Greater Toronto Area Surgical Gynaecology Quality Scorecard
Quality Improvement & Outcomes
The Surgical Gynaecology Scorecard is an online platform for surgeons to log-in, input perception of their surgical performance, and subsequently view how they anonymously benchmark against colleagues across the network with respect to seven clinically-meaningful performance metrics for hysterectomy. Our project has enhanced surgeons’ understanding of personal performance and encouraged self-reflection. We have expanded to 10 hospitals across 4 universities and provided performance reports to 120 surgeons. Our learnings on surgeon perception of performance was published in a leading medical journal. Our data has helped us to answer important clinical questions that impact patient care, resulting in 10 publications, 5 research awards and several knowledge translation initiatives. For example, we created a personalized risk calculator using our data to facilitate improved surgeon-patient counselling on risks of complications at elective hysterectomy.
Our objective was to develop and implement the Surgical Gynaecology Scorecard, an online platform for surgeons to biannually view their performance across several quality metrics and benchmark with other hospitals, all with the goal of facilitating surgeon self-reflection and improving patient outcomes. We now have a repository of clinical data for >5000 hysterectomies. This information has helped us to answer several important clinical questions. We have published our findings in leading medical journals and embarked on knowledge translation with widely shared infographics. Highlighted key learnings that have led to improvements in clinical care include:
– Many patients were unnecessarily having their ovaries removed at hysterectomy leading us to launch an awareness campaign for surgeons.
– We found that 1/5 patients were anemic at the time of hysterectomy and there was considerable hospital and surgeon-level variation in preoperative anemia rates. We launched a multi-center funded initiative to address this issue.
– We learned that 1.8% of patients undering hysterectomy for a benign indication had an unexpected malignancy. We educated surgeons on this patient counselling point.
– Using our data, we created an online personalized hysterectomy complication prediction calculator to allow surgeons and patients to engage in patient-centric counselling of the risks of surgery.
We have shared our learnings at many provincial and national venues. We hope to expand past the 10 hospitals in our network. We are uniquely positioned to harness our infrastructure to perform system-wide quality improvement projects, which is our next aim. We have partnered with a digital marketing company to launch the Gynaecology Quality Improvement website (www.GYNQI.com) which contains resources for patients and surgeons. The goal is to create a community of practice and disseminate knowledge from Scorecard initiatives. We currently have >1400 visits/mo.
This project has secured additional $250,000 through the Kavelman-Fonn grant and $27,800 from various sources to support clinical research projects from Scorecard. We recently received a UofT Department of OBGYN Synergy grant ($80,000) to use the Scorecard infrastructure to implement a quality improvement bundle focused on perioperative hemoglobin optimization at 7 UofT-affiliated hospitals.
“With data for >5000 hysterectomies, we have been able to answer several important clinical questions, resulting in 10 publications. Click here for associated infographics. The online personalized hysterectomy complication prediction calculator based on publication #5 below can
be found here.
1. Predictors and variation in preoperative anaemia (2023, PMID: 36655534)
2. Surgeon Gender and Performance Outcomes for Hysterectomies (2023, PMID: 36332819)
3. Accuracy of Surgeon Self-Reflection on Hysterectomy Quality Metrics (2022, PMID: 35849454)
4. Assessing the impact of obesity on surgical quality outcomes among patients undergoing hysterectomy (2022, PMID: 35688107)
5. Individualized Assessment of Risk of Complications after Benign Hysterectomy. (2022, PMID 35504556)
6. Unexpected malignancy at the time of hysterectomy performed for a benign Indication (2022, PMID 35504556)
7. Avoidable bilateral salpingo-oophorectomy at hysterectomy (2022, PMID 35324543)
8. Impact of Minimally Invasive Gynaecology Fellowship Training on Quality Performance Metrics for Hysterectomy (2021, PMID: 34153536)
9. Unnecessary bilateral salpingo-oophorectomy at the time of hysterectomy and potential for ovarian preservation (2020, PMID: 32898023)
10. A Case for a Uniform Report Card System for Gynaecologic Surgery (2017, PMID: