How many doctors does it take to manage an elective general surgical patient? Individualised surgeon specific outcomes data misrepresent modern team-centred work practices

Abstract

Introduction: The recent adoption of publishing surgeon-specific mortality data in some settings has prompted concerns that the complex team working environment is misrepresented. This has led to consideration that outcomes data would be more accurately conveyed if team-based outcomes were published. However, there has been little investigation into what constitutes a clinical team within the surgical setting and if team size increases when providing person-centered care to more complex patients. Here, we seek to address these questions in elective colorectal surgery. Methods: This is a multi-centre retrospective case cohort study. Data were obtained from 3 Scottish sites. All elective colorectal resection procedures within a 2-month period were included. A standardised proforma was used to establish the number of professionals involved in patient care, diagnosis, management and outcome. Data were obtained from referral to discharge from cancer resection. Results: Thirty-eight cases were included. Median age was 69.5, with 63.2% being male. The number of patients with underlying co-morbidities was 15. The mean number of doctors involved in care was 19 (range 26-87). Complications were associated with a larger in-hospital medical team (p <0.001) but there were no differences in team size by co-morbidity status. Conclusion: Our study would suggest that publication of outcomes based upon one named clinician is an oversimplification of modern, person-centered management. The publication of team-based outcomes may both be more transparent with regard to clinical pathways and in turn support individual clinicians. Such reporting may enhance transparency while protecting individuals in an increasing culture of blame.