Objective

This expository study features a NSQIP surgical quality improvement project involving the implementation of multiple best practices over a five-year period, including computerized decision support (EndoTool) for post-operative blood glucose management.

Setting

763-bed acute care teaching and research hospital.

Results

• Surgical site infections decreased 42.5% over a five-year period, from an O/E ratio of 1.6 to 0.92.
• 30-day mortality decreased 51.4% over a five-year period, from an O/E ratio of 1.7 to .83, and from 3.7% to 1.8% of surgeries.
• Incidence of hyperglycemia >150 mg/dL decreased 48.4% with EndoTool, from 31% to 16% of patients.

Conclusions

Participation in NSQIP or some other collaborative network of hospitals is strongly encouraged, as the business case for adoption of surgical process improvements is supported by lower incidence of surgical site infections, 30-day mortality and hyperglycemia.