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Cumulative Sum (CUSUM) charts for medical student peripheral venous cannulation; development of a difficulty-adjusted CUSUM. Dr Harry Murgatroyd SpR Anaesthesia Leeds Teaching Hospitals Trust Sumaiyah Kola Medical Student Leeds University Medical School.
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Dr Harry Murgatroyd
Leeds Teaching Hospitals Trust
Leeds University Medical School
Runcie CJ. Assessing the performance of a consultant anaesthetist by control chart methodology. Anaesthesia. 2009; 64(3): 293-296
Audit of quality clinical practice
Graphical presentation over time
Used to determine competency
definition of success / failure
acceptable failure rate
unacceptable failure rate
Score falls with success
Score increases with failure
Success is seen as a fall in the graph
Failure seen as a rise in the graph
Each point represents a single cannulation attempt
Score derived using the CUSUM formula
de Oliveira. Anesth Analg 2002;95:411-6.
Williams et al. BMJ 1992;304:1359-61.
Upper and lower boundries
0= failure,1= success
Data is plotted sequentially
Running total, CUSUM
Example if “IF” formula in Excel
Table shows the scoring of each of the recorded variables. These are then added up to give the total score for the cannulation attempt
Shows the standard CUSUM formula, whilst incorporating different failure rates and scores dependent on the difficulty of the variables recorded.
Spreadsheet showing the final added up scores of the different variables. Hence including the vein, consciousness and cannula size. Using “IF” formulas the correct value of S is selected from the table above and the CUSUM then plotted in the same way as before.
Bolson S, Colon M. Int J Health Care Qual Assur 2000;12:433-438.
Kestin IG. BJA 1995;75:805-809.
Potentially corrects for patient variability
Easier and more intuitive than other methods of adjustment
Failure rates set by the user
The more variables ‘corrected’ for, the more layers of estimation and inaccuracy
Loss of statistical element of conventional CUSUMDifficulty adjusted CUSUM