Table 1, Chapter 14Example of interventions and associated impact on outcomes in American College of Surgeons national surgical quality improvement program for hospitals/collaboratives

Hershey Medical Center, Penn State 2619.3% SSI in diabetics; 8% in non-diabetics
VTE 3.4% (2008)
Glucose control protocol
VTE risk assessment and order set
Reduction of SSI O/E 1.31 to 0.78
Reduction of VTE rate 3.4% to 0.2% (2008-2009)
University of Virginia2717.6% SSI (national average 8.1%) colorectal resections. High BMI was a risk factor.Protocol for wound wicking for BMI >25 kg/m2, SCIP measures, glycemic controlReduction of SSI from 17.6% to 11.2% (36% reduction)
Massachusetts General Hospital27Vascular 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 select patients, identify procedures not requiring a catheter, educational campaign for cliniciansReduction of UTI 7.0% to 1.8%.
Morbidity O/E ratio went from 1.19 [99% CI 0.93 to 1.48] to 0.93[(99% CI 0.67 to 1.48]
(76% reduction)
Hospital AIdentified a rise in organ space infectionsStandardized orders, proper antibiotic use, morbidity conference presentations, skin preparation changesOrgan space infection increase attributed to increased leak rates and identified surgical technique issues and saw improvements, but rate still high.
Hospital BVTE 17.6%Risk stratification, best practices, standardized ordersVTE decreased from 17.6 to 2.3%; O/E 1.88 to 1.05
Hospital CUnplanned reintubation 3% (O/E=1.56)
Ventilator >48 hrs 3.84% (O/E=1.71)
Tracking tool, risk assessment, improved pulmonary toilet interventionTBD
Hospital DVentilator >48 hrs 2.24% (O/E=1.7)Tracking tool, standardized orders, patient teachingVentilator >48 hrs 2.24% to 1.19%
(O/E=1.7 to 0.83)
Hospital EOverall orthopedic DVT 3.1%
Knee Arthroplasty DVT rate 10.1%
Identified variations in DVT prophylaxis practice, surgeon specific review, standardized careReduction of overall orthopedic DVT rate 3.1% to 1.1%
Reduction of knee arthroplasty DVT rate 10.1% to 1.6%

Notes: DVT, deep venous thrombosis; VTE, venous thromboembolism; Hospital A-E are representative examples taken from ACS NSQIP Data Portal Web site, accessed December, 13, 2011. Reprinted by permission from the American College of Surgeons NSQIP.

From: Chapter 14, Use of Report Cards and Outcome Measurements To Improve Safety of Surgical Care: American College of Surgeons National Quality Improvement Program (NEW)

Cover of Making Health Care Safer II
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 211.

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