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Emory Surgery's Focus on Quality Improvement

Surgical site infection prevention OR poster for colorectal surgery

The Wound Infection Group's Colorectal Surgery Checklist poster is a fixture in various Emory operating rooms. Future plans include revising the format for other types of surgery.

Led by Emory Surgery's chief quality officer Dr. Joe Sharma, associate professor of general and endocrine surgery, our quality and safety program participates in various quality alliances and protocols, and oversees surgical quality teams representing our specialties and associated facilities that are charged with creating surgical service-specific quality metrics and checklists, defining areas needing improvement, and designing and enacting strategies to tackle any shortfalls.

Emory Surgery's quality and safety-centered resources, initiatives, and organizational memberships include:

Wound Infection Group
University HealthSystem Consortium
Best Practices for Better Care
American College of Surgeons National Surgical Quality Improvement Program
Surgical Care Improvement Project

Wound Infection Group

The Wound Infection Group (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

The University HealthSystem Consortium (UHC) is an alliance of the nation's leading academic medical centers, all of whom contribute billing and core measure data to the Consortium's Quality and Accountability Study. The study is a truly objective, data-driven measure that identifies high-performing principal member organizations in the areas of quality and safety, provides tools as a catalyst for organizational improvement, and allows the member centers to compare their systems. Emory joined UHC in 2006.

Emory University Hospital (EUH) ranked fourth in the nation among academic medical centers included in UHC's 2015 Quality and Accountability Study, and was a recipient of the 2015 Bernard A. Birnbaum, MD, Quality Leadership Awards, formerly known as the UHC Quality Leadership Awards. This was the fifth consecutive year that EUH ranked in the top 10 for demonstrating superior performance as measured by the UHC. Emory University Hospital Midtown ranked 24th in the listing, and ranked third in the nation among academic medical centers receiving the 2015 UHC Supply Chain Performance Excellence Award.

The climb to UHC's top tier has been greatly influenced by the efforts of Emory Surgery's teams at these hospitals. UHC's rankings are based on multiple domains of quality: safety, mortality, effectiveness, efficiency, equity, and patient-centeredness. These rankings are widely considered 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

In 2012, Emory Surgery's quality program joined Best Practices for Better Care (BPBC), a surgical safety collaborative and multi-year initiative of the UHC and the Association of American Medical Colleges. 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.

Emory Surgery's quality program and over twenty other academic medical centers are collecting data and transmitting it to BPBC for tracking, trending, and reporting. Since Emory Surgery 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 EUH 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

The American College of Surgeons National Surgical Quality Improvement Program (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

The Surgical Care Improvement Project (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 Emory Surgery joined SCIP in 2009, Emory University Hospital has gradually risen in compliance levels.

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