QUALITY IMPROVEMENT
Step, Error, and Event Frameworks in Endovascular Aortic Repair
Lauren Gordon, Gilles Soenens, Bart Doyen, Juliana Sunavsky, Mark Wheatcroft, Charles de Mestral, Vanessa Palter, Teodor Grantcharov, Isabelle Van Herzeele
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Overview
This study aimed to develop comprehensive evaluation frameworks for steps, errors, and events in elective endovascular aortic repair (EVAR) procedures, utilizing data captured by the OR Black Box®. The research employed a modified Delphi consensus process, involving 38 international experts from Vascular Surgery and Interventional Radiology. Through multiple survey rounds, the experts identified and rated key elements of EVAR procedures, reaching consensus (Cronbach α>0.7) after three rounds.
The resulting evaluation tool comprises 32 procedural steps, 15 potential errors, and 25 notable events, with high agreement levels (74%-100%) among experts for each item. This detailed framework is designed to provide targeted feedback on technical performance in EVAR procedures, potentially enhancing skill development for both trainees and experienced surgeons. The authors plan to validate this tool on recorded procedures in future work, with the goal of promoting surgical mastery and focusing on common errors and hazardous steps in EVAR. This approach represents a significant step towards more comprehensive, data-driven feedback in competency-based surgical education.
Results
Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82-0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%-100%).
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