University of Iowa Health Care

Transcription

1 University of Iowa Health Care Sharing and Displaying NSQIP data Locally: Considerations When it is Up Close and Personal Mary E. Belding-Schmitt, RN, BSN, CPHQ No Disclosures

2 Background Large Academic, > 500 Bed Hospital, GS/Vasc Procedure Targeted Site Joined Adult NSQIP Sept Surgeon Champion: Dr. Timothy Kresowik 2 Adult NSQIP Abstractors Myself Department of Surgery (GS and Vasc) Nancy Krutzfield Department of Clinical Quality, Safety & PI Joined Peds NSQIP Jan Surgeon Champion: Dr. Joel Shilyansky Metabolic and Bariatric Surgery Accreditation and QI Program (MBSAQIP) April 2012 Surgeon Champion: Dr. Isaac Samuel

3 Risk-Adjusted Data-Considerations Read the SAR-Know what you are presenting Read the ACS NSQIP Bar Plot Legend Length and placement of confidence interval Decile Spacing and placement of odds ratio estimate Trend the odds ratio and or decile ranking over time

4 Risk-Adjusted Data

5 Using NSQIP Data for Case Review

6 Case Review SUSP Surgeon Champion Reviews Surgeon Review and address preventability Update database SUSP Committee Review

7 Using NSQIP data to drive improvements

8 Considerations Timeliness of data collection Persistence Scorecards Annual reports for quality projects Posting and presenting progress

9 Considerations Timeliness of data collection Extremely important when trying to drive improvements with frequent display of data Use Phone calls or s for follow-up Cases are selected manually everyday Upload using ACS uploader One cycle abstracted every week As many followups as possible every week

10 Annual Project Reports Summarizes and highlights progress Presented at numerous committees and meetings Include Leadership

11 Annual Project Reports

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13 Using NSQIP data for Physician OPPE

14 OPPE Considerations: Data is NOT risk-adjusted Minimum Case Requirement Case Selection Outcomes/Measures

15 OPPE Considerations: Case Selection and Outcomes Unplanned Related ROR Rate Sent Centrally for all MD s in Database General Surgery: Surgeon must have 10 cases General Surgery: Elective cases only (Emergent General Surgery Division receives divisional report) Use SAR to determine areas of weakness and include in OPPE All surgeons receive SSI and UTI outcomes Include targeted specific outcomes

16 OPPE Considerations: Case Selection and Outcomes Vascular Surgery: At least 10 Cases Elective surgery SSI, UTI, and readmission rates Specific criteria for EVAR, AAA, and CEA CEA Cases: Elective Asymptomatic (UIHC Definition) 1. Asymptomatic-no history of any symptoms in either carotid or the vertebrobasilar distribution. Dizziness or lightheadedness alone are not considered symptoms. 2. Symptomatic-ipsilateral carotid territory (cerebral hemisphere or eye) symptoms within 120 days of the procedure 3. Other symptomatic-remote ipsilateral (more than 120 days prior) or any contralateral or true vertebrobasilar symptoms. Outcomes: % of cases with LOS >2 Days Mortality Rate CVA Rate Serious Morbidity Rate (NSQIP Definition)

17 Open or endovascular AAA repair cases: 1. Elective 2. Non-Ruptured 3. Infrarenal 4. Aneurysm diameter < 6.0 cm in men, < 5.5 cm in women Outcomes: LOS; EVAR % of cases with LOS > 2D, Open LOS > 7D EVAR and Open - Mortality Rate EVAR and Open Serious Morbidity Rate (NSQIP Definition)

18 OPPE Automate frequent queries:

19 OPPE op_date cpt dtnoted Occurrence comments_post 9/20/ /28/2012 Superficial Incisional Wound erythema, 4 staples removed, cultured fluid positive for enterobacter 10/5/ /19/2012 Organ/Space SSI CT showed left retroperitoneal abscess, IR placed drain:many PROBABLE ANAEROBIC GRAM POSITIVE RODS, Unable to 10/11/ /16/2012 Superficial Incisional On POD #5, a few staples from the middle portion of his abdominal incision were opened as he had some purulent 2/15/ /1/2013 Organ/Space SSI IR placed drain with positive culture Enterococcus 3/29/ /3/2013 Organ/Space SSI IR drain placement with positive culture. 4/19/ /2/2013 Superficial Incisional Drain site placed at time of surgery with erythema and pus, cultured positive. 7/11/ /29/2013 Organ/Space SSI IR placed drain, culture with E Coli 8/14/ /25/2013 Organ/Space SSI IR placed drain with positive culture.

20 OPPE Average Expected Probablity of SSI 2012 All Surgeon A Surgeon B Surgeon C Average Expected Probablity of Morbidity 2012 All Surgeon A Surgeon B Surgeon C

21 OPPE Division Heads And Dept Head Suggestions and/or recommendations Kept on file in Department Individual Providers

22 The End