Clifford Y. Ko, MD MS MSHS FACS Director, Division of Research and Optimal Patient Care
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Transcript of Clifford Y. Ko, MD MS MSHS FACS Director, Division of Research and Optimal Patient Care
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Intersection of Surgical Outcomes and Medical Education:
The ACS Perspective(Division of Research and Optimal Patient
Care)
Clifford Y. Ko, MD MS MSHS FACSDirector, Division of Research and
Optimal Patient CareAmerican College of Surgeons
Professor of SurgeryDavid Geffen School of Medicine at UCLA
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No Disclosures
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Dedicated to improving the care of the surgical patient and to
safeguarding standards of care in an optimal and ethical practice
environment
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Four Guiding Principles of Continuous Quality Improvement
2. Right Infrastructure• Staffing
level/Specialists• Equipment• Checklists• The Quality
Processes
1. Standards• Individualized by
patient• Backed by research
3. Rigorous Data• From medical charts• Backed by research• Post-discharge tracking• Continuously updated
4. Verification• External peer-
review• Creates public
assurance
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ACS: 100 Years of Quality ImprovementBench to Bedside to Policy
1917
1913 1922 1950
1951
1998
2004
2005
2011
Minimum Standard for
Hospitals
COMMITTEE ON TRAUMA
SSR
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Current Issues in Surgery1. Understanding the Metrics in Quality2. Transparency/Public Reporting of
Quality3. Patient Experience4. Real Data 5. Appropriateness6. Sustained Quality Improvement
–QI Process–Leadership/Team/Culture
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Metrics: SCIP1: Prophylactic antibiotic received within
one hour prior to surgical incision2: Prophylactic antibiotic selection for
surgical patients 3: Prophylactic antibiotics discontinued
within 24 hours after surgery end time (48 hours for cardiac patients)
4: Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose
5: Surgery patients with appropriate hair removal
6: Colorectal surgery patients with immediate postoperative normothermia
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Current Metrics Don’t Work So Well: SCIP has little correlation with Risk Adjusted Clinical
Outcomes
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“All Cause Harm”: Readmissions
• 11%, if no complications
• 36%, if complications
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Readmission Rates Within 30 days
for Colectomy
No Cx
Dehis PE
No CxSSISup
SSIOrg
RenalInsuff
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Measuring Patient Experience with S-CAHPS
Consumers Assessment of Healthcare Providers and Systems
Surgical Patient Experience (6)1. Surgeon Communication Before Your Surgery2. Surgeon Communication After Your Surgery3. Surgeon Care Before Your Surgery4. Surgeon Care on the Day of Your Surgery5. Surgeon Care After Your Surgery6. Clerks and Receptionists at Surgeon’s Office
www.cahps.ahrq.gov
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Procedure Any Cx
Total SSI
Total Pulm
UTI
Esophagectomy 47.33%16.46
% 29.22% 2.06%
Cystectomy 41.13%12.77
% 8.51% 10.64%AAA 39.32% 3.42% 24.29% 4.84%
Pancreatectomy 35.31%18.75
% 11.35% 6.73%
Colectomy 29.85%11.65
% 12.45% 4.84%
Proctectomy 27.59%13.49
% 8.18% 6.01%AoIliac bypass 24.22% 7.32% 7.49% 2.96%
Liver Rx 25.00%11.08
% 10.92% 4.11%
Abdominoplasty 20.93%11.63
% 0.00% 0.00%Lung Rx 15.46% 1.28% 9.81% 1.60%
Endo AAA 11.83% 2.35% 3.91% 1.63%Nephrectomy 13.24% 1.78% 3.16% 3.36%Hysterectomy 9.60% 2.32% 1.79% 4.32%
REAL DATARates of Complications (w/o
publication bias)
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Outcome
% occurring post D/C
Median Day
Colectomy Length of Stay 6Mortality 18% 10Superficial Surgical Site Infection 53% 9Deep SSI 45% 10Organ Space SSI 39% 11Wound Disruption 34% 10Pneumonia 7.2% 6Cardiac Arrest 55% 5Myocardial Infarction 21% 3Renal Failure 15% 6DVT/PE 28/38% 10/8Bleeding requiring 4u transfusion 6% 1Sepsis 27% 4Failure to wean/Unplanned Reintub
14% 2
Urinary Tract Infection 35% 9
Following our patients for 30 days
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Appropriateness: Essential for the Patient Provider Discussion
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High Quality Surgical Care
Best Practices/Standards/
Implementation
Feedbackand
Planning
Data Collection/Analysis
Surgeons Leading QI
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88%
48%
0
10
20
30
40
50
60
70
80
90
100
Surgeons ratingteamwork
Nurses ratingteamwork
% R
atin
g q
ual
ity
of
colla
bo
rati
on
&
com
mu
nic
atio
n h
igh
or
very
hig
h
Scoring Teamwork:Teamwork in the Eye of the Beholder
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A Start…
• “Quality in Training” Collaborative Pilot in NSQIP .
• A pilot project designed to bring together Training Facilities within ACS-NSQIP.
• Enable easy manipulation of data to provide standardized resident reports.
• Build ways to include quality evaluation, patient safety, and performance improvement that teach to real world use– Start to live it and understand it in training.
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For more information on this ACS NSQIP Pilot
Breakfast meeting tomorrow (Thursday)
Time: 630-800AM Room: Aqua 312
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Thank You
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Intersection of Surgical Outcomes and Medical Education:
The ACS Perspective(Division of Research and Optimal Patient
Care)
Clifford Y. Ko, MD MS MSHS FACSDirector, Division of Research and
Optimal Patient CareAmerican College of Surgeons
Professor of SurgeryDavid Geffen School of Medicine at UCLA