Surgeon Champion: Getting Started, What You Need to Know

Ninh T. Nguyen, MD, FACSProfessor of SurgerySurgeon Champion

Vice-Chair, Dept Surgery

University of California, Irvine, Medical Center, Orange, CA

What You Need to Know as a SC!

• Why did I do this?

• What do I need to get started?

• What was the hardest/easiest things in starting?

• What do I wish I had known before I got started?

Surgery and the Public’s Health

• 50% of Surgical Complications Preventable

• Each year, ACS NSQIP hospital has opportunity to reduce complications by 250-500 and save 12-36 lives

Hall et al. Ann Surg 2009

Why did I do this?

• Quality improvement is important- Opportunity to improve the care for patients

• Opportunity to learn about quality

• Opportunity to educate your peers and other specialists

Role of the Surgeon Champion

• Serve as resources for SCR

• Local liaison to the ACS NSQIP program

• Local advocate for quality initiatives

• Share NSQIP learning, best practices, case studies with staff and surgeons

Learning about Quality

• Sampling methodology

• Data collection – definition

• Risk adjustment

• Opportunity to educate others (surgeons, residents, students)

What do I need to get started?

• Buy-ins from your department- Secure funding for your position- Average 5-8 hours a week time commitment

• Commitment for an SCR

• Educational resources- Review available toolkit - Case studies- Best practice guidelines

•Aim: Determine Who the Surgical Champion and How Does

Surgical Champion Achieves Change

•Study Population: All 238 NSQIPSurgical Champions Surveyed

Role of the Surgeon Champion

• 72% were not compensated for their effort

• Factors associated with demonstrable CQI efforts:- Longer duration of participation- Frequent meeting with SCR- Frequent presentation of data to administration - Compensation for surgical champion effort- Providing individual surgeon with feedback

What was the hardest/easiest things in starting?

• Easiest- Commitment of an SCR- Available concise data at your finger tips

• Hardest- Now what?- Communicating data to surgeons- Implement quality improvement efforts

Presenting the Data

• Using data as quality diagnostic tool• Benchmark to other hospitals• Identifying areas for improvement

QI Practice Patterns for Surgical Champions

• Presenting data to Administration

• Presenting data to Individual surgeons, Division chiefs & Department chairs , Nursing, Anesthesiology

• Incorporate NSQIP data into peer review M&M process

Acknowledging the Problem

Acknowledge the Problem

Smart surgeon learn from their mistakes, Brilliant surgeons learn from other surgeons’mistakes

Acknowledge the problem

Beyond Communications

• Establish the next layer of champions- Divisions- Other departments

• Begin to use the data

"Every hospital should follow every patient it treats long

enough to determine whether the treatment has been

successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in

the future.”

Ernest Codman, 1914

Data collection

QI

Lean Six Sigma Methodology

• Define

• Measure

• Analyze

• Improve

• Control

SC

Quality Improvement Efforts

• Analyze NSQIP data

• Obtain more specific data

• Work with various committees to implement quality improvement efforts

Deep venous thrombosis after general surgical operations at a university hospital:

two-year data from the ACS NSQIP

• 35 (1.6%) of 2169 developed DVT• 94% based on symptoms vs. 6% based on routine

screening• Location: Upper (40%), Lower (46%), Both (14%)• Catheter-associated in 60%• CQI

- Routine DVT screening for transfer patients with lines- Increase awareness of the necessity of the line & for earlier removal

Smith et al. Arch Surg 2011

SC Resources• Available from the ACS NSQIP secure website

• Best Practices Case Studies• Best Practices Guidelines

• Prevention of Catheter-Associated Urinary Tract Infections • Prevention and Treatment of Venous Thromboembolism• Prevention and Assessment of Intravascular Catheter-Related

Bloodstream Infections• Prevention of Surgical Site Infections

• SC monthly conference calls

• Collaborative (regional, state-wide, system-wide)

What do I wish I had known before I got started?

• Compensation for the position

• Quality begets quality

Quality Officer

NSQIP

UHC ranking

Patient safety indicators

SCIP Core Measures

Patient Safety Indicator (PSI)- PSI is a tool developed by the Agency for Healthcare Research & Quality (AHRQ) to screen for problems that patients experience as a result of exposure to the health care system.- Identify potentially preventable complications that occur during an inpatient hospitalization

• PSI 2: Death in low-mortality DRG• PSI 3: Pressure Ulcer• PSI 4: Death among surgical inpatients with serious treatable complications• PSI 5: Foreign body left in during procedure• PSI 6: Iatrogenic pneumothorax• PSI 7: Central venous catheter-related bloodstream infections• PSI 8: Postoperative hip fracture• PSI 9: Postoperative hemorrhage and hematoma• PSI 10: Postoperative physiologic/metabolic derangement• PSI 11: Postoperative respiratory failure• PSI 12: Postoperative PE or DVT• PSI 13: Postoperative sepsis• PSI 14: Postoperative wound dehiscence• PSI 15: Accidental puncture/laceration (APL)• PSI 16: Transfusion reaction

2010 APL Occurrences by ServiceTotal APL by Service 2010

Hep

atob

iliary

Ser

vice

Gyn

ecol

ogy

Onc

olog

y

Sur

gica

l Onc

olog

y

GI S

urge

ry

Vasc

ular

Sur

gery

Neu

rosu

rger

y

Gen

eral

Sur

gery

Uro

logi

cal S

ervi

ce

Col

orec

tal S

urge

ry

Acut

e C

are

Ser

vice

Oto

lary

ngol

ogy

0

2

4

6

8

10

12

14

Service

Cas

es

“The pessimist complain about the wind; the optimist expects it to

change; the realist adjusts the sail”William Ward – American Poet

Quality is the result of a carefully constructed cultural environment. It has to be the fabric of

the organization, not part of the fabric

ninhn@uci.edu