Data is the name of the game in healthcare quality improvement. But how exactly do healthcare leaders turn raw data into actionable information that leads to better outcomes? Cliff Ko, MD, director of the American College of Surgeons National Surgical Quality Improvement Program and the Division of Research and Optimal Patient Care at ACS, explains steps healthcare providers can take to improve surgical quality.
1. Collect and report data. The first step in using data for quality improvement is collecting and then reporting data. NSQIP is a tool developed by surgeons to collect surgical outcome information and benchmark data across institutions. To ensure accuracy, NSQIP trains surgeons to collect data and performs audits to verify the data. A study published in the Journal of the American College of Surgeons found readmission data from NSQIP is more accurate than administrative data on readmissions. "A lot of hospitals use claims-based data because it's easily accessible," Dr. Ko says. "But for quality improvement and patient care, we've found it's not as good as using [NSQIP] clinical data."
2. Analyze data. Once leaders report the outcomes data and benchmark their organization against others, they can identify areas of weakness and opportunities for improvement. To decrease an infection rate, Dr. Ko suggests drilling down on the data to first determine what procedural and patient characteristics are associated with the high infection rate. For example, a high infection rate may occur primarily in a certain operating room, with a particular surgeon or with elective surgeries.
Once the "who" and "where" of the infection are determined, healthcare providers should identify the cause of the infection. The high infection rate may be due to inadequate instrument sterilization, poor hand hygiene or improper postoperative care, for instance.
3. Implement steps to address the causes of high infection. After identifying the causes of the high infection rate, the surgical team needs to work together to develop an action plan to address the causes. NSQIP offers several tools to support providers in their improvement efforts, according to Dr. Ko:
• Guidelines. NSQIP provides guidelines on the most common surgical complications, including surgical site infections, venous thromboembolisms and renal failure. The guidelines include best practices not only from the literature, but also from surgeons' experience.
• Case studies. NSQIP has case studies of hospitals that have improved surgical outcomes based on its guidelines. These case studies are helpful for answering hospitals' questions about everything from scheduling meetings with the surgical team to changing the organization's culture, Dr. Ko says.
• Preoperative risk calculator. The third tool NSQIP offers is a preoperative risk calculator that estimates the percent chance of an infection or other complication for patients undergoing procedures. This information helps providers prepare needed resources and keeps patients informed about their risks. "It allows us to get the right resources in the right area, versus overuse problems, which leads to inefficiencies due to lack of resources," Dr. Ko says.
Surgical quality improvement leads to culture change
Beyond improving patients' health, reducing infection rates and surgical complications will save hospitals money and lead to a broader culture change, according to Dr. Ko. "Once a hospital starts to achieve better care, and usually the best way is through teamwork, the culture of the hospital improves," he says.
More Articles on NSQIP:
Study: NSQIP Hospitals Have Better Surgical Outcomes
NSQIP Data Shows 30% of Colorectal Surgery Patient Hospital Readmissions Are Preventable
Study: Readmission Data From American College of Surgeons Program More Accurate Than Administrative Data