New risk calculators from the American College of Surgeons aim to help evaluate individual patients risks of complications and death from surgical procedures, as I write in my column today.
But access to the calculators, which will cover 20 different types of surgery eventually, is limited to about 250 hospitals in the American College of Surgeons National Surgical Quality Improvement Program, known as NSQUIP. Adapted from a program used to monitor and improve surgical quality in Veterans Health Administration hospitals, the program was launched in the non-VA hospitals in 2005, and has had marked success in reducing mortality rates and complication rates, according to a September 2009 study in the Annals of Surgery.
So why arent more hospitals using it?
Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons, tells the Health Blog that NSQUIP was initially designed for large community hospitals and academic medical centers — and its $35,000 annual fee to participate is a barrier for some institutions. The college is working on a pilot to offer lower-cost participation to smaller and rural hospitals which perform fewer types of surgeries and dont need to collect as much data, but still want to participate and evaluate their own quality.
The American College of Surgeons is also partnering with the Florida Hospital Association to launch a modified version of NSQIP to focus on just four quality measures: surgical site infection, urinary tract infection, colorectal outcomes and elderly surgery outcomes.
NSQUIP gathers data on 140 different factors ranging from pre-operative risks to 30-day surgical outcomes, and uses 40 different quality measures. Dr. Ko says that unlike some quality improvement programs that use data from billing claims, NSQUIP measures outcomes, and thus can provide a more reliable picture of success rates, complications and mortality .
One draw is that hospitals can use data from the quality improvement program to compare their performance against a national benchmark, and tell patients, for example, whether their complication rates are lower than the national average. Henry Pitt, a surgeon who is chief quality officer of Indiana University Hospital in Indianapolis, says participation in NSQUIP helped his hospital identify and tackle a problem with infections in surgeries to remove all or part of the pancreas and other digestive organs for patients with pancreatic cancer and tumors.
By focusing on preventive measures such as the use of antibiotics and monitoring patient wounds, the hospital has reduced infection rates steadily, Dr. Pitt says. He uses the risk calculator to help patients understand the potential complications of long and arduous pancreatic surgical procedures, which carry special risks for surgical site infectionsbut he is also able to reassure them that his hospital infection rates are now below national averages for the procedures.
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