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CMAJ Open. 2018 Aug 28;6(3):E353-E359. doi: 10.9778/cmajo.20170166. Print 2018 Jul-Sep.

Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study.

Author information

1
Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont. timothy.jackson@uhn.ca.
2
Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.

Abstract

BACKGROUND:

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals.

METHODS:

All Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools. Outcome measures included the level of quality-improvement capacity, collaborative-wide aggregate data on postoperative complications, and self-reported rates of surgical site and urinary tract infections.

RESULTS:

Eighteen hospitals that enrolled in the ON-SQIN in 2015 reported an increase in their capacity for quality improvement after 18 months. Analysis of the collaborative-wide aggregate data in a 6-month period (14 748 surgical cases) revealed a substantial reduction of acute renal failure (relative risk 0.48, 95% confidence interval 0.25-0.95) and urinary tract infection (relative risk 0.77, 95% confidence interval 0.61-0.97). Most hospitals that targeted prevention of surgical site infection and urinary tract infection reported reduction of these occurrences during a 1-year period.

INTERPRETATION:

The ON-SQIN supported the uptake of the NSQIP in Ontario hospitals and promoted targeted surgical quality-improvement initiatives, resulting in increased quality-improvement capacity and development of the community of practice. Furthermore, our early experience suggests that improvements in surgical care are being realized.

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