Improving Surgical Quality
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Elizabeth Mort, MD, MPH, senior vice president for quality and safety for MGH and Massachusetts General Physician Organization, says she and MGH administrators "endorse this work wholeheartedly. We're all being asked to improve quality and safety while making healthcare more affordable. Reducing adverse events hits the sweet spot because you're improving patient safety and reducing cost as well."
Three of Baptist Health South Florida's hospitals based in Miami joined NSQIP about 12 years ago, says Thinh Tran, MD, corporate vice president and chief medical and quality officer, and a fourth recently came on board.
"We participate in every single measure, unless the hospital does not provide that care," he says.
Tran says that before Baptist Health started NSQIP each hospital had its own protocol. "And they were all different. The variation in that care is really a problem." After they received data on how they compared with other hospitals in Florida and across the country, they had the motivation they needed to improve.
They focused on dozens of issues, especially preventing ventilator-associated pneumonia and use of blood-thinning products to prevent blood clots. "And on adopting single protocols rather than four or five," he says.
"We actually have a full Web-based dashboard from which we share information back to our physicians, surgeons, internal medicine doctors. The benefit for me, particularly with my surgical colleagues, is that these are really meaningful outcomes" and through benchmarks, internally, regionally, and nationally, "we can learn from others' best practices," Tran says.
Based on NSQIP's risk-adjustment algorithm, which adjusts for patient comorbidities, Tran says Baptist would have had 64 more deaths and 1,061 complications throughout 2011 if it hadn't been for the changes it implemented. And that saved Baptist $21.3 million in care it didn't have to provide.
Asked if surgeons resisted the project, Tran says there were some at first.
"Initially, it was just a matter of education, answering questions like, 'Where is the data coming from?' and proving that the data is actually accurate—'Was the case done by Dr. X, or his or her partner?' "
But each hospital's NSQIP participation requires a "physician champion," someone whose job it is to work with surgeons to explain questions and develop plans of attack to specific problems. If physicians aren't able to improve on a certain procedure, there is more intense effort to find out why.
Tran says that though NSQIP requires considerable resources, it has the support of the hospital system's board and there hasn't been a problem getting support for its cost.
For Daley, UTMC's NSQIP "champion," one of the unexpected developments that he's seen is how willingly hospitals that compete with each other in Tennessee are sharing information and talking openly about problems.
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