Hospital quality improvement efforts are all too often inconsistent and unsustainable because they lack adequate patient data and the right approach, leaders from the American College of Surgeons (ACS) told hospital executives from around the country yesterday as part of a panel discussion at U.S. News & World Report’s Hospital of Tomorrow conference.
At a panel session called “Making Quality Stick,” the surgeons drew examples from a variety of quality improvement programs developed by the ACS to show that with the right data, standards, infrastructure and external review, hospitals can establish a continuous loop of surgical quality improvement that delivers sustainable improvements in the delivery of surgical services. Surgical quality improvement is an integral part of the mission of the American College of Surgeons, which over its 100-year history has developed these four principles for improving quality.
“This approach improves outcomes on a consistent and sustainable basis,” said David B. Hoyt, MD, FACS, ACS Executive Director. “By becoming learning organizations in this way, hospitals can meet the changing demands of our health care system, such as the move toward an outcomes-based payment structure.”
One of the key elements to improving quality is to collect accurate, robust data that adjust for the patient’s condition, track the patient’s outcome after they leave the hospital, are collected from the patient’s medical chart not insurance bill, and can be compared to national benchmarks, said Clifford Ko, MD, MS., MSHS., FACS, Director of the ACS Division of Research and Optimal Patient Care. ACS developed the National Surgical Quality Improvement Program (ACS NSQIP®) to provide risk-adjusted data gathered from medical charts and surgical patient outcomes 30 days after the operation (more than half of all complications happen after discharge). The average hospital that participates in ACS NSQIP saves 12-36 lives, has 250 to 500 fewer complications and save millions of dollars – each year, he said.
“Many quality improvement programs use insurance data, which miss most complications and are inadequate in other ways as well,” Dr. Ko said. “With the right data, analyzed and used in effective ways, hospitals can deliver better care at a lower cost.” He added that the Centers for Medicare and Medicaid (CMS) recently began to recognize the value of ACS NSQIP in its value-based purchasing and outcomes reporting initiatives.
“Making quality stick requires hospitals to develop a culture centered on patients, performance, transparency, safety, employee engagement and a commitment to quality from leadership,” said J. Michael Henderson, MD, ChB, FRCSEd, FACS, Chief Quality Officer at the Cleveland Clinic. The Cleveland Clinic was part of a hospital collaborative that used ACS NSQIP to reduce the rate of blood stream infections in intensive care units, and came up with solutions that reduced the rate by 45 percent over the last five years, Dr. Henderson said.
The Memorial Health University Medical Center in Savannah, Ga., used ACS programs and data to pinpoint and correct problem areas, such as higher than expected rates of urinary tract infections (UTI) and colorectal surgical site infections (SSI), said Carl Boyd, MD, FACS, a general surgeon at Memorial Health University Medical Center and a professor of surgery at Mercer University School of Medicine, Macon, Ga. The hospital has since implemented a number of actions to significantly reduce colorectal SSI and UTI infection rates.
“As physicians, we promise to ‘first of all, do no harm,’” Dr. Boyd said. “Preventing a complication means less pain and suffering – essentially, less harm – for the patient. In the end, that’s what this initiative is all about.”
“Hospital of Tomorrow” is a three-day forum (November 4–6, 2013) of top hospital executives and health care visionaries convened by U.S. News & World Report to address the critical challenges and opportunities facing health systems, from a shifting patient population and transformed regulatory environment to rapidly advancing technological innovation and soaring costs. The event focuses on how leading hospitals create solutions and examines the pioneering best practices that are emerging in the new era of medicine ushered in by the Affordable Care Act.