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Quality Improvement

Surgical site infection prevention OR poster for colorectal surgery

WIG's Colorectal Surgery Checklist poster has become a fixture in various Emory operating rooms. Future plans include revising the format for other types of surgery.

Led by Dr. John Sweeney, chair of the Department of Surgery of the Emory University School of Medicine, the Department's quality and safety program participates in the University HealthSystem Consortium (UHC), Best Practices for Better Care (BPBC), American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), and the Surgical Care Improvement Project (SCIP). Through these resources, Dr. Sweeney and such surgical quality teams as the Wound Infection Group (WIG) develop surgical service-specific quality metrics and checklists, define areas needing improvement, and assist in designing strategies to tackle any shortfalls.

Wound Infection Group (WIG)

Led by general surgeon Dr. Joe Sharma, WIG formed in January 2012 with a mandate to reduce surgical site infection (SSIs) at Emory hospitals. SSIs are one of the more common healthcare-associated infections. The group includes general surgeons and acute care, surgical oncology, colorectal, vascular, plastics, and urology surgeons; anesthesiologists; infectious disease and infection control specialists; preoperative and floor nurses; coders; administrative coordinators; medical students; a CDC liaison; and residents.

WIG's agenda involves all aspects of patient care—from preoperative visits and perioperative counseling to intraoperative issues and post-op care, even to coordinating with facilities management to monitor and increase OR temperatures. WIG collects outcomes data, feeds it into the ACS NSQIP database, and extracts areas from the results that need improvement. By then implementing associated initiatives, WIG has lowered the incidence of surgical site infections at Emory hospitals.

Educating both the treated and those who treat has been key to WIG's success. Examples include its Colorectal Surgery Checklist for clinicians and their teams, an interactive PDF and printed poster that delineates the pre-operative, pre-incision, intra-operative, and closing stages that contribute to effective wound closure for colorectal surgery, and its "Come Clean: Stop Surgical Infections Before They Start" iPad app for patients. The app educates patients about wound care and how to reduce their risks for SSIs, and describes such measures as proper hygiene procedures, eliminating smoking, and controlling blood sugar prior to surgery.

University HealthSystem Consortium (UHC)

An alliance of 117 academic medical centers and 310 of their affiliated hospitals, UHC receives billing data and core measure quality data from its members. In turn, the consortium allows member hospitals to benchmark with each other by accessing its transparent, web-enabled database, and by reviewing UHC-generated quarterly management reports. Emory joined UHC in 2006.

In 2014, UHC ranked Emory University Hospital (combined with Emory University Orthopaedics & Spine Hospital) eighth and Emory University Hospital Midtown 22nd in the 2014 UHC Quality Leadership Awards. This is the fourth consecutive year that Emory University Hospital (EUH) has ranked in the top 10 for demonstrating superior performance in delivering high-quality care and safety excellence.

Last year, EUH ranked second and EUH Midtown ranked third nationally in the UHC rankings. Emory Healthcare is the only organization to ever have had two hospitals within the same system rank in the top 10 (both in 2012 and 2013).

The climb to UHC's top tier has been greatly influenced by the efforts of Dr. Sweeney's teams at these hospitals. UHC's rankings are based on multiple domains of quality: mortality, core measures (process of care), equity of core measures, readmissions, safety, patient centeredness, and efficiency. These rankings are the most rigorous in health care and examine how major teaching hospitals are doing in multiple dimensions of quality and safety, and are traditionally looked upon as providing the best, most non-biased national quality measurement system available for teaching hospitals.

Best Practices for Better Care (BPBC) Surgical Safety Collaborative

In 2012, the Department's quality program joined the BPBC, a surgical safety collaborative and multi-year initiative of the UHC and the Association of American Medical Colleges (AAMC). The BPBC's mission is to expand the use of evidence-based best practices in surgery through cooperation between UHC-member academic medical centers. BPBC's five primary commitment areas include teaching quality and patient safety to the next generation of doctors; ensuring safer surgery through use of surgical checklists; reducing infections from central lines using proven protocols; reducing hospital readmissions for high-risk patients; and researching, evaluating, and sharing new and improved practices.

The Department's quality program and over twenty other academic medical centers are collecting data and transmitting it to BPBC for tracking, trending, and reporting. Since the Department had already implemented a Surgical Safety Checklist at EUH, it used the rollout of the Surgical Safety Checklist at EUH Midtown as its first project for the BPBC. The initiative allowed Midtown's surgical process improvement teams to draw from the experience of physicians across the nation while also sharing Emory's innovations with other peer institutions.

American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)

The ACS NSQIP employs a prospective, peer reviewed database to quantify 30-day risk-adjusted surgical outcomes that encompass such variables as preoperative risk factors and postoperative mortality and morbidity, allowing comparison of outcomes among all hospitals in the program. Enrolled hospitals abstract case data into the database, the data is quantified, and the database generates comprehensive semiannual reports to the hospitals as well as real-time, continuously updated, online benchmarking reports. Participating programs can then monitor their quality improvement efforts and compare their surgical outcomes—on a blinded basis—with peer hospitals and national averages.

Surgical Care Improvement Project (SCIP)

SCIP is a national quality partnership of organizations focused on improving surgical care by significantly reducing surgical complications. Such a reduction requires that surgeons, anesthesiologists, preoperative nurses, pharmacists, infection control professionals, and hospital executives work together to make surgical care improvement a priority. SCIP has developed quality indicators/measures based on scientific evidence that can reflect guidelines, standards of care, or practice parameters for its partner hospitals. Measures include recommended catheter removal; appropriate hair removal from surgical sites; the timing, dosage, and duration of antibiotics; blood glucose control; and maintaining normothermia.

By converting medical information from patient records into rates or percentages for comparison to the quality indicators/measures, partner hospitals can evaluate their care alongside state and national benchmarks and identify those areas needing improvement. Since the Department of Surgery joined SCIP in 2009, Emory University Hospital has gradually risen in compliance levels.

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