GETTING STARTED Getting Started Getting Started to Success Session 1.
Surgeon Champion: Getting Started, What You Need to Knowweb2.facs.org/download/NinhNguyen.pdfSurgeon...
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Surgeon Champion: Getting Started, What You Need to Know
Ninh T. Nguyen, MD, FACSProfessor of SurgerySurgeon Champion
Vice-Chair, Dept Surgery
University of California, Irvine, Medical Center, Orange, CA
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What You Need to Know as a SC!
• Why did I do this?
• What do I need to get started?
• What was the hardest/easiest things in starting?
• What do I wish I had known before I got started?
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Surgery and the Public’s Health
• 50% of Surgical Complications Preventable
• Each year, ACS NSQIP hospital has opportunity to reduce complications by 250-500 and save 12-36 lives
Hall et al. Ann Surg 2009
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Why did I do this?
• Quality improvement is important- Opportunity to improve the care for patients
• Opportunity to learn about quality
• Opportunity to educate your peers and other specialists
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Role of the Surgeon Champion
• Serve as resources for SCR
• Local liaison to the ACS NSQIP program
• Local advocate for quality initiatives
• Share NSQIP learning, best practices, case studies with staff and surgeons
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Learning about Quality
• Sampling methodology
• Data collection – definition
• Risk adjustment
• Opportunity to educate others (surgeons, residents, students)
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What do I need to get started?
• Buy-ins from your department- Secure funding for your position- Average 5-8 hours a week time commitment
• Commitment for an SCR
• Educational resources- Review available toolkit - Case studies- Best practice guidelines
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•Aim: Determine Who the Surgical Champion and How Does
Surgical Champion Achieves Change
•Study Population: All 238 NSQIPSurgical Champions Surveyed
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Role of the Surgeon Champion
• 72% were not compensated for their effort
• Factors associated with demonstrable CQI efforts:- Longer duration of participation- Frequent meeting with SCR- Frequent presentation of data to administration - Compensation for surgical champion effort- Providing individual surgeon with feedback
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What was the hardest/easiest things in starting?
• Easiest- Commitment of an SCR- Available concise data at your finger tips
• Hardest- Now what?- Communicating data to surgeons- Implement quality improvement efforts
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Presenting the Data
• Using data as quality diagnostic tool• Benchmark to other hospitals• Identifying areas for improvement
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QI Practice Patterns for Surgical Champions
• Presenting data to Administration
• Presenting data to Individual surgeons, Division chiefs & Department chairs , Nursing, Anesthesiology
• Incorporate NSQIP data into peer review M&M process
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Acknowledging the Problem
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Acknowledge the Problem
Smart surgeon learn from their mistakes, Brilliant surgeons learn from other surgeons’mistakes
Acknowledge the problem
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Beyond Communications
• Establish the next layer of champions- Divisions- Other departments
• Begin to use the data
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"Every hospital should follow every patient it treats long
enough to determine whether the treatment has been
successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in
the future.”
Ernest Codman, 1914
Data collection
QI
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Lean Six Sigma Methodology
• Define
• Measure
• Analyze
• Improve
• Control
SC
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Quality Improvement Efforts
• Analyze NSQIP data
• Obtain more specific data
• Work with various committees to implement quality improvement efforts
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Deep venous thrombosis after general surgical operations at a university hospital:
two-year data from the ACS NSQIP
• 35 (1.6%) of 2169 developed DVT• 94% based on symptoms vs. 6% based on routine
screening• Location: Upper (40%), Lower (46%), Both (14%)• Catheter-associated in 60%• CQI
- Routine DVT screening for transfer patients with lines- Increase awareness of the necessity of the line & for earlier removal
Smith et al. Arch Surg 2011
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SC Resources• Available from the ACS NSQIP secure website
• Best Practices Case Studies• Best Practices Guidelines
• Prevention of Catheter-Associated Urinary Tract Infections • Prevention and Treatment of Venous Thromboembolism• Prevention and Assessment of Intravascular Catheter-Related
Bloodstream Infections• Prevention of Surgical Site Infections
• SC monthly conference calls
• Collaborative (regional, state-wide, system-wide)
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What do I wish I had known before I got started?
• Compensation for the position
• Quality begets quality
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Quality Officer
NSQIP
UHC ranking
Patient safety indicators
SCIP Core Measures
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Patient Safety Indicator (PSI)- PSI is a tool developed by the Agency for Healthcare Research & Quality (AHRQ) to screen for problems that patients experience as a result of exposure to the health care system.- Identify potentially preventable complications that occur during an inpatient hospitalization
• PSI 2: Death in low-mortality DRG• PSI 3: Pressure Ulcer• PSI 4: Death among surgical inpatients with serious treatable complications• PSI 5: Foreign body left in during procedure• PSI 6: Iatrogenic pneumothorax• PSI 7: Central venous catheter-related bloodstream infections• PSI 8: Postoperative hip fracture• PSI 9: Postoperative hemorrhage and hematoma• PSI 10: Postoperative physiologic/metabolic derangement• PSI 11: Postoperative respiratory failure• PSI 12: Postoperative PE or DVT• PSI 13: Postoperative sepsis• PSI 14: Postoperative wound dehiscence• PSI 15: Accidental puncture/laceration (APL)• PSI 16: Transfusion reaction
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2010 APL Occurrences by ServiceTotal APL by Service 2010
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“The pessimist complain about the wind; the optimist expects it to
change; the realist adjusts the sail”William Ward – American Poet
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Quality is the result of a carefully constructed cultural environment. It has to be the fabric of
the organization, not part of the fabric