This review assessed regional collaborations in surgical practices and practice-related quality improvement. The authors concluded that such collaborations could improve quality of care and clinical outcomes. The review had some methodological and reporting weaknesses, but the authors’ conclusions appear to be broadly reliable.

To assess the effectiveness of regional collaborations with a substantial leadership role for surgeons in improving quality and outcomes of surgery.

MEDLINE, EMBASE, The Cochrane Library and EBSCO Health Business Elite were searched up to July 2006. The search was restricted to the English language and the search terms were reported. The reference lists of retrieved papers were reviewed to identify additional studies.

Studies of any design that assessed regional collaborations in surgical practice that related to initiatives to enhance quality improvement, quality of care, patient safety or knowledge transfer were eligible for inclusion. Collaborations had to include a substantial leadership role for surgeons and incorporate an audit and feedback cycle. Collaborative initiatives formed to address issues around breast cancel or bowel cancer, coronary artery bypass grafting and surgical site infection were included. A wide range of educational interventions were used to improve practice across the included studies.

Two reviewers applied the inclusion criteria and selected the studies.

The authors did not report quality assessment of studies included in the review.

Data were extracted on changes in outcomes between the pre- and post-intervention periods.

The authors did not state how data were extracted.

Studies were combined in a narrative synthesis. Differences between studies were presented in tables and discussed in the text.

Seven regional collaborative initiatives that examined surgical practices related to quality improvement met the inclusion criteria. The seven studies were reported in 21 articles. Five initiatives took place in USA, one in UK and one in Australia. Most studies were before/after studies without a control.

Improvements in processes of care outcomes were reported by all collaborative initiatives. Reductions in mortality rates, duration of intubation and surgical site infections were reported in one study each.

A community of practice framework that incorporated the success elements identified in the review could serve as a model for collaboration among surgeons and health care organisations to improve quality of care and foster continuing professional development.

This review addressed a broad question in terms of interventions (collaborative initiatives) and outcomes. Study design inclusion criteria were not specified explicitly. The search included appropriate electronic databases. The search was restricted to studies published in English and hence might not have been included all relevant data. Study selection was performed by two reviewers, which minimised risk of errors and bias. Methods used for data extraction were not reported. A narrative synthesis was appropriate in view of the heterogeneity of included studies. In view of the lack of inclusion criteria for study design and any quality assessment of the included studies, the strength of the evidence base was uncertain. Overall, the review had some methodological and reporting weaknesses, but the authors’ conclusions were in line with evidence presented and appear broadly reliable.

The authors did not state any implications for practice or further research.

The study was supported by the Ottawa Hospital, Ottawa, Ontario, Canada.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.