National Surgical Quality Improvement Program - NSQIP Experiences - - PowerPoint PPT Presentation

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National Surgical Quality Improvement Program - NSQIP Experiences - - PowerPoint PPT Presentation

Apr 12, 2023 151 likes •467 views

National Surgical Quality Improvement Program - NSQIP Experiences to date in NSW Arthur Richardson Associate Professor of Surgery University of Sydney Head HPB/UGI Surgery Westmead Hospital Chairperson Surgical Services Taskforce ACI Ernest

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National Surgical Quality Improvement Program - NSQIP

Experiences to date in NSW

Arthur Richardson Associate Professor of Surgery University of Sydney Head HPB/UGI Surgery Westmead Hospital Chairperson Surgical Services Taskforce ACI

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Ernest A. Codman, MD, FACS (1869-1960)

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Participating Hospitals

Participating Hospitals

Participating Hospitals

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NSQIP

  • Half or more of all complications occur after discharge
  • Quality programs based on admin data don’t track post-discharge
  • Complications after discharge can lead to readmissions

Tracking quality can’t stop at the hospital’s door

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NSQIP

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Program Logic

1. Hospitals collect clinical data 2. Data are analysed and benchmarked 3. Data are reported back to hospitals 4. Hospitals target QI actions based on results 5. Hospitals monitor impact of actions and share learnings 6. Patients experience better quality surgical care

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Program Overview

Benefits of participation include:

Identifying quality improvement targets Improving patient care and outcomes Decreasing institutional healthcare costs

ACS NSQIP is a data-driven, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care.

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Program Overview (cont'd)

SCR training/certification and hospital audits insure data quality Advanced data analytics provide risk adjustment and smoothing (reliability adjustment for small sample sizes) Provides data-driven tools for clinical decision making Includes general and vascular surgery cases as well as subspecialties and targeted procedures Program uses clinical data, not administrative data Outcomes assessed at 30 days after index surgery (inpatient or

  • utpatient)

Highly standardised and validated data definitions

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Data Collection

  • Demographics
  • Clinical laboratory variables
  • 1. Preoperative data:
  • Surgical Profile
  • Clinical variables and complications
  • 2. Intraoperative data:
  • 30-day outcomes (inpatient and outpatient)
  • Complications and discharge variables
  • 3. Postoperative data:
  • Allows sites to create their own variables for internal tracking and evaluation
  • 4. Custom fields:
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Utilising Hospital Outcomes for Quality Improvement

  • All hospitals have an opportunity to improve care.
  • Even hospitals with “Exemplary” or “As Expected” outcomes can

benefit from quality improvement efforts.

  • Quality improvement is a multi-disciplinary effort.
  • Collaboration with quality management, hospital administration, and

clinical providers from all specialties promotes success.

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Staffing

Surgeon Champion (SC)

  • Program Mentor and Advocate
  • Experienced in quality improvement

Surgical Clinical Reviewer (SCR)

  • Data Collector
  • Outstanding communicator
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Semi-Annual Reports (SAR)

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Results

Semi-Annual Report 2018

Cases from 1 Jan 2017 – 31 Dec 2017

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NSW Collaborative Rates 2018

