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

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

Participating Participating Hospitals Hospitals Participating Hospitals

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

NSQIP

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

Program Overview ACS NSQIP is a data-driven, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care. Benefits of participation include: Identifying quality Improving patient care Decreasing institutional improvement targets and outcomes healthcare costs

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

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

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.

Staffing Surgeon Champion (SC) • Program Mentor and Advocate • Experienced in quality improvement Surgical Clinical Reviewer (SCR) • Data Collector • Outstanding communicator

Semi-Annual Reports (SAR)

Results Semi-Annual Report 2018 Cases from 1 Jan 2017 – 31 Dec 2017

NSW Collaborative Rates 2018 Collaborative NSQIP 95% 95% Lower Upper Total Observed Observed Adjusted Estimated Population CL CL Cases Events Rate Rate OR Rate Outlier Model Name 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%

Colorectal Rates 2017

Colorectal Rates 2017 (cont'd)

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

Procedure Target – Whipple Pancreatectomy

Whipple Pancreatectomy – Westmead Hospital

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

Current Hospitals  Westmead Liverpool  Nepean Bankstown  Port Macquarie John Hunter  Coffs Harbour  Royal North Shore  Prince of Wales  RPAH  Concord

Awaiting Acceptance  Woolongong  St Vincents  Wagga Wagga  Dubbo/Orange

Interstate Hospitals  Peter Mcallum  Bendigo  Redcliffe  Logan  Also 3 Paediatric hospitals

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

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

What is the Future? 1 2 3 4 In NSW plan is to These hospitals Quality Customisable data expand to 25 sites perform about 75% Improvement by base for NSW in next 2 years of all surgery in setting and Australasia public sector benchmarks - best practice

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

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 !!

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

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