ACS NSQIP Conference Salt Lake City
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1 ACS NSQIP Conference 2012 Salt Lake City
2 ACS NSQIP Conference 2011 in Boston
3 New York Times article about ACS NSQIP Conference 2011 in Boston the 2011 NSQIP Conference NSQIP is one of the most far-reaching efforts and is transforming surgery.
4 ACS NSQIP 7 th Annual Conference
5 Largest NSQIP Conference Yet
6 This year s conference Quality improvement topics (in depth) Several preconference courses Clinical topics (more topics/sub specialties) New findings (investigative work) Targeting multiple levels of experience More time to network
7 Utah Olympic Park (Monday night)
8 Numerous Ancillary Meetings Collaboratives Pilots Specialty Groups Hospital Systems Etc
9 Keynote Speakers Carolyn Clancy Don Berwick Mark Chassin Lucien Leape Peter Pronovost Atul Gawande
10 Brent James, MD, MStat Institute of Medicine University of Utah School of Medicine Harvard School of Public Health Univ of Sydney School of Public Health Chief Quality Officer, and Executive Director, Institute for Health Care Delivery Research at Intermountain Healthcare First, Do No Harm: Profession Values Drive Business Success
11 Wisdom of Crowds i clickers
12 Practice Question Should NSQIP try to bring back caterpillar plots? A.Yes, definitely B.Yes, but not for every model C.Definitely not D.Don t feel strongly either way E.Go back to drawing board and think of something totally new and unique
13 : ) and : ( or : O CEUs/CMEs Speaker Presentations
14 Update: NSQIP Numbers
15 NSQIP Participation
16 500+ hospitals in NSQIP
17 Procedure Percent of U.S. cases performed in NSQIP hospitals Pancreas resection 53% Liver resection 53% Gastrectomy 34% Small Bowel Rx 26 % Even though NSQIP is in approximately ~10% of hospitals Colectomy in the US 24% Proctectomy 30% Appendectomy 22% Cholecystectomy 20% Ventral Hernia 25%
18 Procedure Percent of U.S. cases performed in NSQIP hospitals AAA 37% Endo AAA 34% LEB 33% Breast Recon/ 40% NSQIP may be the best single source for Abdominoplasty 37% evaluating surgical care across specialties Thyroidectomy 30% Lung Rx 37% Esophagectomy 57% Hysterectomy 29% Prostatectomy/Nephrectomy 36%/37% Hip Replacement/Laminectomy 25%/28%
19 Update: NSQIP Modules C L A S S I C E S S E N T I A L S S M A L L / R U R A L T A R G E T E D M E A S U R E S
20 Procedure Targeted: Hospitals Participating by Procedure Pancreatectomy 84 Colectomy 126 Proctectomy 85 VHR 89 Bariatric 64 Hepatectomy 68 Thyroidectom 66 Esophagectomy 59 Appendectomy 62 CEA 83 CAS 38 AAA 80 AAA EVAR 80 Aortoiliac (open) 57 Aortoiliac (endo) 41 LE Bypass (open) 80 LE Bypass(endo) 48 Hysterectomy 69 Reconstruction 31 Spine 69 Brain Tumor Rx 44 TURP 39 Bladder Susp 43 Prostatectomy 68 Nephrectomy 62 Cystectomy 46 TKA 75 THA 73 Hip Fx 57 Breast Flap 39 Breast Reduc 39 Breast Recon 47 Abdplasty 35 Lung Rx 47
21 Pediatric NSQIP Almost 50 hospitals SAR release
22 Regional Collaboratives * * * * * * * * * * * * * * * * *
23 Regional Collaboratives Canadian National Surgical Quality Improvement Collaborative (CAN NSQIP) Connecticut Surgical Quality Coalition (CTSQC) Florida Surgical Care Initiative (FSCI) Illinois Surgical Quality Improvement Collaborative (ISQIC) MaineHealth Collaborative Northern CaliforniaSurgical Quality Collaborative (NCSQC) Nebraska Collaborative Oregon NSQIP Consortia Pennsylvania NSQIP Consortia Tennessee Surgical Quality Collaborative (TSQC) Upstate New York Surgical Quality Initiative Virginia Collaborative Indiana Collaborative (Pending) Georgia Collaborative (Pending) MarylandCollaborative (Pending) Texas Collaborative (Pending) Wisconsin Collaborative (Pending)
24 Complication % Impr Renal Failure 25% Cardiac 7% Vent time 15% Super SSI 19% Deep SSI 18% Nerve inj 28% Sepsis 10%
25 A countdown of what s new in NSQIP
26 10. Advancing Our Message: Raise Community Consciousness Elevate the awareness within the surgical community about achieving quality and its necessity. David Hoyt, MD, FACS Executive Director ACS
27 9. Clinical Support FAQs
28 8. AHRQ SUSP Project (Surgical Unit-based Safety Program)
29 8. National SUSP CRS SSI Sign up sheet at registration desk Contact: Lisa Lubomski, PhD Phone: Fax: Lisa Lubomski, MD Sean Berenholtz, MD
