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What is the Hype about NSQIP anyway? Doug Cochrane Marlies van Dijk Kimberly McKinley Michael Arget
What is the Hype about NSQIP anyway?
Doug CochraneMarlies van Dijk
Kimberly McKinleyMichael Arget
Fraser Health AuthorityAbbotsford Regional Hospital
Burnaby HospitalChilliwack General Hospital
Delta HospitalEagle Ridge Hospital
Jim Pattison Outpatient Care and Surgery centreLangley Memorial Hospital
Peace Arch HospitalRidge Meadows HospitalRoyal Columbian HospitalSurrey Memorial HospitalInterior Health Authority
Penticton Regional HospitalRoyal Inland Hospital
Northern Health AuthorityUniversity Hospital of Northern BC
Providence Health AuthoritySt. Paul’s Hospital
Mount Saint Joseph HospitalProvincial Health Services AuthorityBritish Columbia Children’s HospitalVancouver Coastal Health Authority
Lions Gate HospitalRichmond Hospital
Vancouver General HospitalUniversity of British Columbia Hospital
Vancouver Island Health AuthorityNanaimo Regional General Hospital
Royal Jubilee HospitalVictoria General Hospital
How is it executed
• Surgeon Led – not as easy as it sounds• Surgical Clinical Reviewer – clinical data• Team effort │ Front line solutions• Administrative Leader is an important enabler• Findings are population specific• Implementation of evidence – local context
dependant
How does it look?
Enter Clinical Data & 30 day post-op follow up
with Patients
Raw Data TrendsSemi Annual Risk Adjusted Reports
Analyse Drilling Down
Quality Improvement Focus
Implementing and Testing Changes with
front line clinical teams
Why it works
• Surgeons are interested in how well their patients do. – We all like to see patients get better
• Outcome data (risk adjusted, comparable) and describes ,our work shows us where we can improve – We are all a “touch” competitive and with data we want to
provide better care• Surgical teams know “process” and recognize that they
are dependent upon each other• Define and implement solutions
Early Results – July 2012
Risk Adjusted Reports20 sites
Exemplary Amongst the Highest Performing NSQIP Sites
• 11 sites have exemplary outcomes in 1 and up to 8 outcome measures
• Surgical services are leaders best outcomes amongst peer organizations in North America
Need for Improvement Amongst the Lowest Performing NSQIP Sites
• 18 out of 20 sites have one or more outcomes that fall in the “need for improvement” category– Range 1-20 outcomes
• Common across the facilities:– Morbidity overall– UTI and SSI – Management of the Elderly
• General Surgery, Orthopaedics, Cardiac, Urology and Neurology
Local Risk Adjustment
Engagement!Surgeons and
others
Culture
Fall Surgical Quality Action Network
Benefit Analysis
Activity
Patient Journey
Post-op occurrences identified?
Follow up treatment
Inpatient (Readmissions)
Identified during hospitalization?
No
Yes
No
Yes
Outpatient (ED or GP Visit)
Discharge (Prolonged LOS)
Discharge
Cases reviewed for each Specialty
19 sites are participating in the Benefits Analysis
•Surrey Memorial
•Penticton
•Royal Inland
•Nanaimo
•Victoria General
•Royal Jubilee
Sites
Components of the Analysis
Surgical Specialties
Post-op Occurrences
•General Surgery
•Vascular
•Gynecology
•Urology
•SSI
•Urinary Tract
•DVT/PE
•Cardiac
Outcomes
•Length of Stay
•Occurrence Rate
•Readmission Rate
•Mortality Rate
Reduced Occurrence Rate
There is an economic benefit due to reduced occurrence rates
NSQIP informs the site that they are above expected occurrence rate for Specialty Y
Leaders at the site:
- Review the situation
- Do something different
The site achieves an improved occurrence rate
1 2 3
Note: Other factors may also be contributing to the improved occurrence rate
Post-op occurrences identified?
Follow up treatment
Inpatient (Readmissions)
Identified during hospitalization?
No
Yes
No
Yes
Outpatient (ED or GP Visit)
Discharge
Cases reviewed for each Specialty
Reduced Occurrence Rate
Improved Outcome
Reduced Occurrences
Discharge (Prolonged LOS)
Benefits Analysis
What we did: – Went to the raw data– Captured all occurrence types across all specialties– “Pure” occurrence types only– Used the detailed data to estimate “Additional Days Per
Opportunity” (based on 19 sites)– Included cases with multiple occurrences
Capped amounts: – Max impact of UTI: 2 days – Max impact of a single occurrence SSIs, Cardiac,
Respiratory ... is: 7 days– Max impact of a 2 or more occurrence SSIs, Cardiac,
Respiratory ... is: 14 days
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
25% 50% 75% 100%
% Reduction in Occurrence Rate
Pat
ient
Day
Opp
ortu
nity
(pe
r ye
ar)
Building the Province-wide Picture (19 sites)Total opportunity is 7,700 to 31,100 patient days per year
[1,380 to 5,500 additional cases accessing beds per year]
Take Away’s
• Analysis based on in-house numbers – not post discharge – very conservative numbers
• Capped numbers – not actual LOS’s• Bigger return for focusing on SSI, Pneumonia
and Ventilator within 48 hrs vs. UTI• Plenty of opportunity
Culture Improvement in Surgery• 14 hospitals• Over 70 units• 2633 health care
professionals
High Quality, Unit-level Data
• Safety Attitudes Questionnaire– Validated survey instrument
• High response rate (67% average across the participating units)
• Administered at the unit level = accuracy
Results from BC culture survey
Teamwork Climate
Arrows point to operating rooms
Doug Cochrane, MD, Surgery co-lead, SQAN and Chair of BC Patient Safety and Quality [email protected]
Peter Doris, MD, Surgery co-lead [email protected]
Kimberly McKinley, Data Analyst and SCR [email protected]
Rebecca Brooke, Quality [email protected]
Marlies van Dijk, [email protected]
