Example of interventions and changes in outcomes in ACS NSQIP hospitals/collaboratives
| Hospital | Complication | Intervention | Outcome |
|---|---|---|---|
| Hershey Medical Center, Penn State35 | 19.3% SSI in patients with diabetes; 8% in patients without diabetes VTE 3.4% (2008) | Glucose control protocol VTE risk assessment and order set | Reduction of SSI O/E from 1.31 to 0.78 Reduction of VTE rate from 3.4% to 0.2% (2008–2009) |
| University of Virginia37 | 17.6% SSI (national average 8.1%) in colorectal resections, high BMI was a risk factor | Protocol for wound wicking for BMI >25 kg/m2, SCIP measures, glycaemic control | Reduction of SSI from 17.6% to 11.2% (36% reduction) (2003–2006) |
| Massachusetts General Hospital37 | Vascular surgery morbidity O/E ratio 1.19, (99% CI 0.93 to 1.48) UTI rate 7.0% vs 4.7% (p<0.087) | Physician order entry templates, Foley catheter removal algorithm, silver-coated catheters for selected patients, identify procedures not requiring a catheter, educational campaign for clinicians | Reduction of UTI from 7.0% to 1.8% Morbidity O/E ratio decreased from 1.19 (99% CI 0.93 to 1.48) to 0.93 (99% CI 0.67 to 1.48) (76% reduction) (2003–2004) |
| Hospital A | Identified a rise in organ space infections | Standardised orders, proper antibiotic use, morbidity conference presentations, skin preparation changes | Organ space infection increase attributed to increased leak rates and identified surgical technique issues; improvements seen, but rate still high (2005–2010) |
| Hospital B | VTE 17.6% | Risk stratification, best practices, standardised orders | VTE decreased from 17.6 to 2.3%; O/E decreased from 1.88 to 1.05 (2006–2010) |
| Hospital C | Unplanned reintubation 3% (O/E 1.56) Ventilator>48 h 3.84% (O/E 1.71) | Tracking tool, risk assessment, improved pulmonary hygiene intervention | TBD |
| Hospital D | Ventilator use for >48 h 2.24% (O/E 1.7) | Tracking tool, standardised orders, patient education | Ventilator use for >48 h decreased from 2.24% to 1.19% (O/E 1.7 to 0.83) (2008–2010) |
| Hospital E | Overall orthopaedic DVT rate 3.1% Knee arthroplasty DVT rate 10.1% | Identified variations in DVT prophylaxis practice, surgeon-specific review, standardised care | Reduction of overall orthopaedic DVT rate from 3.1% to 1.1% Reduction of knee arthroplasty DVT rate from 10.1% to 1.6% (2008–2010) |
Hospitals A–E are representative examples taken from the ACS NSQIP data portal website, accessed 13 December 2011. Reprinted by permission of American College of Surgeons NSQIP.
ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Project; BMI, body mass index; DVT, deep venous thrombosis; SCIP, Surgical Care Improvement Project; SSI, surgical site infection; TBD, to be determined; UTI, urinary tract infection; VTE, venous thromboembolism.