Download - Dellinger: Acting on the Data
![Page 1: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/1.jpg)
Acting on the Data---
Surgical leadership
E. Patchen Dellinger, MD, FACS
Professor of Surgery, Chief of General Surgery, Chief of Staff,
University of Washington Medical Center (UWMC), Seattle, Washington
![Page 2: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/2.jpg)
Or
![Page 3: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/3.jpg)
How I Got Involved
With NSQIP and What
I Think I’ve Learned
![Page 4: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/4.jpg)
![Page 5: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/5.jpg)
Development of Surgical Outcomes Research Center
(SORCE) at UW, 2000
Analysis of Washington State discharge data base -• Bile duct injuries after lap chole• Negative appendectomy• Survival advantage after gastric bypass
Support of clinical trials
![Page 6: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/6.jpg)
Development of Surgical Care Outcomes Assessment Program (SCOAP), 2002
Sponsored by• SORCE• Foundation for Health Care Quality (FHCQ)• Washington State ACS Chapter
Supported by• Life Science Discovery Fund• Third party payers
![Page 7: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/7.jpg)
![Page 8: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/8.jpg)
Initial Focus of SCOAP• Colorectal Surgery• Bariatric Surgery• Appendectomy
Quarterly feedback • Outcomes• process measures
Have now added• Gastrectomies• Pediatric Surgery• Vascular Interventions• Spine Surgery
![Page 9: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/9.jpg)
Surgical Care and Outcomes Assessment
Program
•Voluntary, grassroots clinician collaborative in WA•Surveillance, benchmarking, practice change
interventions
•58 hospitals (~95%)-rural and urban
![Page 10: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/10.jpg)
Surgical Care and Outcomes Assessment
Program
•Modules in general, pediatrics, bariatrics, vascular interventions(cardiology/IR/surgery), spine (neuro/ortho), advanced cancer care
•SCOAP reports;•Focus on risk adjusted outcomes (up to 12 months)
•Best practices (20-30) and ~50 “exploratory” metrics
![Page 11: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/11.jpg)
How To Read A SCOAP Report
![Page 12: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/12.jpg)
![Page 13: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/13.jpg)
![Page 14: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/14.jpg)
Surgical Care and Outcomes Assessment
Program
Conducts statewide campaigns aimedat practice change
•Preop nutritional interventions
•Glycemic control
•Checklist
•Lymph node sampling for colorectal cancer
•Accurate interpretation of imaging for appendicitis
![Page 15: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/15.jpg)
BeforeElective Colorectal Resection, CHARS 2000-2003
17.7±38.2%
![Page 16: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/16.jpg)
After Elective Colorectal Resection CHARS 2006-2009
9.6±29.4%
![Page 17: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/17.jpg)
Re-operative Complications
Elective Colon/Rectal Resections
![Page 18: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/18.jpg)
Why the Improvement?Testing Low Rectal Anastomoses for
Leak
![Page 19: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/19.jpg)
Reducing Unnecessary Appendectomy
![Page 20: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/20.jpg)
Improving the Use of Dx Imaging
Use of US/CT in Women with Suspected Appendicitis
![Page 21: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/21.jpg)
Improves SCIP Performance
![Page 22: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/22.jpg)
SCOAP Glycemic Metrics
• Glucose checked periop (pre-op to recovery)
• Insulin started• POD 1• POD 2• Lowest blood sugar
![Page 23: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/23.jpg)
![Page 24: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/24.jpg)
![Page 25: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/25.jpg)
Avoiding Hypoglycemia
![Page 26: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/26.jpg)
SCOAP Data on Perioperative Glucose Levels and Insulin Use
11630 patients from 2005-2010 withBariatric operation (5360)
Colectomy (6273)
Who eitherExperienced hyperglycemia [glucose > 180] (3383)
Or did not (8247)
During the perioperative period or onPOD 1 or POD 2
Kwon. Ann Surg. 2013; 257: 8-14
![Page 27: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/27.jpg)
SCOAP Data on Perioperative Glucose Levels and Insulin Use
Diabetic pts 4098 (35%)Hyperglycemic 2369 (58%)
Nondiabetic pts 7532 (65%)Hyperglycemic 1014 (13%)
30% of all hyperglycemic patients were not diabetic!
