slc bc working group presentationweb2.facs.org/download/olm and smith.pdf · microsoft powerpoint -...
TRANSCRIPT
BC NSQIP Working Group
BC Hospitals Participating in NSQIP
Start‐Up Fall 2011
Using the ACS NSQIP program, the BC NSQIP Working Group aims to providing reliable, consistent and robust data by standardizing
surgical data collection and analysis for improving the quality of surgical care in BC.
Challenges• Geographical restrictions
• Face to face meetings very difficult to arrange
• Independent Health Authorities
• Program Options ‐Pediatric specific challenges
Pediatric Program Challenges• Variable & coding differences• Only pediatric site in Canada• Isolation
Overcoming the Challenges• Hold regular monthly teleconference meetings• Take advantage of conferences for inpersonmeetings
• Group can accomplish more than individuals• Focus on similarities not differences• Each member acts as rep for their health authority and their SCRs
Publicity • Email
• Posters
• Invitations to speak
• Word of mouth
•Information bulletins
Letter to BC PhysiciansRE: National Surgical Quality Improvement Program –30 day Follow Up Information
Dear Family Physician,
We are writing to advise you that BC has embarked on an exciting new surgical initiative and to request your participation in it. Twenty‐two hospitals (listed on next page) are involved in the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP). One of the hallmarks of this program is to determine the 30 day post‐operative outcomes.
NSQIP is an internationally recognized program designed to identify the surgical programs’ strengthsand weaknesses and gaps in surgical practices. Data generated from the risk‐adjusted and online reports will be used for the development of goals and quality improvement activities in BC’s surgical programs.
NSQIP collects data on preoperative risk factors, intraoperative variables, and 30‐day post‐operativemortality and morbidity outcomes for patients undergoing surgical procedures.To provide accurate and actionable data, your participation is critical to the success of this program and our ability to strive for excellence in the care we provide to patients in this province. Members of the NSQIP team may be contacting you or your office staff to retrieve information on the surgical patients.
We would greatly appreciate your assistance in this important initiative. If you want to learn moreabout who is involved or if you have any questions, please go to www.bcpsqc.ca
Sincerely,Dr. Peter Doris M.D., MSc, FRCSC, FACSD. Douglas Cochrane M.D., FRCSC, FAAPSurgical Lead Provincial Patient Safety & Quality Officer andSurgical Quality Action Network – NSQIP Chair, B.C. Patient Safety &Quality Council
Robust Data = Meaningful Reports
In God we trust all others must bring data‐W. Edwards Deming
Pathways for Consistency
• Case selection algorithm
• 30 day follow up algorithm
• Vacation cycle algorithm
Challenges of CPT Coding
• Created grouping lists for commonly used codes
•Created updates on changes to included /excluded CPT codes to all SCRs within province.
CPT Coding Challenges cont…
Hemicolectomy Partial Colectomy
Endarterectomy Thrombectomy
One Voice
SCR
BCWG member
BCWG Agenda
ACS NSQIP
Response to BCWG
Variables Definition Change Table
Variable My Original Interpretation
Start Date of original
Definition Change
Date of New Def./cycle start
Supportive Documentation
Type of Anesthesia
Open Wound
Case Studies
Image of google docs
ChecklistCase Selection √Vacation Cycles √Frequently used CPT coding tools √Chapter 4 Variables √Follow up √Documentation Table √Ongoing Education √
TRUSTED CONSISTENT DATA
Interagency Affiliations• Never pass up on opportunities
• Invitations to speak
• Membership on committees‐ SQAN
• Maintain independence
• Allegiance to NSQIP for data quality
Budget
• We have no budget $$$
• Outside financial support is helpful SQAN
• (Webex, workshop costs)
Future Plans• Workshop planning for SCR/SCs
• Education
• CPT discussion board
• Sharepoint website w/ SQAN
• Case studies
• Relationships with other working groups
“Quality is top of mind for hospitals today, but the work is far from done. Participating in [NSQIP] will give hospitals and surgeons an effective tool to improve patient outcomes. This translates not just to improved health and saved lives, but also reduced costs. Everyone wins – and no one more than the patient.”
