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The snapshot audit methodology: design, implementation and analysis of prospective observational cohort studies in surgery

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

For some surgical conditionns and scientific questions, the “real world” effectiveness of surgical patient care may be better explored using a multi-institutional time-bound observational cohort assessment approach (termed a “snapshot audit”) than by retrospective review of administrative datasets or by prospective randomized control trials. We discuss when this might be the case, and present the key features of developing, deploying, and assessing snapshot audit outcomes data.

Methods

A narrative review of snapshot audit methodology was generated using the Scale for the Assessment of Narrative Review Articles (SANRA) guideline. Manuscripts were selected from domains including: audit design and deployment, statistical analysis, surgical therapy and technique, surgical outcomes, diagnostic testing, critical care management, concomitant non-surgical disease, implementation science, and guideline compliance.

Results

Snapshot audits all conform to a similar structure: being time-bound, non-interventional, and multi-institutional. A successful diverse steering committee will leverage expertise that includes clinical care and data science, coupled with librarian services. Pre-published protocols (with specified aims and analyses) greatly helps site recruitment. Mentored trainee involvement at collaborating sites should be encouraged through manuscript contributorship. Current funding principally flows from medical professional organizations.

Conclusion

The snapshot audit approach to assessing current care provides insights into care delivery, outcomes, and guideline compliance while generating testable hypotheses.

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Funding

Dr. Lane-Fall reported grant support from the NIH (3R01HL153735-02S1, 5P30AG059302-04, 1U01OD033246-01, 1R01HD105446-01), Agency for Healthcare Research and Quality (AHRQ; 5K12HS026372-04), and PCORI (21,106). Dr Vail reported grant support from Agency for Healthcare Research and Quality (AHRQ; Agency for Healthcare Research and Quality (AHRQ; K12HS026372).

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Authors and Affiliations

  1. Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA

    Gary A. Bass & Lewis J. Kaplan

  2. Division of Trauma and Emergency Surgery, Orebro University Hospital and Faculty of School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden

    Gary A. Bass, Éanna J. Ryan & Shahin Mohseni

  3. Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISC-LDI), University of Pennsylvania, Philadelphia, PA, USA

    Gary A. Bass, Meghan Lane-Fall, Caoimhe C. Duffy & Emily A. Vail

  4. Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 3400 Spruce St, 5 Dulles, Philadelphia, PA, 19104, USA

    Gary A. Bass, Meghan Lane-Fall, Caoimhe C. Duffy & Emily A. Vail

  5. Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA

    Lewis J. Kaplan

  6. Department of Surgery, Tallaght University Hospital, Dublin, Ireland

    Éanna J. Ryan

  7. Department of Clinical Epidemiology and Biostatistics, Orebro University, Orebro, Sweden

    Yang Cao

  8. Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA, 19104, USA

    Meghan Lane-Fall, Caoimhe C. Duffy & Emily A. Vail

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  1. Gary A. Bass
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  2. Lewis J. Kaplan
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  4. Yang Cao
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  5. Meghan Lane-Fall
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  7. Emily A. Vail
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  8. Shahin Mohseni
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Contributions

GAB, SM, and LJK conceived the idea for the study; GAB and EJR collected the data; GAB and YC analyzed the data; GAB, SM, LJK, CCD, EAV, IM and MLF wrote the manuscript, and the final version was reviewed and approved by all authors. The diverse international authorship brought together expertise in surgical outcomes research, biostatistics, study methodology and implementation science.

Corresponding author

Correspondence to Gary A. Bass.

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Conflict of interest

The authors have no conflict of interest to report. No funding was received for the execution of the current study.

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Bass, G.A., Kaplan, L.J., Ryan, É.J. et al. The snapshot audit methodology: design, implementation and analysis of prospective observational cohort studies in surgery. Eur J Trauma Emerg Surg 49, 5–15 (2023). https://doi.org/10.1007/s00068-022-02045-3

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