%0 Journal Article
%T CUSUM: A tool for early feedback about performance?
%A Winston R Chang
%A Ian P McLean
%J BMC Medical Research Methodology
%D 2006
%I BioMed Central
%R 10.1186/1471-2288-6-8
%X Twenty consecutive patients who underwent total hip or knee arthroplasty received a simple dressing ¨C blue gauze and Tegaderm. Cusum charting was used to assess the dressing with regards to skin blistering. At an acceptable level of performance the curve would oscillate about the horizontal axis and the overall trend therefore said to be flat. If performance is unacceptable, the cusum slopes upward.The cusum plot for the twenty patients did not cross the specified control limits. This showed that our simple dressing met specified standards with regards to wound blistering postoperatively.We recommend the use of this simple, yet versatile cusum technique in the early evaluation of a clinical procedure before its implementation.The practice of medicine has evolved through time to the current era of evidence based practice. Medical audit is thus vital to any clinical practice. Systematic approaches to peer review of medical care should be encouraged in order to identify opportunities for improvement and provide a mechanism for realising them. Therefore, some form of objective monitoring, or quality control, of practices or procedures is needed so that periods of suboptimal performance in relation to an agreed standard can be recognised and, ideally, remedied.The use of the cumulative sum (cusum) has been suggested for both surveillance and quality control [1]. First described by Page in 1954 [2], they were applied later to medical problems, replicability of urea estimations and cough remedies by 1965 [3], and were advocated for medical use by Healy in 1968 [4]. Cusum plots may be performed on any data gathered serially. Their main use is in quality control in medical laboratories and industry. Recent experience with this simple yet versatile and powerful statistical technique has amply confirmed its utility, and it is my hope that this study, as an example, will encourage and lead to its wider use in orthopaedics.We had noted a recent increase in postoperative wound bl
%U http://www.biomedcentral.com/1471-2288/6/8