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Raising the quality of hernia care: Is there a need?

  • SAGES HERNIA TASK FORCE
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Abstract

Introduction

With a focus on raising the quality of hernia care through creation of educational programs, SAGES formed the Hernia Task Force (HTF). This study used needs assessment survey to target opportunities for improving surgical training and thus patient outcomes and experience.

Methods

This qualitative study included structured interviews and online surveys of key stakeholders: HTF members, surgeons, nurses, patients, hospital administrators, healthcare payers and medical suppliers. Questions included perceptions of recurrence and complication rates, their etiologies, perceived deficits in current hernia care and the most effective and training modalities.

Results

A total of 841 participants included 665 surgeons, 66 patient care team members, 12 hospital administrators and 14 medical supply providers. Assessment of technical approach revealed that nearly 26 % of surgeons apply the same, limited range of techniques to all patients without evaluation of patient-specific factors. The majority (71 %) of surgeon respondents related hernia recurrence rates nearing 25 % or more. HTF members implicated surgeon factors (deficits in knowledge/technique, etc.) as primary determinants of recurrences, whereas nurses, medical supply providers and hospital administrators implicated patient health factors. Surgeons preferred attending conferences (82 %), reading periodicals/publications (71 %), watching videos (59 %) and communicating with peers (57 %) for learning and skill improvement. Topics of the greatest interest were advanced techniques for hernia repairs (71 %), preoperative and intraoperative decision making (56 %) and patient outcomes (64 %). Eighty-six percent of nurses felt that there was room for improvement in hernia patient safety and teamwork in the OR. Only 24 % believed that the patients had adequate preoperative education.

Conclusions

Major reported deficits in hernia care include: lack of standardization in training and care, “one size fits all” technical approach and inadequate patient follow-up/outcome measures. There is a need for a comprehensive, flexible and tailored educational program to equip surgeons and their teams to raise the quality of hernia care and bring greater value to their patients.

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Acknowlegments

Gina L. Adrales, Dartmouth-Hitchcock Med Ctr., Lebanon, NH; Igor Belyansky, Anne Arundel Med Ctr., Annapolis, MD; Parag Bhanot, Georgetown Univ Hsp, Washington, DC; Ibrahim Bulent Cetindag, University of Iowa, Iowa City, IA; Andrew J. Duffy, Yale Univ School of Med/New Haven Hsp, New Haven, CT; David Bryan Earle, Baystate Med Ctr., Springfield, MA; Robert J. Fitzgibbons, Creighton Univ Med Ctr., Omaha, NE; B. Todd Heniford, Carolinas Medical Center, Charlotte, NC; Brian P. Jacob, Mount Sinai Medical Center, New York, NY; Dennis R. Klassen, Queen Elizabeth II Health Sciences Center, Halifax, NS; Karl A. Leblanc, Louisiana State Univ, Baton Rouge, LA; Brent D. Matthews, Carolinas Med Ctr., Univ. of N.Carolina, Charlotte, NC; John D. Mellinger, Southern IL Univ School of Med, Dept of Surgery, Springfield, IL; Philip A. Omotosho, Duke University Medical Center, Durham, NC; Adrian Park, Anne Arundel Medical Center, Annapolis, MD; Richard A. Pierce, Vanderbilt University Department of Surgery, Nashville, TN; Carla Marie Pugh, University of Wisconsin, Madison, WI; Bruce J. Ramshaw, Advanced Hernia Solutions, Daytona Beach, FL; John Scott Roth, Univ of KY, Lexington, KY; Douglas S. Smink, Brigham and Women’s Hospital, Boston, MA; Monica Torres-Jimenez, Alexandra Marine and General Hospital (Goderich), Goderich, ON; Shirin Towfigh, Beverly Hills Hernia Center, Beverly Hills, CA; Melina C. Vassiliou, McGill Univ, Montreal, PQ; and Guy R. Voeller, University of Tennessee, Memphis, TN.

Disclosures

Drs. Adrian E. Park, Hamid Reza Zahiri, Carla M. Pugh, Melina Vassiliou and Guy Voeller have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway Dr., 1st Floor, Annapolis, MD, 21401, USA

    Adrian E. Park & Hamid Reza Zahiri

  2. Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA

    Carla M. Pugh

  3. Department of Surgery, McGill University School of Medicine, Montreal, Canada

    Melina Vassiliou

  4. Department of Surgery, University of Tennessee School of Medicine, Memphis, TN, USA

    Guy Voeller

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  1. Adrian E. Park
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Correspondence to Hamid Reza Zahiri.

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Park, A.E., Zahiri, H.R., Pugh, C.M. et al. Raising the quality of hernia care: Is there a need?. Surg Endosc 29, 2061–2071 (2015). https://doi.org/10.1007/s00464-015-4309-4

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