What s next? Joint Commission for Transforming Healthcare Colorectal Surgical Site Infections (SSIs) 1
Public Launch SSI Storyboard 2
COLORECTAL SURGICAL SITE INFECTIONS: CHARACTERISTICS OF THE PROJECT PARTICIPANTS Participating site Locations Type ACS NSQIP Cedars-Sinai Cleveland Clinic Mayo Clinic Rochester Hospital Los Angeles, California Cleveland, Ohio Rochester, Minnesota No Yes Yes # of licensed Beds 958 registered 1200 registered 700 registered # of Colorectal Surgeries performed annually/monthly 780 cases/ year 65 cases/ month 2854 cases/ year 237 cases/ month 2500 cases/ year 208 cases/ month # of surgeons performing Colorectal surgeries 47 surgeons 16 surgeons 8 surgeons North Shore-Long Island Jewish Health System Great Neck, New York No 1290 registered 662 cases/ year 55 cases/ month 31 surgeons Northwestern Memorial Hospital OSF Saint Francis Stanford Hospital & Clinics Chicago, Illinois Peoria, Illinois Palo Alto, California Yes Yes Yes 894 registered 616 registered 613 registered 404 cases/ year 33 cases/ month 250 cases/ year 21 cases/ month 380 cases/ year 32 cases/ month 8 surgeons 13 surgeons 47 surgeons 3
Project Metrics - Results Proportion 0.24 0.18 0.12 0.06 Primary metric: Observed Colorectal SSIs (Update 22 June 2012) Baseline Improve Post Improvement UC L=0.2517 UC L=0.1920 P=0.1430 LC L=0.0941 UC L=0.2226 P=0.1577 LC L=0.0927 P=0.1111 0.00 LC L=0 Mar-09 Sep-09 Mar-10 Sep-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 Quarter/ Year Note - This chart only prov ides data av ailable from all 7 participating hospitals as of 22 June 2012 Tests performed w ith unequal sample sizes Boxplot of Aggregate (7 hospitals) Superficial OE, Baseline versus Post Improve Individual Value 2.0 1.5 1.0 0.5 0.0 Secondary Metric: Colorectal SSI OE Ratio (Update 22 June 2012) 2.0 Baseline Improv e Post Improv ement UCL=1.888 UC L=1.552 X=1.13 LC L=0.708 UC L=1.667 X=1.254 Mar-09 Sep-09 Mar-10 Sep-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Quarter/ Year Note: This chart only prov ides data av ailable from all 7 participating hospitals as of 22 June 2012 0.5 Data 1.5 1.0 Baseline Superficial OE LC L=0.840 P-Value = 0.006 Nov-11 X=0.908 LC L=-0.073 Jan-12 Mar-12 Post Improve Superficial OE 4
Measurement System Colorectal Surgical Site Infections: Types of Measures Input Measures Surgical Process Performance Measures Output Measures Outcome Measures Risk Factors Contributing Factors Short-Term Project Metric Patient Surgical Consult & Pre Admin Testing Admission & Transfer Processes Preoperative Holding Area Perioperative OR Postoperative Recovery PACU/ICU Postoperative Care Patient Care Unit & Discharge Post Discharge & 30-Day Follow Up SSI Outcomes Modifiable versus Non -modifiable risk factors Surgical Planning & Preoperative optimization Elective vs Emergent cases Assessment & Preparation Preoperative preparation Surgical preparation, Surgical techniques & instruments, Surgical team work, Surgical closing process * Process risks points Postoperative care management Measurement of defective parts in the process Wound management Patient & Discharge educations Relationship analysis to Measures: 1. Length of Stays 2. Readmission 3. Re-operation 4. Postop wound occurrence & culture Stratification By Types: Superficial Deep Incisional Organ Space Financial Impacts: Cost of SSIs 5
CURRENT SSI PILOT PARTICIPANTS Four Pilot Hospitals for Phase One: 1. Vanderbilt University (TN) academia medical center 2. Barnes Jewish West County Hospital (MO) hybrid (academia/community) 3. Virtua Marlton (NJ) community hospital 4. Missouri Baptist (MO) community hospital Measurement system used for tracking SSIs: CDC NHSN Scope: ICD 9 codes for Colon and Rectal procedures Currently recruiting Phase Two pilot hospitals. 6
Improvement spread through Targeted Solutions Tool Web-based tool free to Joint Commission accredited organizations >19,000s health care organizations or >4500s hospitals in US. No added cost for access. Educational, no jargon, no special training and no knowledge of RPI methodology needed Guides users to customized solutions. Data analysis conducted by the tool, not the user. Tool walks user through process of: Measuring current state Determining root causes Selecting targeted solutions Control of process after implementation All solutions proven by testing in hospitals 7
Sample view from Hand Hygiene Project 8
Ways to Collaborate with the for Transforming Healthcare Collaboration - Complete Initial work with Robust Process Improvement (RPI) experienced organizations to determine and validate root causes and targeted solutions Pilot Phase 1 - In process Validating work completed by collaborating organizations in organizations that might not have RPI experience Pilot Phase 2 - Active Recruiting Further validation of work by collaborating and Pilot Phase 1 organizations Beta -testing the draft Targeted Solutions Tool Anticipate to start Q4 2012 9
This SSI pilot work with the is about taking the time to critically evaluate our current processes in caring for our colorectal surgical patients. It is not about taking someone else s protocol and implementing without careful evaluation of our organization. Lisa C. Laphan-Morad, Administrative Director Surgical & Ambulatory Services, Virtua Marlton. 10
QUESTIONS OR COMMENTS? 11