Collaborative NSQIP Model Name Total Cases Observed Events Observed Rate Adjusted Rate 95% Lower CL 95% Upper CL Outlier Estimated OR Population Rate ALLCASES Mortality 5,128 68 1.33% 0.95% 0.76% 1.15% 0.95 0.99% ALLCASES Morbidity 5,128 528 10.30% 9.28% 8.72% 9.87% High 1.57 6.12% ALLCASES Cardiac 5,128 35 0.68% 0.59% 0.42% 0.79% 0.93 0.63% ALLCASES Pneumonia 5,114 95 1.86% 1.47% 1.25% 1.70% High 1.52 0.97% ALLCASES Unplanned Intubation 5,125 27 0.53% 0.51% 0.34% 0.72% 0.71 0.72% ALLCASES Ventilator > 48 Hours 5,117 49 0.96% 0.77% 0.60% 0.97% 1.02 0.76% ALLCASES VTE 5,128 59 1.15% 0.99% 0.79% 1.22% 1.21 0.82% ALLCASES Renal Failure 5,119 28 0.55% 0.49% 0.35% 0.66% 1.06 0.47% ALLCASES UTI 5,116 114 2.23% 1.87% 1.63% 2.13% High 1.77 1.06% ALLCASES SSI 5,107 263 5.15% 5.30% 4.88% 5.73% High 2.14 2.55% ALLCASES Sepsis 5,092 62 1.22% 1.14% 0.91% 1.39% 1.17 0.97% ALLCASES C.diff Colitis 5,128 12 0.23% 0.24% 0.11% 0.41% 0.63 0.38% ALLCASES ROR 5,128 176 3.43% 3.15% 2.78% 3.53% High 1.35 2.36% ALLCASES Readmission 5,128 347 6.77% 6.49% 5.95% 7.05% High 1.31 5.03%

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Colorectal Rates 2017

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Colorectal Rates 2017 (cont'd)

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Westmead HPB Collaborative

  • Was the only HPB centre outside of NorthAmerica
  • Collect data on Pancreatectomy and liver resection
  • Compared against approximately 120 centres in North America
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Procedure Target – Whipple Pancreatectomy

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Whipple Pancreatectomy – Westmead Hospital

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Why NSQIP?

  • Serious problem with reproducible and comparable clinical data in NSW
  • A need for quality improvement programs in NSW
  • High quality publicly reportable data
  • International and local benchmarking
  • Seed funding provided by ACI in 2015
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Current Hospitals

  • Westmead

Liverpool

  • Nepean Bankstown
  • Port Macquarie John Hunter
  • Coffs Harbour
  • Royal North Shore
  • Prince of Wales
  • RPAH
  • Concord
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Awaiting Acceptance

  • Woolongong
  • St Vincents
  • Wagga Wagga
  • Dubbo/Orange
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Interstate Hospitals

  • Peter Mcallum
  • Bendigo
  • Redcliffe
  • Logan
  • Also 3 Paediatric hospitals
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Quality Improvement Bundles

  • Complication specific quality improvement programs for local

implementation

  • Developed by various NSQIP participants and shared across

Collaboratives worldwide

  • Includes toolkits, change management strategies, patient info sheets,

clinical info guides

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Quality Improvement Bundles (cont’d)

Site QI Focus Status Nepean UTI Evaluation SSI Implementation Pre-operative optimisation Implementation Westmead SSI Implementation UTI Design / Development Unplanned readmissions Design / Development Port Macquarie SSI Evaluation + Interdistrict implementation Coffs Harbour SSI Evaluation + Interdistrict implementation Sydney Children’s Hospital SSI Design / Development Children’s Hospital Westmead SSI Design / Development Pneumonia Design / Development

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What is the Future?

In NSW plan is to expand to 25 sites in next 2 years

1

These hospitals perform about 75%

  • f all surgery in

public sector

2

Quality Improvement by setting benchmarks

3

Customisable data base for NSW and Australasia

  • best practice

4

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Vision for the next two years

  • Consistent collection of data across hospitals from January 2020
  • Annual Quality and Safety Conference
  • Procedure specific data collection 12 procedures
  • Linkage with CINSW data
  • Linkage with activity based financial data
  • ?Report cards to LHD’s
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What is the Future?

  • Variation in care
  • Low value care
  • Benchmarking for high acuity low volume surgery
  • Procedure specific databases
  • Public reporting
  • Research
  • Other database linkages
  • Surgical Leadership !!
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Australasian Collaborative

  • 1. NSW 25 HOSPITALS – will capture approx. 75% of public sector

surgery

  • 2. Queensland?
  • 3. Victoria?
  • 4. Tasmania (1 or 2?)
  • 5. New Zealand
  • 6. Private sector involvement
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NSW Hospitals

  • Westmead
  • Nepean
  • Port Macquarie
  • Coffs Harbour
  • Sydney Children’s Hospital
  • Children’s Hospital at Westmead
  • Prince of Wales
  • Gosford