Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes
- 1 April 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 214 (4), 709-714
- https://doi.org/10.1016/j.jamcollsurg.2011.12.012
Abstract
Led by the Tennessee Chapter of the American College of Surgeons, in May 2008 a 10-hospital collaborative was formed between the Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation. We hypothesized that by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data, overall patient surgical outcomes would improve. All NSQIP data from the 10-hospital collaborative for the time periods January to December 2009 (period 1) and January to December 2010 (period 2) were collected. Data on 20 categories of postoperative complications and 30-day mortality were compared between periods. Complication comparisons and hospital costs associated with complications were calculated per 10,000 procedures. Statistical analysis was performed by Z-test. There were 14,205 total surgical cases in period 1 and 14,901 surgical cases in period 2. Between periods (per 10,000 cases) there were significant improvements in superficial surgical site infections (-19%, p = 0.0005), on ventilator longer than 48 hours (-15%, p = 0.012), graft/prosthesis/flap failure (-60%, p < 0.0001), acute renal failure (-25%, p = 0.023), and wound disruption (-34%, p = 0.011). Although mortality (per 10,000) was higher in period 2 (237.6 vs 232.3), no statistical difference was noted. Net costs avoided between these periods were calculated as $2,197,543 per 10,000 general and vascular surgery cases. Data organization and scrutiny are the initial steps of process improvement. Participation in our regional surgical quality collaborative resulted in improved outcomes and reduced costs. Although the mechanisms for these changes are likely multifactorial, the collaborative establishes communication, process improvement, and frank discussion among the members as best practices are identified and shared and standardized processes are adopted.Keywords
This publication has 11 references indexed in Scilit:
- Excess Costs Attributable to Postoperative ComplicationsMedical Care Research and Review, 2011
- The business case for the reduction of surgical complications in VA hospitalsSurgery, 2011
- How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of CareHealth Affairs, 2011
- The Michigan Surgical Quality CollaborativeAnnals of Surgery, 2007
- Intended and Unintended ConsequencesMedical Care, 2007
- The National Surgical Quality Improvement Program in Non-Veterans Administration HospitalsAnnals of Surgery, 2002
- Achieving And Sustaining Improved Quality: Lessons From New York State And Cardiac SurgeryHealth Affairs, 2002
- The Department of Veterans Affairs' NSQIPAnnals of Surgery, 1998
- PRACTICE MANAGEMENT GUIDELINES FOR TRAUMA CAREThe Journal of Trauma and Acute Care Surgery, 1994
- The Hawthorne Experiments: First Statistical InterpretationAmerican Sociological Review, 1978