ACS NSQIP The Critical Role of the Surgeon Champion

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ACS NSQIPThe Critical Role of the Surgeon
Champion

• J. Michael Henderson, MD
• Cleveland Clinic

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ACS NSQIP

• Why did we get into it?
• VA data is persuasive
• Post-op mortality ? 27
• Post-op morbidity ? 45
• Measures real outcomes.
• Applicable to all surgical specialties.
• Risk adjusted national outcomes data.
• Keystone to driving our Surgical Quality Program.

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ACS NSQIP

• What did it take to get started?
• A Champion
• Department / Institution buy-in
• There are s
• A committed nurse coordinator
• Education

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ACS NSQIP

• What have I learned?
• Sampling methodology valid in representing our
  patient population.
• Data collection excellent definition of
  parameters / end points.
• Believable risk adjustment we do not have the
  sickest patients!
• A huge opportunity to educate.

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ACS NSQIP

• Surgeon Champion
• Phase I Set-up
• Educate about the program
• - Department / Division Chairs
• - Staff /Fellows /Residents
• Recruit and train a nurse coordinator
• Work with systems for
• - Patient identification
• - Data capture

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ACS NSQIP

• Surgeon Champion
• Phase 2 1st 6 months
• Keep your nurse coordinator alive.
• Improve data capture use of auto-feeds.
• Establish methods to follow-up patients
• - letters / phone calls / visits etc.
• Education staff / residents / support personnel

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ACS NSQIP

• Surgeon Champion
• Phase 3 6 months plus
• Passed the audit.
• 1st cycle of data the opportunity really
  starts.
• Establish next layer of Champions in each
  department (General, Colorectal and Vascular
  Surgery).
• Begin to use the data.

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ACS NSQIP

• Data the opportunities
• Standardizing definitions for Institutional
  practice education of staff, fellows,
  residents
• SSI, cardiac, pulmonary, renal, etc.
• Patient profiling How sick are your patients?
• Outcomes How good are you?
• Quality improvement.

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ACS- NSQIP

• Data Use for Surgeon Champion.
• O/E ratios Objective data for performance of
  Center and Depts.
• A stick to drive quality improvements
• Drill down on factors for morbidity
• Performance improvement projects
• Educate / improve / measure
• If data are pertinent to clinical practice
  chance of buy-in and use improve.
• Outcomes reporting.

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NSQIP
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ACS NSQIP

• EXAMPLE What does it help drive?
• Perioperative infection questions
• Core measures Antibiotic choice, timing,
  duration
• hyperglycemia / temp control
• ?
• Outcomes SSI / sepsis / pneumonia / UTI
• Other Core Measures can be linked to Clinical
  Outcomes
• ß-blocker ----------------- cardiac
  events
• DVT prophylaxis ----------- events

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ACS - NSQIP

• OUTCOMES REPORTING
• Department specific outcomes books
• NSQIP general outcomes included
• Disease specific outcomes reported

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National Surgical Quality Improvement
ProgramJuly 1, 2004 - June 30, 2005
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Observed
Expected
15

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N 678
5
0
Mortality
Morbidity

• Neither 30-day mortality nor morbidity is
  significantly different from the projected rate,
  risk-adjusted, for Cleveland Clinic patients.

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ACS NSQIP

• Future prospects
• Expand to all specialties.
• Tie data capture to the EMR pre-op HP, intraop
  data, discharge follow-up data.
• Improve automation of data role of coordinator
  moves to validation more than capture.
• Implement in all hospitals in our health system
  (9 for CCHS)
• Move to an era where this is standard of care.

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Role of the Surgeon Champion

• Garner resources
• Assure adherence to program for data collection
  /submission
• Use the data to improve Quality and Outcomes
  its all about the patient.
• Educate / educate / educate