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Surgeon-Driven Quality Effort Slashes Complications, Costs

Cheryl Clark, for HealthLeaders Media, May 10, 2013

In NSQIP, as many as 134 data points are collected, including adverse events like frequency and type of surgical site infections, unplanned intubation, the need for patients to return to the operating room, number of patients spending more than 48 hours on a ventilator, occurrence of preventable blood clots, or excessive lengths of stay, to name a few.

Hospitals and their surgeons may pick from several measurement programs, or select the "procedure targeted" option, which allows a choice of 35 operations they want reviewed, such as appendectomies or colectomies or ventral hernia repairs. Twice a year, hospitals get reports showing each surgeon's score is "exemplary," "as expected," or "needs improvement," like a golf score, Daley says. "You're at par, above par, or below par."

For surgeons at UTMC, a 581-bed hospital in Knoxville that joined NSQIP as part of a 10-hospital Tennessee collaborative in 2009, the project "has been very eye-opening because surgeons, in their heart of hearts, want the best for their patients, but they also know that they have problems," Daley says.

"This just gives them an easier way to put a number on that and makes the surgeon feel much more comfortable they have real data."

And it has paid off. UTMC selected vascular and general surgery to work on. In surgical site infections, NSQIP data revealed "rates were above what we expected," Daley says. But care improvements, and minding to details, reduced infections by better than half between the first six months of 2009 and the first six months of 2012, Daley says. Thirty-day mortality rates also declined, from 7 per 1,200 surgical cases between January and June of 2009, to 5 per 1,200 cases three years later.

NSQIP makes it easier to track outcomes for surgical patients who, these days, are less likely to spend the night in the hospital, Daley says. "The majority of my patients now go home the same day. But NSQIP follows them, contacts my office, keeps track of them, and collects that 30-day outcome data. So we catch any infections, for example, that the big Centers for Medicare & Medicaid Services database doesn't," and the same is true for non-Medicare beneficiaries as well.

At 907-bed Massachusetts General Hospital in Boston, one of the original NSQIP hospitals, Matthew Hutter, MD, MPH, director of the Codman Center for Clinical Effectiveness in Surgery, has similar praise.

"We've been hooked on NSQIP," he says. There's the saying, "if you can't measure it, you can't improve on it, and that really holds true in this situation."

Take for example urinary tract infections, he says. "When we first started, we got back data showing our UTIs were much higher than the national average, 7% compared with 4.9%" in FY 2003.

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