Quality Surgery : Suggestions l Indication & technique – Established surgery is judged medicolegally. – Innovation : ERB is wise / mandatory l Surgery itself – Taping the whole procedure for review – For defense in case of complications l Complications – Definitions : • any laparotomy for a procedure which can be done by laparoscopy is a complication.

Informed consent l Information will be given on – – Indication The aim is to inform about the best treatments available Results Complications occurring in more than 1% Based upon the peer reviewed literature/guidelines l In addition individualised information will be given i. e. l – Data of personal results and complications – when exact data are not available, this will be clearly stated l Definition of a complication – ‘a complication is something which was not necessary, or avoidable and which enhances the morbidity or mortality of the patient’

Quality Surgery : Suggestions l Voluntary Information of patient – Preoperative counseling of indication & technique • Is mandatory l Individualised data on results & complications • Is becoming unavoidable – Established techniques – New techniques need ERB l www. Gyn. Surgery. org – Open to all gynaecologists – Info by individuals or associations on what, how, why

Controversies In Obstetrics and Gynaecology Berlin 2003 A Quality Guide for Surgery Information of the consumer is becoming and necessary Information is becoming individualised Correct information is an advantage A “star” guide ? unavoidable