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Carlos S. Morales, MD; Foula Kontonicolas MD;

Performance Improvement: Getting an Early Start. Carlos S. Morales, MD; Foula Kontonicolas MD; Anita Volpe DNP; Pierre F. Saldinger MD, FACS Royd Fukumoto, MD, FACS Department of Surgery and Department of Performance Improvement

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Carlos S. Morales, MD; Foula Kontonicolas MD;

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  1. Performance Improvement: Getting an Early Start Carlos S. Morales, MD; Foula Kontonicolas MD; Anita Volpe DNP; Pierre F. Saldinger MD, FACS Royd Fukumoto, MD, FACS Department of Surgery and Department of Performance Improvement Danbury Hospital, Danbury CT

  2. INTRODUCTION • NSQIP - a measurement of surgical outcomes Why NSQIP for PI? - Standard methodology for abstraction and collection of data - Allows for equitable comparison of variables - Enables honest evaluation of system process • SCIP - process measure • Timing of VTE or antibiotic prophylaxis

  3. METHODS • Identify target • Deep dive • Identify involved services • Create taskforce • Create action plan • Implementation • Monitor and validate • Resident Champion (RC) was started in July 2010, as a way to introduce residents to NSQIP/SCIP NSQIP

  4. METHODS • The RC presents timely feedback on NSQIP and SCIP performance to other residents at our weekly residency program meeting • The RC participates in multidisciplinary committees

  5. Residents as active participants of PI • ACGME • Systems Based practice • Practice Based Learning and Improvement • Medical Knowledge • Patient Care • Professionalism • Interpersonal and communications skills

  6. RESULTS • Surgical Progress Note • Accelerated computer tomography of the abdomen and pelvis (ACTAP) • Modified risk assessment tool (MRAT) for VTE prevention

  7. Surgical Progress Note • Incorporates 5 of the 10 core SCIP measures that are pertinent to general surgery - Appropriate antibiotic prophylaxis - Prophylactic antibiotics discontinued within 24 hours of surgery - Urinary catheter removed on postoperative day 2 - Appropriate perioperative temperature management - Appropriate VTE prophylaxis Increased SCIP compliance to 100% in those 5 measures over last quarter

  8. ACTAP • 2009 risk model for age 65 or greater identified increased mortality in general surgery

  9. MRAT • In 2010, we were failing VTE SCIP measures, our O/E 1.14 • 48 patients with VTE were identified - 48% had inadequate prophylaxis based on current guidelines • MRAT

  10. MRAT • Validation of the tool • MRAT and the Caprini model was applied to 1000 patients 1.1% had a VTE score that differed from Caprini’s 0.1% would have required a change in prophylaxis • O/E- 0.95

  11. Conclusions

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