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NSQIP at SMH September 2010

NSQIP at SMH September 2010. NSQIP. NSQIP Information Semiannual Report on Colorectal Surgery Colorectal Initiatives Implemented Colorectal Data 2009 Emergency Colorectal Surgery. What is NSQIP?. Program Overview. Outcomes-based program. Risk-adjusted.

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NSQIP at SMH September 2010

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  1. NSQIP at SMHSeptember 2010

  2. NSQIP • NSQIP Information • Semiannual Report on Colorectal Surgery • Colorectal Initiatives Implemented • Colorectal Data 2009 • Emergency Colorectal Surgery

  3. What is NSQIP? Program Overview • Outcomes-based program • Risk-adjusted • Reports – SAR , benchmarking, ,ad-hoc, • 240 Participating Sites • 5 Canadian Sites • General, Vascular, ENT, Thoracic

  4. More about NSQIP • Systematic sampling process • Inclusion/exclusion criteria • Data Preoperative Intraoperative Postoperative (30-day outcome) • Sources of Data - Chart, EMR, phone call/letter, Dr office visits

  5. American College of Surgeons National Surgical Quality Improvement Program Semiannual Report, June 2010 Dates of Surgery: January 1, 2009-December 31, 2009 Fraser Health - Surrey Memorial Hospital

  6. Results • Risk adjustment use of preoperative risk factors to account for “patient risk” • O/E Ratio “O” number of observed adverse events “E” number of expected adverse events based on patients’ characteristics or preoperative risk factors

  7. Interpretation of Results • Observed to Expected (O/E) Ratio • Represents the hospital’s outcomes compared to the other ACS NSQIP hospitals, adjusted for inter-hospital differences in patients’ characteristics, comorbidities, and preoperative laboratory values LOW OUTLIER: If the upper bound of the O/E confidence interval is <1.0, the hospital’s outcomes are statistically better than expected. Thus, the hospital’s outcomes are “Exemplary.” AS EXPECTED HIGH OUTLIER: If the lower bound of the O/E ratio is >1.0, the hospital’s outcomes are statistically worse than expected. Thus, the hospital’s outcomes “Need Improvement.” ACS NSQIP Hospital ID Number

  8. Interpretation of Results • Over-Time Performance • Represents the hospital’s previous O/E ratios from the 10 most recent semi-annual reports High Outlier As Expected Current O/E Ratio Low Outlier ACS NSQIP Hospital ID Number

  9. Semiannual Report Statistics: • Jan 1, 2009 – Dec 31, 2009 • NSQIP - 268143 cases • SMH - 1321 • General Surgery cases - 1251 • Colorectal cases - 130

  10. Colorectal Surgery 30-Day Mortality Observed Rate: 9.23% Expected Rate: 5.87% O/E Ratio: 1.57 Status: As Expected

  11. Colorectal Surgery 30-Day Morbidity Observed Rate: 29.23% Expected Rate: 34.53% O/E Ratio: 0.85 Status: As Expected

  12. Colorectal Surgery Length of Stay Observed Rate: 42.39% Expected Rate: 37.43% O/E Ratio: 1.13 Status: As Expected

  13. Colorectal Surgery Surgical Site Infection Observed Rate: 13.08% Expected Rate: 17.01% O/E Ratio: 0.77 Status: As Expected

  14. Colorectal Initiatives • Colorectal carepath and orderset Best practices for pneumonia and UTI prevention • Use of silver catheter in the OR • Enhanced Stoma care • Patient Education • Colorectal Education Day

  15. Colorectal Data SMH NSQIP 130 colorectal cases in 2009 Emergent 54 (42%) Elective 76 (58%) Mortality Rate 12 ( 9.2%) Emergent 66.7% Elective 33.3% 25,815 cases 16 % 84% 4.1% 62.9% 37.1%

  16. Colorectals • Preop Risk Factors:

  17. Colorectals Preop Risk Factors: SMH NSQIP Dyspnea 16.9% 11.7% DNR 6.2% 1.1% Partially Dependent 24.6% 7.1% Totally Dependent 6.2% 3.8% Ascites 2.3% 1.5% CVA 10.8% 4.9% Weight Loss 8.5% 5.6% Radiotherapy 7.7% 3.7% Sepsis/Shock 14.7% 9.2%

  18. Preop Documentation Missing data Height 26/130 (20 %) Weight 24/130 (18 %) Smoking History 55/130 (42 %) Functional Status Chemo/Radiotherapy Open Wounds Weight Loss

  19. Colorectals • Outcome SMH NSQIP Pneumonia 6.2% 3.6% PE 2.3% 0.7% UTI 5.4% 4.0% Cardiac Arrest 3.8% 1.1% MI 3.8% 1.0%

  20. Colorectal LOS Average: 13.5 days Mode: 6 days Median: 9 days SD: 17

  21. Mortality Report Postop DNR 6/12 (50%) Emergent cases: 8/12 (67%)

  22. Wait Time Emergent Case Wait Time (Door to Skin) n = 54 average 44 Hours mode 3 Hours median 4 Hours sd 152 min 1.5 Hours max 762 Hours

  23. Emergency Colorectals Pearson Chi2 p-value = 0.001 NSQIP: Emergent with 0 risk factor: 11% ASA 1 vs NSQIP 0 Risk Factor : McNemar Test: p-value = <.001

  24. Emergency Colorectals

  25. Emergency Colorectals

  26. Emergency Colorectals Outcome: Cases with at least 1 postoperative occurrence 24/54 = 44%

  27. Is our data reflective of what our patients are really like?

  28. Request • Enhance preoperative assessment • Improve documentation • Resume PDSA OR and Surgical Units • Patient and staff education

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