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Beating NSQIP’s Lock date

Beating NSQIP’s Lock date. April 2012. Cases by Cycle. INTRODUCTION. Presentation:. Our Struggle and Triumphs with ACS NSQIP -Kelli Jennison-Gustafson RN SCR. Our Struggles and Triumphs with ACS-NSQIP. Nanaimo Regional General Hospital Kelli Jennison-Gustafson RN SCR. NRGH.

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Beating NSQIP’s Lock date

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  1. Beating NSQIP’s Lock date April 2012

  2. Cases by Cycle INTRODUCTION

  3. Presentation: Our Struggle and Triumphs with ACS NSQIP -Kelli Jennison-Gustafson RN SCR

  4. Our Struggles and Triumphs with ACS-NSQIP Nanaimo Regional General Hospital Kelli Jennison-Gustafson RN SCR

  5. NRGH • Acute Care Facility and Trauma Center 234 acute care beds 22 long tem care beds. • Population: over 300,000 residents • Busiest ER in Vancouver Island • We employ over 1,700 individuals locally

  6. NSQIP at NRGH • Classic Multispecialty • 2 FT SCRs

  7. In the beginning… • July 2011 1st day on the job - Boston conference • August 2011 Office set-up 2 weeks of full time online training and learning • Sept 2011 Ramp-up

  8. Unfamiliar territory • CPT and ICD Codes • Data cleaning

  9. Recipe For Disaster • 1 cycle = 1 month • OR log procedure ≠ OR report procedure - days to pick cases • Paper-based and electronic charts • Waiting Game: Data entry to workstation until all information is complete • Continue with the above process knowing that the system won’t work!

  10. Angela to the rescue • First site visit on December 5. • Tips and tricks : - at a “glance” when selecting cases - use oversampling for excluded cases • CPT coding techniques • Data cleaning template

  11. Rescue continues! • Open the EMR/paper chart, start the case in the workstation. • No more paper reviews: saves time and reduces data input errors • “Tips and tricks” for post op occurrences: - check labs, diagnostics, surgeons notes and discharge summaries • Vacation cycles-spaced, watch lock out dates

  12. More changes • New OR form- “Report of Operations” -accurate OR procedure by surgeon • Cheat sheet of CPT and ICD-9 codes commonly used at our hospital • New “pre-op admission form” being created; NSQIP friendly history questions

  13. How are we doing now? • Up to date with our cycles • 89% 30 day follow up on all cases • Data cleaning – watch lock out dates • Looking at our “raw data” • Created a custom field, preoperative antibiotics vs. incision time

  14. Then and Now

  15. Our Current Cycle Tree

  16. What if we fall behind again? • Raw reports will not be “real time” • Difficult to tell if new QI initiatives are working or need tweaking • No time for follow up and data cleaning • Missed cases • Stressed SCR’s again

  17. You can do it too! Thank you

  18. Advantages of being at least 60 days behind lock date: *Holidays/sick time – you can use vacation cycles anytime! *Report back to teams- real-time reports *Time to find missing data *Verify/Confirm data with SC and anesthesia *Clean and discuss interesting cases *Act on unusual trends timely

  19. Taking advantage of your vacation cycles: Using vacation cycles need a little bit of planning When do you plan to use it? - SCR holidays - catch up with lock date - Short/Difficult cycles

  20. Taking advantage of your vacation cycles: SCR Holidays: You can use vacation cycles anytime if you are working on cases that are at least 60 days to lock date - Can somebody take over your cases? - What is your status? how far behind are you? - Can you use your vacation cycle without compromising your 30-day follow-up ? - Is there a potential that you will abandon charts while you are away?

  21. Taking advantage of your vacation cycles: SCR Holidays: When you come back, you want to make sure that you have enough time to work on your cases that are close to lock date - review, ff-up and clean

  22. Taking advantage of your vacation cycles: Catch up with lock date: - What is your status? how far behind are you? - What format do you use to report back to teams? Run charts, SPC charts, bar charts Interval? Monthly, Quarterly - What is the impact of using vacation cycle in your data?

  23. Taking advantage of your vacation cycles: Short/Difficult Cycles – not enough cases (cycle 46, easter weekend) 46 cycles – 4 vacation cycles = 40 cycles 42 cycles x 40 cases = 1680 cases/year If: 40 cycles x 40 = 1600 and: 2 cycles x 15 = 30 (cycle 46 and easter) so: 1600 + 30 = 1630 (short 50 cases) – Cycle includes difficult cases Goal: Find areas for improvement We want these cases!!!

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