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The Monitoring and Improvement of Surgical-Outcome Quality
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.
Authors
William Woodall; Sandy Fogel; Stefan Steiner.
Source
Published in Journal of Quality Technology, Volume 47, Issue 4, p383-399.
Year
2015
Tags
- Cost Savings
- Healthcare-Associated Infections
- Hospital-Acquired Conditions
- Hyperglycemia Reduction
- Hypoglycemia Reduction
- Length of Stay
- Surgical Site Infections
- Glucose Variability
- Mean Glucose Improvement
- Target Goal Attainment
- Time in Range
- Time on IV Insulin
- Time to Target
- Burn Injury
- Cardiac Surgery
- DKA/HHS Management
- Emergency Department
- Induced Hypothermia
- Intra-op Glucose Management
- Obstetrics/Labor & Delivery
- Pediatrics
- Residual Insulin Adjustment
- BG Check Compliance
- BG Test Reduction
- Nursing Satisfaction
- Protocol Adherence
- Provider Satisfaction
- Workflow Improvements