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Surgeon Champion: Getting Started, What You Need to Know
Ninh T. Nguyen, MD, FACSProfessor of SurgerySurgeon Champion
Vice-Chair, Dept Surgery
University of California, Irvine, Medical Center, Orange, CA
What You Need to Know as a SC!
• Why did I do this?
• What do I need to get started?
• What was the hardest/easiest things in starting?
• What do I wish I had known before I got started?
Surgery and the Public’s Health
• 50% of Surgical Complications Preventable
• Each year, ACS NSQIP hospital has opportunity to reduce complications by 250-500 and save 12-36 lives
Hall et al. Ann Surg 2009
Why did I do this?
• Quality improvement is important- Opportunity to improve the care for patients
• Opportunity to learn about quality
• Opportunity to educate your peers and other specialists
Role of the Surgeon Champion
• Serve as resources for SCR
• Local liaison to the ACS NSQIP program
• Local advocate for quality initiatives
• Share NSQIP learning, best practices, case studies with staff and surgeons
Learning about Quality
• Sampling methodology
• Data collection – definition
• Risk adjustment
• Opportunity to educate others (surgeons, residents, students)
What do I need to get started?
• Buy-ins from your department- Secure funding for your position- Average 5-8 hours a week time commitment
• Commitment for an SCR
• Educational resources- Review available toolkit - Case studies- Best practice guidelines
•Aim: Determine Who the Surgical Champion and How Does
Surgical Champion Achieves Change
•Study Population: All 238 NSQIPSurgical Champions Surveyed
Role of the Surgeon Champion
• 72% were not compensated for their effort
• Factors associated with demonstrable CQI efforts:- Longer duration of participation- Frequent meeting with SCR- Frequent presentation of data to administration - Compensation for surgical champion effort- Providing individual surgeon with feedback
What was the hardest/easiest things in starting?
• Easiest- Commitment of an SCR- Available concise data at your finger tips
• Hardest- Now what?- Communicating data to surgeons- Implement quality improvement efforts
Presenting the Data
• Using data as quality diagnostic tool• Benchmark to other hospitals• Identifying areas for improvement
QI Practice Patterns for Surgical Champions
• Presenting data to Administration
• Presenting data to Individual surgeons, Division chiefs & Department chairs , Nursing, Anesthesiology
• Incorporate NSQIP data into peer review M&M process
Acknowledging the Problem
Acknowledge the Problem
Smart surgeon learn from their mistakes, Brilliant surgeons learn from other surgeons’mistakes
Acknowledge the problem
Beyond Communications
• Establish the next layer of champions- Divisions- Other departments
• Begin to use the data
"Every hospital should follow every patient it treats long
enough to determine whether the treatment has been
successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in
the future.”
Ernest Codman, 1914
Data collection
QI
Lean Six Sigma Methodology
• Define
• Measure
• Analyze
• Improve
• Control
SC
Quality Improvement Efforts
• Analyze NSQIP data
• Obtain more specific data
• Work with various committees to implement quality improvement efforts
Deep venous thrombosis after general surgical operations at a university hospital:
two-year data from the ACS NSQIP
• 35 (1.6%) of 2169 developed DVT• 94% based on symptoms vs. 6% based on routine
screening• Location: Upper (40%), Lower (46%), Both (14%)• Catheter-associated in 60%• CQI
- Routine DVT screening for transfer patients with lines- Increase awareness of the necessity of the line & for earlier removal
Smith et al. Arch Surg 2011
SC Resources• Available from the ACS NSQIP secure website
• Best Practices Case Studies• Best Practices Guidelines
• Prevention of Catheter-Associated Urinary Tract Infections • Prevention and Treatment of Venous Thromboembolism• Prevention and Assessment of Intravascular Catheter-Related
Bloodstream Infections• Prevention of Surgical Site Infections
• SC monthly conference calls
• Collaborative (regional, state-wide, system-wide)
What do I wish I had known before I got started?
• Compensation for the position
• Quality begets quality
Quality Officer
NSQIP
UHC ranking
Patient safety indicators
SCIP Core Measures
Patient Safety Indicator (PSI)- PSI is a tool developed by the Agency for Healthcare Research & Quality (AHRQ) to screen for problems that patients experience as a result of exposure to the health care system.- Identify potentially preventable complications that occur during an inpatient hospitalization
• PSI 2: Death in low-mortality DRG• PSI 3: Pressure Ulcer• PSI 4: Death among surgical inpatients with serious treatable complications• PSI 5: Foreign body left in during procedure• PSI 6: Iatrogenic pneumothorax• PSI 7: Central venous catheter-related bloodstream infections• PSI 8: Postoperative hip fracture• PSI 9: Postoperative hemorrhage and hematoma• PSI 10: Postoperative physiologic/metabolic derangement• PSI 11: Postoperative respiratory failure• PSI 12: Postoperative PE or DVT• PSI 13: Postoperative sepsis• PSI 14: Postoperative wound dehiscence• PSI 15: Accidental puncture/laceration (APL)• PSI 16: Transfusion reaction
2010 APL Occurrences by ServiceTotal APL by Service 2010
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“The pessimist complain about the wind; the optimist expects it to
change; the realist adjusts the sail”William Ward – American Poet
Quality is the result of a carefully constructed cultural environment. It has to be the fabric of
the organization, not part of the fabric