A method for detecting runs of good and bad clinical outcomes on variable life-adjusted display charts

In recent years there has been a growing need for effective monitoring of clinical outcomes. Two techniques for continuous monitoring that have emerged almost simultaneously are the variable life-adjusted display (VLAD) and risk-adjusted cumulative sum charts (CUSUM). The VLAD supplies clinicians and management with an easily understandable overview of outcome history and is now in routine use in several hospitals. Although it can indicate runs of good and bad outcomes, unlike the CUSUM, it does not provide a quantitative means for assessing whether they merit investigation. This paper introduces a scheme for applying control limits from CUSUM charts onto the VLAD, thus enhancing its role as an effective monitoring tool.