30 Who can join SUSP? Participation in the program is available to any hospital in any state, as well as hospitals in the District of Columbia and Puerto Rico. Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group. Armstrong Institute for Patient Safety and Quality 30
31 8b. NSQIP CUSP Working Group For those who cannot join AHRQ/SUSP We are assembling a smaller group within NSQIP who want to learn and perform CUSP Sunday Breakfast session (Project Scope) 7am Riviera Room (3 rd Floor) Monday Breakfast session (Next Steps) 7am Riviera Room (3 rd Floor)
32 7. Preoperative Risk Calculator CPT Description Colectomy, partial; with anastomosis Age 65 Sex 0 (0 = Male, 1 = Female) Smoker 0 (0 = No, 1 = Yes) BMI 25 Functional Status 0 (0 = Independent, 1 = Partially Dependent, 2 = Totally Dependent) DYSPNEA 0 (0 = No, 1 = With Moderate Exertion, 2 = At Rest) COPD 0 (0 = No, 1 = Yes) Ascites 0 (0 = No, 1 = Yes) CHF 0 (0 = No, 1 = Yes) History of MI 0 (0 = No, 1 = Yes) Previous Cardiac Intervention 0 (0 = No, 1 = Yes) PVD 0 (0 = No, 1 = Yes) Dialysis 0 (0 = No, 1 = Yes) Stroke or TIA 0 (0 = No, 1 = Yes) Disseminated Cancer 0 (0 = No, 1 = Yes) Steroid 0 (0 = No, 1 = Yes) Weight Loss 0 (0 = No, 1 = Yes) Bleeding Disorder 0 (0 = No, 1 = Yes) Creatinine 0 (0 = unknown) Albumin 0 (0 = unknown) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1% Colectomy, partial; with anastomosis Blue: Low Risk Patient Red: Your Patient Green: High Risk 1% 4% 9% 7% 16% 20% 16% 31% Mortality Serious Morbidity Overall Morbidity
33 Preoperative Risk Calculator CPT Description Colectomy, partial; with anastomosis Age 80 Sex 0 (0 = Male, 1 = Female) Smoker 1 (0 = No, 1 = Yes) BMI 30 Functional Status 2 (0 = Independent, 1 = Partially Dependent, 2 = Totally Dependent) DYSPNEA 2 (0 = No, 1 = With Moderate Exertion, 2 = At Rest) COPD 0 (0 = No, 1 = Yes) Ascites 1 (0 = No, 1 = Yes) CHF 0 (0 = No, 1 = Yes) History of MI 0 (0 = No, 1 = Yes) Previous Cardiac Intervention 0 (0 = No, 1 = Yes) PVD 0 (0 = No, 1 = Yes) Dialysis 0 (0 = No, 1 = Yes) Stroke or TIA 1 (0 = No, 1 = Yes) Disseminated Cancer 0 (0 = No, 1 = Yes) Steroid 0 (0 = No, 1 = Yes) Weight Loss 0 (0 = No, 1 = Yes) Bleeding Disorder 0 (0 = No, 1 = Yes) Creatinine 0 (0 = unknown) Albumin 1 (0 = unknown) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colectomy, partial; with anastomosis 69% 52% 47% 31% 31% 20% 16% 16% 9% 7% 4% 1% 1% Mortality Serious Morbidity Overall Morbidity
34 6. Toolkits Surgeon Champion Administrator SCR (in development)
35 Teamwork and communications between the SCR and SC Engaging surgeons Using online reports Using the semiannual report Implementing NSQIP ROI: Case Study Engaging administrators
36 5. Two New Virtual Collaboratives In Development 1. Quality in Training Meeting: Sunday 7:00am Belvedere (3 rd Floor) 2. Electronic Health Record Automation
37 New virtual collaborative: Electronic Health Record/Automation Session: Breakout 6 (Sunday) 130pm Ancillary Meeting: Monday morning AND Monday lunch discussion of the pilot. 7:00 am: Fountainbleau 3 rd Floor 12:15 pm: Fountainbleau 3 rd Floor If you/your hospital is interested in participating in a pilot that will aim to automate data into NSQIP, please attend these sessions.
38 4. Newest Guideline: Surgery in the Elderly Preoperative Assessment
39 3. CMS believes registries are a good thing
40 2. Public Reporting on Hospital Compare
41 2. Public Reporting on Hospital Compare
42 1. Real-time, risk-adjusted outcome reports
43 New Things in ACS NSQIP 10. Raising the community consciousness 9. Clinical Support FAQs 8. SUSP/NSQIP CUSP 7. All procedure risk calculators 6. Toolkits 5. Virtual Collaboratives (Training, EHRs) 4. Elderly Surgery Guidelines 3. CMS Rule on Clinical General Surg Registry 2. NSQIP on Hospital Compare 1. Real time, risk adjusted reports
44 NSQIP Staff
45 Thank you Expansion Working Committee (Mike Henderson) SCR Advisory Committee (Karen Richards) Methods and Evaluation Committee (Bruce Hall) Pediatric Committees (Peter Dillon/Keith Oldham) Surgeon Champion Group (John Morton) Best Practices (Nestor Esnaola)
46 Thank you Conference Speakers/Moderators
47 Hospitals that have lead the way with vision SCRs, Surgeon Champions, QI personnel the entire team
48 New York Times article about the 2011 NSQIP Conference There isn t anyone who isn t a part of the QI process
49 Thank you
50
51
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