‐ Don Berwick MDOutgoing Administrator of Centers for Medicare and Medicaid Services. Former President and CEO of IHI.
Questions
BC Working Group MembersCheryl Olm: [email protected] Smith: [email protected] Drake: [email protected] Chan: [email protected] Gottenbos: [email protected] Cardwell: [email protected] Sibbelee : [email protected] Jennison‐Gustafson: Kelli.Jennison‐[email protected] Cameron‐Lane: Mary.Cameron‐[email protected] MacLeod: [email protected]
Vacation Cycle Algorithm• Not enough cases in a certain specialty for a single cycle?
• “Max cases” • (See Appendix 1) • Abstract cases from another specialty • Use standard ACS NSQP • systematic sampling • (See Appendix 2)
• Abstract cases from only ONE specialty to reach required cases per cycle or to “Max Cases” • (See Appendix 1) • Abstract cases from another specialty (x) based on highest max cases • per specialty/cycle. • (e.g. Table s 1 & 2) • Start review of cases • Start review of cases • Start review of cases
• Abstract cases from another specialty (y) based on next highest max cases per specialty/cycle. • (e.g. Tables 1 & 2) • Enough cases in specialty (x)? • Enough cases in specialty (y)? • Continue to abstract cases from other specialties based on max cases per specialty/cycle • (e.g. Tables 1 & 2) until “Max Cases” • (See Appendix 1) • CHOOSE ONE OPTION ONLY • Site Decision (SCR & Surgeon Champion)
Appendix for Vac. Cycle
Appendix 1• Max out a cycle by choosing
“Max Cases” in the “Manage Cycles” section of the “My Account” tab of the Workstation.
Appendix 2• ACS NSQIP standard
systematic sampling process is found in Chapter 2 of the ACS NSQIP Operations Manual; particularly sections:
• 2.2.1 Systematic Sampling Process on Pages 2‐1 & 2‐2
• 2.2.2 Determining Case Inclusion on Pages 2‐2 to 2‐6
• 2.2.3 Selecting the required number of cases per cycle on Page 2‐6
Table 1 – Sampling based on maximum number of cases per cycle – EXAMPLE ONLY
Cases to Aim For Initial Achievement Step 1 Step 2 ‐ Continue as necessary Step 3 ‐ Continue as necessary
ENT 5 3 3
General 22 22 22 + 2
Plastics 4 4 4
Urology 9 9 9
Total 40 40 40
Picked up 2 extra cases from highest max number of cases
Table 2 – Sampling based on maximum number of cases per cycle – EXAMPLE ONLY
Cases to Aim For Initial Achievement Step 1 Step 2 ‐ Continue as necessary Step 3 ‐ Continue as necessary
ENT 5 5 55 +1 (next highest to choose from)
General 22 20 20 20
Plastics 4 4 4 4
Urology 9 9 9 + 1 (no more cases available)
10
Total 40 38 40 40
Picked up 1 extra case from highest max number of cases and 1 from next highest
Google Docs• 21 responses• Summary See complete responses • Question 1: Patient takes Varapamil, but hypertension is not documented
anywhere except on the form requesting a pre‐op beta blocker. There is no HTN noted in the history and physical or the Anesthesia Worksheet. The patient has a history of Supraventricular Tachycardia (SVT; that was treated with ablation), and is taking Verapamil for this condition.
• Question 1 Answer Yes 00% No 100% • No Varapamil is a calcium channel blocker. It has been used in the treatment of
hypertension, angina pectoris, or cardiac arrhythmia. With no documented history for HTN, do not count this as "hypertension requiring medication."
• Question 1 Comments• I found this helpful.I like the format. And I also appreciate that there is a place to
comment afterwards. This will help facilitate the discussion. NIcely done!Thanks! Awesome! Thanks for creating the Case Study Questions for the BC SCRs. Especially for the newbies like me. I love these questions. Keep them coming! Thank you, Looks great to me.I like this format. I got the answer correct. Great job. I look forward to learning/reviewing more case studies.