Kwon. Ann Surg. 2013; 257: 8-14
![Page 28: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/28.jpg)
Composite InfectionHyperglycemia vs No Hyperglycemia
All Patients
02468
10121416
All Pts Bariatric Colectomy
Normal
Gluc>180
All p<0.01
Kwon. Ann Surg. 2013; 257: 8-14
![Page 29: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/29.jpg)
Composite InfectionHyperglycemia vs No Hyperglycemia
Diabetic Patients
0
2
4
6
8
10
12
14
Both Ops Bariatric Colectomy
Normal
Gluc>180**
* p<0.05** p<0.01
*
Kwon. Ann Surg. 2013; 257: 8-14
![Page 30: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/30.jpg)
Composite InfectionHyperglycemia vs No Hyperglycemia
Nondiabetic Patients
0
5
10
15
20
All Pts Bariatric Colectomy
Normal
Gluc>180
All p<0.01
Kwon. Ann Surg. 2013; 257: 8-14
![Page 31: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/31.jpg)
Composite Infection in Hyperglycemic Patients With
and Without Use of Insulin
0
0.5
1
1.5
2
2.5
No Insulin Insulin
Odds Ratios
Kwon. Ann Surg. 2013; 257: 8-14
![Page 32: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/32.jpg)
Operative Reintervention in Hyperglycemic Patients With
and Without Use of Insulin
0
0.5
1
1.5
2
2.5
No Insulin Insulin
Odds Ratios
Kwon. Ann Surg. 2013; 257: 8-14
![Page 33: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/33.jpg)
Mortality in Hyperglycemic Patients With and Without Use
of Insulin
00.5
11.5
22.5
33.5
No Insulin Insulin
Odds Ratios
Kwon. Ann Surg. 2013; 257: 8-14
![Page 34: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/34.jpg)
SCOAP Data on Perioperative Hyperglycemia - Odds Ratios
Multivariate regressions accounting for
Age
Sex
Charlson’s comorbidity
BMI
Smoking
Immunosuppression
Preop antibiotics
Cancer
Year
Surgical Procedure
Diabetes
SCOAP data courtesy of Sung (Steve) Kwon
![Page 35: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/35.jpg)
SCOAP Data on Perioperative Hyperglycemia - Odds Ratios
Multivariate regressions
Death 2.71 (1.72–4.28)
Operative intervention 1.80 (1.41-2.30)
Anastomotic leak 2.43 (1.38-4.28)
Composite infection 2.00 (1.63-2.44)
SCOAP data courtesy of Sung (Steve) Kwon
![Page 36: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/36.jpg)
UWMC Glucose Values, 1999 - 2005
![Page 37: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/37.jpg)
NSQIP Moves to the “Private” Sector in 2004
Ann Surg. 2008 Aug; 248(2): 329-36.
