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Before You Let Them Cut You

August 25, 2009
by Mark Hagland
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One would think it obvious that evidence-based, thoughtful surgical care would be the norm already in the healthcare system, but those in the know are very aware that things are far from perfect.

That’s why it’s good news to learn that hospitals participating in the AmericanCollege of Surgeons’ ACS NSQIP (National Surgical Quality Improvement Program) are showing strong, concrete results. According to a survey released last week, hospitals participating in the ACS NSQIP program (though, couldn’t they come up with a better acronym? perhaps something along the lines of “CUT GOOD,” or something?) have shown what the College calls “significant improvement in patient mortality and morbidity, and are preventing 262-524 complications per hospital,” as described in detail in the September issue of the Annals of Surgery.

In fact, “If these results were translated across all U.S. hospitals, we would have the potential to prevent millions of complications a year, save potentially billions of dollars a year and provide evidence to healthcare reformers that higher quality care can cost less,” said Clifford Y. Ko, M.D., director of the Division of Research and Optimal Patient Care at the College of Surgeons, in announcing the study’s results.

The ACS NSQIP program offers participating hospitals a peer-controlled, validated database of outcomes, from pre-operative to 30-day-post-op outcomes, based on clinical, not claims, data.

What’s particularly encouraging here is the breadth of improvement shown in the study. Of the 118 hospitals that began participating in the program in the period of 2005-2007, 82 percent have seen improvement in morbidity rates, and 66 percent have seen improvement in mortality rates, with an average of 11-17 percent improvement every year.

And these improvements have dollar implications. As the College of Surgeons notes, “Previous studies have shown the significant cost of surgical complications, ranging from nearly $13,000 in additional costs to treat a urinary tract infection and $8,500 to treat venous thromboembolism (VTE), to more than $28,000 in additional costs to treat a surgical site infection.”

For those hospitals that have strong surgical information systems, strong EMRs, and good data warehouses and databases, such progress should be reachable even without participating in this worthy program. Clinician and IT leaders in those hospitals pursuing strong clinical performance improvement are making inroads nowadays in surgical outcomes as well as in just about every other patient care area. As I’ve described in both of my books, organizations like Geisinger Health System, Brigham & Women’s Hospital, and Trinity Health, are working forward determinedly to improve patient care outcomes organization-wide, and some, Geisinger in particular, have great results to show in such areas as CABG surgery.

Those organizations also have dynamic CIOs, CMIOs, and other clinical IT executives and leaders, individuals who are making sure that surgeons and other clinicians have the IS tools needed to perform surgeries under optimal conditions, to optimize patient flow and clinician workflow, to analyze clinical outcomes, and to then close the loop and make needed improvements based on such analysis. The ACS NSQIP program is just one example of how evidence-based, data-driven approaches to improving patient care really work. I, for one, would be looking at whatever outcomes data individual hospitals might have to offer publicly, were I to be in a position to need to consider an elective surgery.

What about you? Wouldn’t you like to know—and feel confident in—your hospital’s surgical outcomes, before you go under the knife?

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