the cusp of improving colorectal surgery outcomes v1 · the cusp of improving colorectal surgery...

1
The CUSP of Improving Colorectal Surgery Outcomes The CUSP of Improving Colorectal Surgery Outcomes J.W. Cromwell, MD, M. Belding J.W. Cromwell, MD, M. Belding - - Schmitt, RN, BSN, CPHQ, M.K. Brooks, RN, MSN, CPHQ Schmitt, RN, BSN, CPHQ, M.K. Brooks, RN, MSN, CPHQ University of Iowa Hospitals and Clinics, Iowa City, Iowa Background Background Goals Goals Lessons Learned Lessons Learned NaƟonally, approximately one million people develop a serious complicaƟon as a result of surgery each year Adult colorectal surgery SSI and readmission rates were substanƟally higher than our peers in NSQIP, NHSN and Hospital Compare September 2012—UIHC agreed to parƟcipate in the Agency for Healthcare Research and Quality (AHRQ) Surgical Unitbased Safety Program (SUSP) to reduce surgical site infecƟons (SSI) and other surgical complicaƟons in colorectal surgery Twoyear commitment Over 200 hospitals parƟcipaƟng To achieve signicant reducƟons in surgical site infecƟon and surgical complicaƟon rates To achieve signicant improvements in safety culture To implement the Comprehensive Unitbased Safety Program (CUSP) methodologies CUSP approach can be applied to any safety or infecƟon related opportunity CUSP is a structured strategic framework for safety that integrates communicaƟon, teamwork, and leadership to create and support a culture of paƟent safety that can prevent harms Frequent meeƟngs kept everyone conƟnuously informed and engaged Real‐Ɵme idenƟcaƟon of defects allowed for stepwise best pracƟce implementaƟon Bowel preps make a dierence! Improvement Methodology Improvement Methodology Results Results SSI rate for SUSP pilot surgeons: 8% absolute reducƟon. This equated to six fewer SSIs 3 fewer Deep/Organ Space and 3 fewer Supercial SSI rate for SUSP pilot surgeons is 12.76% versus nonSUSP pilot surgeons’ rate of 35.48% SSI rate for SUSP pilot surgeons in the rst quarter of 2014 was 6.38% (No SSI in January or March 2014) Readmissions due to SSI were reduced 36% from baseline to end of rst year and 51% from baseline to last quarter Hospital Compare results improved from “Worse than U.S. NaƟonal Benchmark” to “No dierent than U.S. NaƟonal Benchmark” Saved $180,000 in extra paƟent costs 95% of SUSP paƟents had a Surgical Safety Checklist completed Interventions Interventions

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Page 1: The CUSP of Improving Colorectal Surgery Outcomes V1 · The CUSP of Improving Colorectal Surgery Outcomes J.W. Cromwell, MD, M. Belding-Schmitt, RN, BSN, CPHQ, M.K. Brooks, RN, MSN,

The C

USP

of Im

prov

ing

Colo

rect

al Su

rger

y Out

com

esTh

e CUS

P of

Impr

ovin

g Co

lore

ctal

Surg

ery O

utco

mes

J.W

. Cro

mwe

ll, MD

, M. B

eldin

gJ.W

. Cro

mwe

ll, MD

, M. B

eldin

g --Sc

hmitt

, RN,

BSN

, CPH

Q, M

.K. B

rook

s, RN

, MSN

, CPH

QSc

hmitt

, RN,

BSN

, CPH

Q, M

.K. B

rook

s, RN

, MSN

, CPH

Q Un

ivers

ity o

f Iow

a Ho

spita

ls an

d Cl

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, Iow

a Ci

ty, Io

wa

Back

grou

ndBa

ckgr

ound

Goals

Goals

Less

ons L

earn

edLe

sson

s Lea

rned

N

aon

ally,

app

roxi

mat

ely

one

mill

ion

peop

le d

evel

op a

se

rious

com

plic

aon

as a

resu

lt of

surg

ery

each

yea

r

Adul

t col

orec

tal s

urge

ry S

SI a

nd re

adm

issio

n ra

tes w

ere

subs

tan

ally

hig

her t

han

our p

eers

in N

SQIP

, NHS

N a

nd

Hosp

ital C

ompa

re

Se

ptem

ber 2

012—

UIH

C ag

reed

to p

arci

pate

in th

e Ag

ency

for H

ealth

care

Res

earc

h an

d Q

ualit

y (A

HRQ

) Su

rgic

al U

nit‐

base

d Sa

fety

Pro

gram

(SU

SP) t

o re

duce

su

rgic

al si

te in

fec

ons (

SSI)

and

othe

r sur

gica

l co

mpl

ica

ons i

n co

lore

ctal

surg

ery

Tw

o‐ye

ar c

omm

itmen

t

Ove

r 200

hos

pita

ls pa

rci

pang

To

ach

ieve

sign

ifica

nt re

duc

ons i

n su

rgic

al si

te in

fec

on

and

surg

ical

com

plic

aon

rate

s

To a

chie

ve si

gnifi

cant

impr

ovem

ents

in sa

fety

cul

ture

To im

plem

ent t

he C

ompr

ehen

sive

Uni

t‐ba

sed

Safe

ty

Prog

ram

(CU

SP) m

etho

dolo

gies

CUSP

app

roac

h ca

n be

app

lied

to a

ny sa

fety

or

infe

con

rela

ted

oppo

rtun

ity

CU

SP is

a st

ruct

ured

stra

tegi

c fr

amew

ork

for s

afet

y th

at in

tegr

ates

com

mun

ica

on, t

eam

wor

k, a

nd

lead

ersh

ip to

cre

ate

and

supp

ort a

cul

ture

of p

aen

t sa

fety

that

can

pre

vent

har

ms

Fr

eque

nt m

eeng

s kep

t eve

ryon

e co

nnu

ously

info

rmed

an

d en

gage

d

Real‐

me

iden

fica

on o

f def

ects

allo

wed

for s

tep‐

wise

be

st p

rac

ce im

plem

enta

on

Bo

wel

pre

ps m

ake

a diffe

renc

e!

Impr

ovem

ent M

etho

dolo

gyIm

prov

emen

t Met

hodo

logy

Resu

ltsRe

sults

SSI r

ate

for S

USP

pilo

t sur

geon

s: 8

% a

bsol

ute

redu

con

. Th

is eq

uate

d to

six

few

er S

SIs

3

few

er D

eep/

Org

an S

pace

and

3 fe

wer

Sup

erfic

ial

SS

I rat

e fo

r SU

SP p

ilot s

urge

ons i

s 12.

76%

ver

sus n

on‐

SUSP

pilo

t sur

geon

s’ ra

te o

f 35.

48%

SSI r

ate

for S

USP

 pilo

t surgeon

s in

the fir

st q

uart

er o

f 20

14 w

as 6

.38%

(N

o SS

I in

Janu

ary

or M

arch

201

4)

Re

adm

issio

ns d

ue to

SSI

wer

e re

duce

d 36

% fr

om

base

line

to e

nd o

f firs

t yea

r and

51%

from

bas

elin

e to

la

st q

uart

er

Ho

spita

l Com

pare

resu

lts im

prov

ed fr

om “

Wor

se th

an

U.S.

Na

onal

Ben

chm

ark”

to “

No

diffe

rent

than

U.S

. N

aon

al B

ench

mar

k”

Sa

ved

$180

,000

in e

xtra

pa

ent c

osts

95%

of S

USP

pa

ents

had

a S

urgi

cal S

afet

y Ch

eckl

ist

com

plet

ed

Inte

rven

tions

Inte

rven

tions