![Page 38: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/38.jpg)
Medicare National Coverage Decision for Bariatric Surgery
– February 2006
• UWMC cancels 30 scheduled cases
• UWMC completes its planned BSCN certification and joins NSQIP
• We get introduced to the infectious enthusiasm of a NSQIP meeting
![Page 39: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/39.jpg)
The Power of
Collaborative Groups of
Clinicians Working Together
to Achieve High-Quality Effective
Surgical Care for Patients:
Colorectal Surgery as an Example
![Page 40: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/40.jpg)
Literature Search on NSQIP and Colorectal
SSI risk 4
Procedure specific 1
Lap v. Open 8
Mortality risk 4
Indications 7
UTI risk 1
VTE risk 2
Elderly 4
QI opportunities 5
Risk calculations 8
Length of stay 2
Resident education 2
Obesity 1
Anemia/transfusion 2
50 references from 2002 to 2012
![Page 41: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/41.jpg)
Using NSQIP to Demonstrate Improved Outcomes in
Colorectal Surgery
Berenguer. Improving SSI Using NSQIP Data. JACS 2010;210: 737-43
*p=0.041
![Page 42: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/42.jpg)
Multiinstitutional Collaboratives Linked to NSQIP Focusing on
Improving Colorectal Outcomes
• Michigan Surgical Quality Collaborative (MSQC) - Colectomy Best Practices Project
• Joint Commission Center for Transforming Healthcare - Colorectal Surgical Site Infection Collaborative – underway & initial results presented at national NSQIP meeting 2012
• TNACS/TNSQC – just getting started
• SUSP/Johns Hopkins/Armstrong Institute/NSQIP
![Page 43: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/43.jpg)
Bowel Preparation Prior to Elective Colectomy in Michigan (n=1648)
Overall SSI Rate in Michigan is 8.0%
Englesbe. Ann Surg 2010;252: 514–520
All patientsGet I.V. antibiotics
![Page 44: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/44.jpg)
Surgical Site Infection Rates following Elective Colectomy
The Michigan Surgical Quality Collaborative
Propensity Matched Analysis(n=740)
Englesbe. Ann Surg 2010;252: 514–520
n=195
All patientsGet I.V. antibiotics
![Page 45: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/45.jpg)
0%
5%
10%
15%
DeepIncisional
OrganSpace
SuperficialIncisional
Overall SSI
No Oral Antibiotics
Oral Antibiotics
Per
cent
of
patie
nts
* P < 0.05
*
*
Oral Antibiotics with a Bowel Preparation
A Propensity Matched Analysis (n=740)
*
Englesbe. Ann Surg 2010;252: 514–520
All patientsGet I.V. antibiotics
![Page 46: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/46.jpg)
0%
5%
10%
15%
C.difficile colitis Prolonged Ileus
No Oral Antibiotics
Oral Antibiotics
Pe
rce
nt o
f pa
tient
s
* P < 0.05
Oral Antibiotics with a Bowel Preparation
A Propensity Matched Analysis (n=740)
Englesbe. Ann Surg 2010;252: 514–520
All patientsGet I.V. antibiotics
![Page 47: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/47.jpg)
Krapohl, G.L., Bowel preparation for colectomy and risk of Clostridium difficile
infection.Dis Col Rectum, 2011. 54:810-7
C. diff No C. diff
No prep (n=578) 2.4% 97.6%
Prep (n=1685) 2.4% 97.6%
No Ab (n=1001)* 2.9% 97.1%
Oral Ab (n=684)* 1.6% 98.4%
* p=0.09
![Page 48: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/48.jpg)
MSQC/NSQIP Colorectal ProjectProphylactic Antibiotic Use
Scheduled Emergency
(2743) (248)
SCIP compliant 84% 52%
Within 1 hr 93% 64% --------------------------------------------------------------------------
Weight adjusted dosing (922) 57%
Redosed when indicated (398) 6%
Hendren. Am J Surg 2011; 201: 290-4
![Page 49: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/49.jpg)
MSQC/NSQIP Colorectal Project
2008 2009
(1387) (1592)
Ab given 99.8% 100%
Within 1 hr 79% 93%
SSI* 9.4% 7.4% p=0.062
Hendren. Am J Surg 2011; 201: 290-4
![Page 50: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/50.jpg)
Oral Antibiotics Without Bowel Prep?
