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SCIPing Forward Together: Revelations from One Six Sigma Perioperative Project

August 19, 2013
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It was fascinating to read the account by Brian J. Galli and four of his colleagues at Huntington Hospital, a community hospital in Huntington, N.Y. that is a member of the North Shore-LIJ Health System, of their work to improve outcomes quality and efficiency in the perioperative area, as described in a case study in the July/August issue of Patient Safety & Quality Healthcare. As Mr. Galli and his colleagues noted, they started out by examining how well their surgical teams were doing in terms of complying with the “Time Out” protocol and certain Surgical Care Improvement Project (SCIP) measures. I would urge anyone interested in perioperative patient safety to read the case study for two reasons—for the value of the pure patient safety improvement information, and also for the implications for healthcare IT leaders.

Let’s start by looking at what Galli et al from Huntington Hospital did. Deploying analytics tools in the context of a Six Sigma process improvement project, the project leaders went in and were able to determine through an observational study and a retrospective extraction of data from patient charts that there was considerable room for improvement in compliance with key SCIP quality measures, and also that there was tremendous variation in the efficiency with which surgical teams were completing the perioperative safety process. So, for example, the Six Sigma team found that “[I]f the safety process is done properly, it does not take a long time to complete. The safety process was found to take longer in the cases where team members were not present to start the process or if the surgical team had to ‘redo’ the process because the team failed to complete a specific safety requirement.”

Then, using a technique called “Failure Modes and Effects Analysis,” the team found 24 areas in which key patient safety processes, including confirmation of body side prior to surgery, delays in communicating that a patient safety checklist item was not completed efficiently, and problems with anesthesiologists’ pre-surgical evaluation, had been present.

The good news? After identifying strong needs for standardization of process flow, “acceptance and perception of the safety process by the perioperative team members,” documentation related to the safety process, and other problems, team members were able to help perioperative teams reduce variation both in compliance with patient safety processes, and the speed and efficiency of key parts of the process.

It is projects like this one that will turn the tide towards improved patient safety and operational efficiency and effectiveness in hospitals nationwide. But notice, of course, that the use of data at every stage of improvement projects like this, is absolutely essential.

What’s more, drilling down to more granular levels, clinical informaticists should, in my view, be deeply involved in helping to design online checklists such as those described in this Huntington Hospital case study, in order to maximize the effectiveness of such tools in improvement projects and beyond.

The bottom line is simple: every kind of clinical performance improvement work that can possibly be undertaken in healthcare in the coming years will require data and will require the information systems—electronic health records, clinical documentation systems, business intelligence and analytics solutions—to succeed, and will require the data and information systems involved to facilitate practically every step of that work. Informaticists, and particularly clinical informaticists, owe it to themselves and to their organizations to move forward as co-leaders and as facilitators of these initiatives. They will be helping their organizations at a profound level; and incidentally, they will also be helping their careers. So if it’s time to “SCIP forward” in the perioperative area, it’s certainly also time to march forward more broadly under the banner of improved patient care outcomes and cost-effectiveness and clinician effectiveness, in every area of clinical performance. After all, we’re all in this together.