What are appropriate agenda items for a surgical steering meeting?

Surgical Steering Meeting Agenda Items

A surgical steering meeting should focus on multidisciplinary review of surgical outcomes, quality improvement initiatives, and system-level performance metrics to reduce morbidity and mortality. 1

Core Agenda Components

1. Multidisciplinary Case Review and Mortality/Morbidity Discussion

• Review all surgical complications and deaths from the preceding period, including both patients who underwent surgery and the "NoLap" population (patients eligible for surgery who did not undergo operation). 1
• Discuss technical aspects, surgical decision-making, multidisciplinary discussions, and communication with families. 1
• Include structured thematic analysis with standard nomenclature to identify patterns and opportunities for improvement. 1
• Review cases where operations were deemed non-beneficial in retrospect to understand decision-making processes and improve future patient selection. 1

2. Quality Improvement and Safety Metrics

• Present compliance data for evidence-based protocols such as WHO Surgical Safety Checklist completion rates, surgical site infection rates, and adherence to Enhanced Recovery After Surgery (ERAS) pathways. 1, 2, 3
• Compare performance against evidence-based standards and benchmarks from other centers. 1
• Review failure-to-rescue events and near-miss incidents using physiological track-and-trigger system data. 1
• Analyze readmission rates, length of stay, and postoperative complications per 100 patients. 2

3. High-Risk Patient Management and Shared Decision-Making

• Discuss cases where multidisciplinary consultation occurred for high-risk patients (defined by validated risk scoring systems including frailty evaluation) before surgery. 1
• Review documentation quality of Goals of Care discussions, including benefits/risks of surgery versus alternatives. 1, 4
• Identify patients who refused recommended surgery and review how these cases were managed, ensuring proper documentation and support were provided. 4
• Discuss involvement of geriatricians or palliative care specialists for appropriate patients. 1

4. System-Level Performance and Resource Allocation

• Review availability and utilization of critical resources including intensive care beds, operating room time, and specialized equipment. 1
• Analyze staffing patterns and identify periods of understaffing that contributed to adverse events or delays in care. 3
• Discuss barriers to implementing evidence-based practices identified through Pareto analysis (e.g., malfunctioning equipment, lack of supplies). 3

5. Quality Improvement Project Updates

• Present progress on ongoing QI initiatives using structured frameworks with specific, measurable, attainable, relevant, and timebound (SMART) goals. 5, 6
• Focus on high-impact components that address: promoting appropriate care, reducing inappropriate or harmful care, reducing regional variations in delivery of care, improving access to care, and educating clinicians and patients. 1
• Review implementation barriers and strategies to overcome them, ensuring projects are sensitive to time, capacity, and local context. 6

6. Protocol Development and Standardization

• Discuss development or revision of local protocols for common surgical conditions, perioperative management pathways, and emergency response procedures. 1
• Review evidence gaps where clinical consensus statements may be needed to reduce practice variability. 1
• Establish or update criteria for high-risk patient identification and triggers for multidisciplinary consultation. 1

7. Educational and Training Needs

• Identify training gaps in palliative care conversations, end-of-life management, and shared decision-making skills among surgical staff. 1
• Discuss opportunities for staff education on new protocols, evidence-based practices, or quality improvement methodology. 6
• Review resident and trainee involvement in complex decision-making and provide emotional support for trainees dealing with difficult cases. 1

8. Patient and Family Experience

• Review patient satisfaction data and family feedback, particularly regarding communication during serious illness conversations. 1, 7
• Discuss cases where communication breakdowns occurred and strategies to prevent similar issues. 7
• Identify opportunities to improve patient-centered care and shared decision-making processes. 1, 4

Meeting Structure and Logistics

• Convene regularly (weekly or biweekly depending on caseload) to keep meetings focused and maintain physician engagement, with each case discussed in 5-10 minutes. 1
• Ensure consistent attendance from senior surgeons, anesthesiologists, nursing leadership, and other relevant specialists (geriatricians, intensivists, infection control). 1
• Pre-distribute materials one week before the meeting in a single consolidated document including agenda, case summaries, and performance metrics. 1
• Designate a program coordinator to facilitate data collection, promote pathway adherence, and provide continuity. 1

Common Pitfalls to Avoid

• Avoid lengthy meetings with too many cases, which reduces active participation and engagement. 1
• Do not focus solely on patients who underwent surgery; include the "NoLap" population to understand the full spectrum of surgical decision-making. 1
• Ensure discussions address not just technical aspects but also communication, decision-making processes, and opportunities to improve patient and family experience. 1
• Do not implement broad quality improvement initiatives simultaneously; focus on a small number of high-impact components initially for better success. 1, 6
• Avoid having discussions without clear documentation of decisions, action items, and assigned responsibilities. 4