Improving Surgical Quality

Cheryl Clark, for HealthLeaders Media , April 15, 2013
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This article appears in the April 2013 issue of HealthLeaders magazine.

When Brian J. Daley, MD, FACS, chief of trauma at University of Tennessee Medical Center, talks about success in improving surgical outcomes, he inserts a joke early in the conversation.

"You know, if you ask a surgeon to name the three best surgeons they know, they have a problem coming up with two other names," he quips. Often, he says, "surgeons think everyone else is having a complication, but not them."

Hospitals and doctors often say they're better than their peers, and they do so without contradiction because for any one surgeon, procedure, or hospital, there are few ways to accurately compare results.

But the National Surgical Quality Improvement Project, a growing effort run by the American College of Surgeons, is trying to fill this gap, adopting an effort that grew out of the 44-hospital National VA Surgical Risk Study in the 1990s.

By analyzing data from all NSQIP participants, "we know the risk-adjusted infection rate, or venous thromboembolism rate, or urinary tract infection rate by surgeon, by hospital, by collaborative, or by state or region," explains Clifford Ko, MD, FACS, NSQIP director and a colorectal surgeon and professor of surgery at UCLA's department of surgery.

"We feed these back to the hospitals. They're all risk-adjusted, so someone can't say, 'Well, my patients were sicker.' That's already taken into account. And then it's up to the hospitals to figure out, if their rates are high, what factors in the hospital lead to that and fix it."

At its start in 2004, some 18 hospitals had signed up; today, more than 500 are participating at some level, with another 100 to 200 in the application process, Ko says.

To date, 83% of NSQIP participants have been able to decrease their complication rates by a statistically significant level, Ko says. Some hospitals have been able to prevent 250–500 complications, save 12–36 lives, and wipe away millions of dollars in costs.

"NSQIP is driven by the surgeons," Daley says. "It's data we understand, it's scientifically gathered, vetted by the VA, and now used throughout private and public hospitals across the country."

In a nutshell, hospital surgical teams participating in NSQIP allow their patients' medical records to be analyzed by an independent "data abstractor" trained and certified by NSQIP but paid by the hospital. The abstractor tracks certain outcomes for up to 30 days after the surgical procedure, a much more accurate quality measure than administrative claims and coding data now used by Medicare and other payers to evaluate quality because it measures far more actual outcomes than just readmissions and mortality.

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