Surgeon Champion: Getting Started, What You Need to Know Ninh T. Nguyen, MD, FACS Professor of Surgery Surgeon Champion Vice-Chair, Dept Surgery University of California, Irvine, Medical Center, Orange, CA
What You Need to Know as a SC! Why did I do this? What do I need to get started? What was the hardest/easiest things in starting? What do I wish I had known before I got started?
Surgery and the Public s Health 50% of Surgical Complications Preventable Each year, ACS NSQIP hospital has opportunity to reduce complications by 250-500 and save 12-36 lives Hall et al. Ann Surg 2009
Why did I do this? Quality improvement is important - Opportunity to improve the care for patients Opportunity to learn about quality Opportunity to educate your peers and other specialists
Role of the Surgeon Champion Serve as resources for SCR Local liaison to the ACS NSQIP program Local advocate for quality initiatives Share NSQIP learning, best practices, case studies with staff and surgeons
Learning about Quality Sampling methodology Data collection definition Risk adjustment Opportunity to educate others (surgeons, residents, students)
What do I need to get started? Buy-ins from your department - Secure funding for your position - Average 5-8 hours a week time commitment Commitment for an SCR Educational resources - Review available toolkit - Case studies - Best practice guidelines
Aim: Determine Who the Surgical Champion and How Does Surgical Champion Achieves Change Study Population: All 238 NSQIP Surgical Champions Surveyed
Role of the Surgeon Champion 72% were not compensated for their effort Factors associated with demonstrable CQI efforts: - Longer duration of participation - Frequent meeting with SCR - Frequent presentation of data to administration - Compensation for surgical champion effort - Providing individual surgeon with feedback
What was the hardest/easiest things in starting? Easiest - Commitment of an SCR - Available concise data at your finger tips Hardest - Now what? - Communicating data to surgeons - Implement quality improvement efforts
Presenting the Data Using data as quality diagnostic tool Benchmark to other hospitals Identifying areas for improvement
QI Practice Patterns for Surgical Champions Presenting data to Administration Presenting data to Individual surgeons, Division chiefs & Department chairs, Nursing, Anesthesiology Incorporate NSQIP data into peer review M&M process
Acknowledging the Problem
Acknowledge the Problem Smart surgeon learn from their mistakes, Brilliant surgeons learn from other surgeons mistakes Acknowledge the problem
Beyond Communications Establish the next layer of champions - Divisions - Other departments Begin to use the data
Ernest Codman, 1914 "Every hospital should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire if not, why not with a view to preventing similar failures in the future. Data collection QI
Define Lean Six Sigma Methodology Measure Analyze Improve SC Control
Quality Improvement Efforts Analyze NSQIP data Obtain more specific data Work with various committees to implement quality improvement efforts
Deep venous thrombosis after general surgical operations at a university hospital: two-year data from the ACS NSQIP 35 (1.6%) of 2169 developed DVT 94% based on symptoms vs. 6% based on routine screening Location: Upper (40%), Lower (46%), Both (14%) Catheter-associated in 60% CQI - Routine DVT screening for transfer patients with lines - Increase awareness of the necessity of the line & for earlier removal Smith et al. Arch Surg 2011
SC Resources Available from the ACS NSQIP secure website Best Practices Case Studies Best Practices Guidelines Prevention of Catheter-Associated Urinary Tract Infections Prevention and Treatment of Venous Thromboembolism Prevention and Assessment of Intravascular Catheter-Related Bloodstream Infections Prevention of Surgical Site Infections SC monthly conference calls Collaborative (regional, state-wide, system-wide)
What do I wish I had known before I got started? Compensation for the position Quality begets quality
Quality Officer NSQIP UHC ranking Patient safety indicators SCIP Core Measures
Patient Safety Indicator (PSI) - PSI is a tool developed by the Agency for Healthcare Research & Quality (AHRQ) to screen for problems that patients experience as a result of exposure to the health care system. - Identify potentially preventable complications that occur during an inpatient hospitalization PSI 2: Death in low-mortality DRG PSI 3: Pressure Ulcer PSI 4: Death among surgical inpatients with serious treatable complications PSI 5: Foreign body left in during procedure PSI 6: Iatrogenic pneumothorax PSI 7: Central venous catheter-related bloodstream infections PSI 8: Postoperative hip fracture PSI 9: Postoperative hemorrhage and hematoma PSI 10: Postoperative physiologic/metabolic derangement PSI 11: Postoperative respiratory failure PSI 12: Postoperative PE or DVT PSI 13: Postoperative sepsis PSI 14: Postoperative wound dehiscence PSI 15: Accidental puncture/laceration (APL) PSI 16: Transfusion reaction
2010 APL Occurrences by Service Total APL by Service 2010 Colorectal Surgery Acute Care Service Hepatobiliary Service Gynecology Oncology Otolaryngology Surgical Oncology GI Surgery Vascular Surgery Neurosurgery General Surgery Urological Service 14 12 10 8 6 4 2 0 Service Cases
The pessimist complain about the wind; the optimist expects it to change; the realist adjusts the sail William Ward American Poet
Quality is the result of a carefully constructed cultural environment. It has to be the fabric of the organization, not part of the fabric ninhn@uci.edu