Standards of surgery beyond metropolitan centers: a fresh look at perioperative quality measures in small-town America

BackgroundSurgical quality measures have room for improvement in both large- and small-town hospitals.MethodsWe sought concurrence of surgical specialists (general, orthopedic, gynecologic) to study accepted quality and safety parameters using a surgical time-out–based platform.ResultsSurgeons and hospitalists participated promptly and actively and recorded enhanced performance measures compared with prior work and within the period of study. Practice patterns varied, and interchange among participating hospitals was helpful.ConclusionsSmaller institutions are more nimble than larger ones and developed interchangeable ideas for improvement. Surgical process measures improved such that all 4 hospitals are concerned about and committed to maintaining the gains.