VASQIP, 9940 patients, 112 hospitals
Incidence SSI
Bowel prep, no oral Ab 39% 20%
No prep at all, no oral Ab 20% 18%
Bowel prep + oral Ab 34% 9%
No prep + oral Ab 7% 8%
Cannon. Dis Col Rectum 2012; 55: 1160-6
![Page 51: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/51.jpg)
Oral Antibiotics for Colorectal Operations
Cannon. Dis Col Rectum 2012; 55: 1160-6
![Page 52: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/52.jpg)
Bowel Prep & Oral AntibioticsVASQIP Data – 8180 patients
Hawn. So Surgical Assoc. Palm Beach, FL, 12 Dec 2012
Oral antibiotic bowel prep 44%
Mechanical prep alone 39%
No prep at all 17%
![Page 53: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/53.jpg)
Bowel Prep & Oral AntibioticsVASQIP Data
Hawn. So Surgical Assoc. Palm Beach, FL, 12 Dec 2012
![Page 54: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/54.jpg)
Bowel Prep & Oral AntibioticsVASQIP Data
Hawn. So Surgical Assoc. Palm Beach, FL, 12 Dec 2012
![Page 55: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/55.jpg)
Antibiotic Choice & SSI After Colectomy
Hendren. Ann Surg 2013;257.469
![Page 56: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/56.jpg)
Surgical Unit-based Safety Program (SUSP)
• Funded by AHRQ
• Sponsored by Johns Hopkins and ACS/NSQIP
• Based on teamwork and the wisdom of the frontline staff
• Focused on Colorectal SSI
• Presented in detail at national NSQIP mtg
• All NSQIP hospitals eligible to participate
![Page 57: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/57.jpg)
Surgical Unit-based Safety Program (SUSP)
Experience with joining national projects previously to kick start a local QI effort and realization of the critical importance of interdisciplinary teamwork has led us to join this important national effort to reduce SSI and other postoperative complications, led by Johns Hopkins and ACS and funded by AHRQ.
![Page 58: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/58.jpg)
Normothermia Project Johns Hopkins
Interventions
• Confirmed that temperature probes were accurate (trial comparing foley and esophageal sensors)
• Initiated forced air warming in the pre-operative area
• Heightened awareness
Wick. J Am Coll Surg. 2012; 215: 193-200
![Page 59: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/59.jpg)
JHU Colorectal CUSP
Other changes – based on input from frontline staff:
– Changing instruments after anastomosis– Weight based dosing for prophylaxis– Having adequate amounts of antibiotic in the
O.R.– Colorectal specific check list
Wick. J Am Coll Surg. 2012; 215: 193-200
![Page 60: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/60.jpg)
JHU Colorectal CUSP
*p < 0.05 Wick. J Am Coll Surg. 2012; 215: 193-200
![Page 61: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/61.jpg)
The Effect of Retrospective Review on Post-Operative Transfusion RatesPrior to 2009, UWMC consistently had higher
than average post-op transfusion rates.In 2010, we began a program of regular
reporting and discussion of post-op transfusion at weekly M&M conference.
Here is what has happened since…
![Page 62: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/62.jpg)
Year UWMC Transfusion Rate
NSQIP Transfusion Rate
UWMC CR Transfusion Rate
NSQIP CR Transfusion Rate
2007 6.2 4.2 16.4 11.4
2008 6.3 4.0 18.9 10.6
2009 5.4 3.8 14.8 10.2
2010 3.2 4.5 6.1 12.0
2011 4.0 5.6 5.4 14.8
2012 3.0 4.9 6.9 13.5
43% decrease for all GS cases (95%CI 42.5%-43.5%, p=<0.001)
63% decrease for colorectal cases (95%CI 61-65%, p=<0.001)
![Page 63: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/63.jpg)
Year UWMC SCOAP Transfusion Free Rate
SCOAP Benchmark Transfusion Free Rate
% Transfusions with Low Hgb (≤ 7)
2009 79.9% 99.2% NA
2010 86.3% 98.5% 38.1%
2011 87.8% 97.8% 70%
More transfusions with associated low Hgb
We are still not a top-performer among SCOAP hospitals
![Page 64: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/64.jpg)
Take AwaysReview and discussion changes practice.We didn’t just give less transfusions, we gave
fewer transfusions that were not evidence-based.
We minimized our patient’s exposure to transfusion-associated risks!
We are better stewards of a scarce resource.We decreased costs.We still have room for improvement.
![Page 65: Dellinger: Acting on the Data](https://reader036.vdocuments.mx/reader036/viewer/2022070318/55748641d8b42a7f348b4779/html5/thumbnails/65.jpg)
Final Thoughts• A surgeon (champion) can’t do “quality” alone.
• Others can’t do surgical quality without surgeon involvement and commitment.
• Without interdisciplinary teamwork no one can do quality.
• Without good data (NSQIP/SCOAP) you don’t know what you need to work on or if your are succeeding.
• Those on the front line have a unique perspective.
• The job never stops.