CUSUM Analysis for Morbidity and Mortality Meeting in Neurosurgery [Neurosurgery Wiki]

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====== CUSUM Analysis for Morbidity and Mortality Meeting in Neurosurgery ======

[[Morbidity and Mortality meeting]]s are essential for improving patient safety, surgical education, and quality of care. Traditionally based on retrospective case discussion, they can be enhanced by incorporating **CUSUM (Cumulative Sum) analysis** to provide **real-time, data-driven insights** into performance trends.

==== Why Use CUSUM in M&M Meetings? ====

  * Offers a **quantitative framework** to complement qualitative discussion
  * Detects **early deviations** from expected complication rates
  * Tracks **individual or team learning curves**
  * Provides **objective support** for supervision decisions, case allocation, or protocol updates

==== Key Features of CUSUM for M&M Use ====

  * **Outcome-based tracking** (e.g., surgical site infection, hemorrhage, misplacement of devices)
  * Case-by-case visualization of performance trends
  * **Visual alert thresholds** to identify when complication rates exceed acceptable limits
  * Ability to **stratify data** by surgeon, resident, technique, or complexity level

==== Suggested Workflow ====

1. **Pre-meeting preparation**:
   - Generate CUSUM charts for relevant procedures (e.g., ICP monitor placement, craniotomy, spinal fusion)
   - Highlight curves crossing predefined alert thresholds (e.g., 2.5)

2. **During the M&M meeting**:
   - Present CUSUM curves alongside traditional case narratives
   - Use the curves to identify whether a complication is part of a **random variation** or part of a **trend**
   - Discuss potential causes: learning curve phase, supervision level, protocol adherence, etc.

3. **Post-meeting actions**:
   - Recommend supervision changes, simulation training, or protocol updates if needed
   - Reassess the operator's CUSUM at the next M&M session

==== Example Application ====

*Case*: A resident presents with 3 complications in 15 ICP monitor placements.  
*CUSUM chart*: Rising trend, crossing alert threshold at case #14.  
*Interpretation*: Trend suggests performance deterioration, not just isolated incidents.  
*Action*: Reinforce direct supervision and review technique; follow-up at next M&M.

==== Benefits for Neurosurgery Services ====

  * **Early detection** of performance issues
  * **Fair and structured evaluation** of trainees and techniques
  * **Reinforces a safety culture** based on transparency and improvement
  * Aligns with **accreditation standards** and clinical governance expectations

Integrating CUSUM into M&M meetings transforms them from anecdotal reviews into **structured, outcome-driven improvement platforms**.