University of Washington Medical Center Approach: Using the NSQIP ROI Calculator to Demonstrate Medical Center Cost Savings

Transcription

1 University of Washington Medical Center Approach: Using the NSQIP ROI Calculator to Demonstrate Medical Center Cost Savings E. Patchen Dellinger, MD Rosemary Mitchell Grant, RN, BSN, CPHQ

2 Disclosures E. Patchen Dellinger Merck Baxter Ortho-McNeil Targanta Schering-Plough WebEx Astellas Care Fusion Durata Pfizer Applied Medical Rib-X Affinium Tetraphase 3M Rosemary Grant - Nothing to disclose

3 Which of These is NOT True of Seattle? A. Seattle has the highest percentage of residents with a college degree of any U.S. city B. People in Seattle buy more sunglasses per capita than any other U.S. city C. Seattle was the first city in the U.S. to play a Beatles song on the radio D. Seattle is the most tattooed city in the U.S.

4 UW Medical Center (UWMC) UWMC is a 450 bed, academic medical center, providing specialized services for cardiac care, cancer care, and stem cell transplantation, obstetrical care (including high risk obstetric care and a level III neonatal intensive care unit), sports, spine and orthopedics care, and solid organ transplantation.

5 UW Division of General Surgery

6 NSQIP at UWMC Joined in late 2006 Bariatric Accreditation Requirement Started with General/Vascular module but moved to procedure targeted in 2013 and added GYN in 2014 Started quarterly meetings with General Surgery in 2008, simply data sharing and looking at reports

7 How do you get Clinicians to Change? A. Tell them what you want them to do and penalize them if they don t do what you want B. Make them read lit reviews that support your position C. Invite them to contribute to discussions with thought leaders and provide opinions about how the change might occur

8 NSQIP at UWMC Started monthly QI meetings with General Surgery in 2010 and embarked upon a series of QI initiatives based on our data Identified priority initiatives Volunteer surgeon champions for each initiative Identified others needed for initiative (dietary, Puget Sound Blood Center, endocrinology, respiratory therapy, anesthesia) Series of meetings planned

9 NSQIP at UWMC UWMC QI Initiatives Unplanned intubation Surgical site infections Glucose control Antibiotic delivery Cancer free margins and lymph node removal in colorectal cancer NG tubes, epidural use, and length of stay Transfusion Albumin

10 Good Quality Evidence Supports Giving a Transfusion When? A. Hgb <7 or Hct <21 B. Patient complaining of fatigue C. Major operation planned with anticipated heavy blood loss D. Patient is at high risk for surgical site infection

11 Transfusion Discussion with Puget Sound Blood Center, small group of surgeons and nurses Considered transfusion triggers and Attending permission to transfuse Intervention: conference review of postoperative transfusions Intention: to avoid transfusions for Hgb >7 unless otherwise clinically indicated Outcome: post-operative transfusion rates

12 Transfusion 43% decrease for all GS cases (p=<0.001) 63% decrease for colorectal cases (p=<0.001) Transfusions are within the OR and/or within 72 hours post-op

13 100.0% Low Hgb Among Post-op Transfusions Elective Colorectal Procedures 80.0% 60.0% 40.0% 20.0% General Other (Gyn) 0.0%

14 Take Home Points We didn t just give fewer transfusions, we gave fewer transfusions that were not evidence-based Patient risks are minimized Stewardship Cost savings Still room for improvement

15 Nutrition- UWMC Data % Complications by Pre-op Albumin Level in Elective Cases % complications < >4 missing

16 Nutrition In 2009, only 60% of elective colorectal surgery cases had albumin tested and of those, nearly 15% had a very low albumin level (<2.5g/dl) Educational and reminder system set up in preop clinic to increase compliance with testing and increase referrals to nutrition By 2011, testing up to 77% and only 3.9% of patients getting an operation with albumin <2.5 Transferred work to Strong For Surgery campaign

17 Decision to Look at ROI Despite our QI interventions.are complications and costs really decreasing?? NSQIP costs money! Hospitals are trying to SAVE money Want justification for every penny spent

18 Which of the Following is True? A. It is impossible to estimate the cost of a complication without hours of work B. Most complications captured in NSQIP do not really cost money C. NSQIP has an easy to use calculator on the website to help estimate the cost of complications

19 ROI Calculator

20 Statistical Significance of Reduction in Complications p-value 30-Day Mortality 1.64% 0.76% Day Morbidity 13.54% 8.27%.0000 Cardiac Complications 0.32% 0.05%.0277 Pneumonia 1.27% 0.56%.0121 Unplanned Intubation 2.16% 1.32%.0271 Ventilator > 48 Hours 2.36% 0.76%.0000 DVT/PE 1.52% 0.51%.0010 Renal Failure 0.70% 0.56%.3012 Urinary Tract Infection 2.47% 1.07%.0006 Surgical Site Infection 6.48% 4.20%.0012

21 Morbidity and Mortality Reductions 16.00% 14.00% 12.00% 10.00% 8.00% 30-Day Mortality 30-Day Morbidity 6.00% 4.00% 2.00% 0.00%

22 UWMC s Cost of Participation in General Surgery QI Registries Personnel Hospital Total Cost Total Cost Cost Fees Per Year Since 2006 NSQIP $110,400 $29,000 $139,400 $836,400 MBSAQIP SCOAP $44,000 $22,250 $66,250 $397,500 $205,650 $1,233,900

23 UWMC s ROI Year Complication Cost Estimate Savings From Previous Year 2007 $ 8,331, $ 7,718,329 $ 613, $ 6,761,166 $ 957, $ 6,312,595 $ 448, $ 5,012,337 $ 1,300, $ 4,433,132 $ 579,205 Total Cost Savings $ 3,898,326

24 Conclusions NSQIP can show you areas for improvement and help you focus NSQIP can estimate your savings from reduction in complications In six years, we spent $1,233,900 on our QI programs including NSQIP and saved $3,898,326 Our net savings from NSQIP were $2,664,426

25 Acknowledgements Andrew Wright David Byrd Kate Curtis David Flum Alex Ruiz Josh Matlock Terry Gernsheimer Jim Perkins Carlos Pellegrini Becky Symons University of Washington Department of Surgery Surgical Outcomes Research Center Foundation for Healthcare Quality