Improving Surgical Quality
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"It shocked me that we were able to go beyond the borders of particular organizations, which had not always acted in a collegial manner, certainly within our community—da Vinci wars, helicopter wars, billboard wars, cancer center wars, and stealing high-ranking or recognized staff members that happen to be in our community," he says.
Ko says that NSQIP is seeing accelerated momentum due to surgeons' and hospitals' not seeing improved clinical results by adhering to Surgical Care Improvement Process measures currently used by CMS in pay-for-performance programs.
These measures reflect whether surgical teams performed certain steps, such as giving a patient an antibiotic within one hour of the first incision, not how well the patient did after the procedure.
"Hospitals that were scoring well on SCIP measures didn't necessarily have better outcomes, and that's consistent with what we're seeing," Ko explains. "If you get great SCIP scores, it doesn't mean you're doing everything right, and you can still have a high rate of surgical site infections.
"What the published literature has demonstrated is that the SCIP scores do not necessarily correlate with better outcomes," Ko says.
In recognition that NSQIP may offer a viable measurement tool, CMS has recently posted on Medicare's Hospital Compare website NSQIP data voluntarily uploaded by some NSQIP hospitals, showing whether hospitals are better than average, average, or worse than average in 30-day surgical complication rates for the following three procedures:
- Lower-extremity bypass surgery, in which surgeons insert a new vein to circumvent blockages in arteries and restore blood flow to the lower leg and foot
- Colon surgery, in which surgeons remove part of the colon affected by polyps, diverticula, or tumors
- Surgical complication rates for patients older than age 64
Daley says for himself, the main lesson has been that quality management must be a constant process. "The biggest thing for me is that you have to keep doing this over and over, like handwashing. You put in a program and get everyone to wash their hands, and a few weeks later they all forget. We can't do that with surgery.
"This isn't gamesmanship; it's not fancy stuff," Daley adds. "It's just someone looking someone else in the eye and asking, 'Did you wash your hands?' or 'Did we do time-outs?' and 'Does everyone agree?'
"It's been an excellent demonstration of the ability of surgeons at multiple organizations to work together for the improvement of the population as a whole," Daley says.
Cheryl Clark is senior quality editor for HealthLeaders Media. She may be contacted at firstname.lastname@example.org.
This article appears in the April 2013 issue of HealthLeaders magazine.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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