PEDIATRIC NSQIP INTERNAL QUALITY ASSESSMENT THINGS YOU CAN DO AT HOME SALT LAKE, 2012
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1 PEDIATRIC NSQIP INTERNAL QUALITY ASSESSMENT THINGS YOU CAN DO AT HOME SALT LAKE, 2012
2 INTERNAL QUALITY AUDIT IT ALL BEGINS WITH ACCURATE AND CONSISTENT DATA
3 INTERNAL QUALITY AUDIT WHAT DO YOU KNOW ABOUT YOUR OWN DATA? NSQIP IS NOT THE ONLY PROGRAM ANALYZING YOUR PERFORMANCE
4 INTERNAL QUALITY AUDIT SPEAK A COMMON LANGUAGE AT HOME CPT CODING CHART REVIEW, DESCRIPTIVE DATA
5 CPT CODING WHO DOES IT? IF THE SURGEON DOES IT, DOES EVERYONE DO IT THE SAME? IF THE SURGEON DOESN T DO IT, HOW IS THE DECISION MADE? WHICH SOURCE IS USED FOR NSQIP SELECTION?
6 CPT CODING FOR APPENDECTOMY PROCEDURE App with open Ladd s Acute pain, neg lap app Lap app, not ruptured Lap app ruptured Open app, not ruptured Open app, ruptured Lap interval app 8 8
7 INTERNAL QUALITY ASSESSMENT WOUND CLASSIFICATION CLEAN IS CLEAN BUT WHAT IS DIRTY? HOW IS WOUND CLASS ASSIGNED AT YOUR INSTITUTION? COMPUTER- BASED ON PREOP CPT NURSE ASSESSMENT SURGEON ASSESSMENT HOW DOES IT COMPARE WITH YOUR SCR ASSESSMENT?
8 DISCOVERY OF A PROBLEM 515 PEDIATRIC SURGERY CASES REVIEWED 481 CASES (93%) HAD A CORRECT WOUND CLASSIFICATION 34 CASES (7%) HAD AN INCORRECT WOUND CLASSIFICATION ALL THE WOUND CLASSIFICATION ERRORS WERE AN UNDER ESTIMATE OF THE CORRECT WOUND CLASSIFICATION.
9 PEOPLE Lack of understanding of correct wound classification and its importance. Lack of awareness that wound classification discrepancies exist in the electronic charting. TECHNOLOGY Auto population contains intrinsic errors Premature placement of wound classification data in computer flow algorithm. Auto population of wound classification produces errors. 9
10 WOUND CLASS ASSIGNMENT FOR APPENDECTOMY BASED ON INTRAOPERATIVE FINDINGS OPERATIVE CLEAN CLEAN FINDINGS CONTAMINATED Ladd s procedure 8 CONTAMINATED DIRTY Acute pain, negative appendix Edema, inflamed Edema, inflamed with cloudy fluid Edema, Inflamed with gross pus Acute inflam with exudate on appendix Gangrene 2 6 rupture 8 Interval appendix 7 1
11 INTERNAL QUALITY AUDIT HEIGHT AND HEIGHT WHY DOES IT MATTER?
12 HEIGHT AND WEIGHT IMPORTANT FOR PATIENT CARE IN DETERMINING MEDICATION DOSING POTENTIAL VALUE FOR NSQIP TRANSFUSION VOLUMES RELATED TO WEIGHT RISING INCIDENCE OF PEDIATRIC OBESITY
13 Abstract(text) abstract 20 CHILDHOOD OBESITY- A RISK FACTOR FOR SURGICAL MORBIDITY? Outcomes of perforated appendicitis in obese and nonobese children. Garey CL, Laituri CA, Little DC, Ostlie DJ, St Peter SD. J Pediatr Surg 2011 Dec:2346 Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP. J Pediatr Surg 2009 Aug:1601 Determination of risk factors for deep venous thrombosis in hospitalized children. Vu LT, Nobuhara KK, Lee H, Farmer DL. J Pediatr Surg 2008 June:1095
14 RUPTURED APPENDIX Patient Demographics July-December 2011 (35 Total Patients) CHARACTERISTIC NUMBER MALES 23 FEMALES 12 MEAN AGE (2-16 yr) MEAN BMI (reported in 9/35 patients)
15 BMIs BEYOND BELIEF Review of all pt BMI greater than 40 Range 41.7 to patients Data review 13 pts correct (BMI 41.7 to 57.3) 3 error due to data download 3 error due to typing entry 3 error due to height entered by nurse in inches but recorded as cm
16 WEIGHT VARIABLE NEONATES GROW QUICKLY EXAMPLE: 2 KG PT GROWS GRAMS/DAY 7 X 20 = KG 7% WT CHANGE IN ONE WEEK SICK PATIENTS DON T GROW WELL SICK PATIENTS GET EDEMATOUS MAY DOUBLE OR TRIPLE WT DUE TO RETAINED FLUID WEIGHT FOR CALCULATION
17 PEDIATRIC NSQIP INTERNAL AUDIT PILOT PROJECTS REVIEW REPORT AND SEE WHAT CASES ARE MOST COMMON REVIEW OCCURRENCE REPORTS BY COMMON CPT AND SEE IF THERE ARE PROBLEM AREAS CHOOSE AN AREA OF LOCAL INTEREST TO VALIDATE SAMPLING CUSTOM FIELD DATA POINTS
18 INTERNAL QUALITY AUDIT AT HOME ENLIST A SUBSPECIALIST FOR EACH SURGICAL SPECIALTY UROLOGY ENT PLASTICS NEUROSURGERY ORTHOPEDICS
19 INTERNAL QUALITY AUDIT ENLIST A SUBSPECIALIST SHOW THEM WHAT WE COLLECT DESCRIBE HOW IT MAY IMPACT THEM ASK THEM HOW WE COULD DO MORE WITH THE DATA
20 Laminectomy for Tethered Cord Patient Demographics NSQIP Sample July-December 2011 CHARACTERISTIC NUMBER MALES 15 FEMALES 18 MEAN AGE (0-18 yr) MEAN BMI (reported in 24/32 patients) 8 18
21 Laminectomy for Tethered Cord July-Dec 2011 TOTAL CASES COMPARED TO NSQIP SAMPLE Data Element All 33 Cases NSQIP 21 Cases Primary Surgery 26 (79%) 15 (71%) Reoperative Surgery 7 (21%) 6 (29%) Mean Length of Surgery (minutes) Mean LOS (days) 3 4
22 HOW TO MAKE IT WORK FOR YOU ENGAGE A SUBSPECIALIST IN EACH AREA LOOK FOR CONSTRUCTIVE PROJECTS SHOW HOW GOOD DOCUMENTATION HELPS FIND AREAS WHERE YOU CAN DO BETTER
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