“The National Surgery Quality Improvement Project” (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit

Patient Safety in Surgery

Maria Castaldi²  John McNelis¹ 

[1] North Bronx Health Network, Jacobi Medical Center, Bronx, NY, USA;Department of Surgery, North Central Bronx Hospital, Rm 513, 1400 Pelham Parkway South, 10461 Bronx, NY, USA

关键词: Performance improvement;    Quality;    Pneumonia;    NSQIP;    SICU;   

Others  :  790250
DOI  :  10.1186/1754-9493-8-19

 received in 2013-12-08, accepted in 2014-04-15,  发布年份 2014

【 摘 要 】

Background

The “National Surgical Quality Improvement Program” (NSQIP) is a nationally validated, risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonia (PNEU) and prolonged ventilator days ≥48 hours (V48) was observed on the surgical service.

Methods

The hospital studied is a 500 bed university-affiliated teaching hospital performing approximately 20,000 surgical operations per year. A multidisciplinary team was formed and a series of interventions were implemented to address high pneumonia rates and prolonged intubation. Specific interventions included enforcement of protocols and adherence to the Institute for Healthcare Improvement (IHI) ventilator bundles, including head of bed elevation, sedation holidays, extubate when ready, and early nutrition. NSQIP collected pre-operative through 30-day postoperative data prospectively on 1,081 surgical patients in the intensive care unit from January 1, 2010 – July 31, 2012. The variables pneumonia and V48 undergo logistic regression and risk adjusted results of observed versus expected are calculated. Mean and confidence intervals are represented in caterpillar charts and bar graphs. Statistical analysis was via Fisher exact t-test.

Results

Progressive improvements were observed over a two-year period via three semiannual reports (SAR). Corrective measures showed a decrease in V48 with an observed to expected odds ratio (O: E) improving from 1.5 to 1.04, or 1.9% ( 7/368 patients) July 31, 2011 to 1.11% (12/1080 patients) July 31, 2012 respectively. Similarly, pneumonia rates decreased 1.36% (5/368 patients) July 31, 2011 to 1.2% ( 13/1081 patients) July 31, 2012 with O: E = 1.4 and 1.25 respectively. Statistical significance was achieved (p < .05).

Conclusion

Given an estimated annual volume of 20,000 cases per year with a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation greater than 48 hours; a projected 32 avoided episodes of pneumonia and 160 avoided episodes of V48 could be realized with potential savings exceeding $5,000,000.

【 授权许可】

   
2014 McNelis and Castaldi; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Jones RS, Brown C, Opelka F: Surgeon compensation: “pay for performance”, the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations. Surgery 2005, 138:829-836.
• [2]Griffin FA: Reducing surgical complications: five million lives campaign. JCAHO J Qual Patient Safety 2007, 33:660-665.
• [3]Fuchshuber PR, Greif W, Tidwell C: The power of the National Surgical Quality Improvement Program—achieving a zero pneumonia rate in general surgery patients. Perm J 2012, 16:39-45.
• [4]Dimick JB, Osborne NH, Hall BL: Risk-adjustment for comparing hospital quality with surgery: how many variables are needed? J Am Coll Surg 2010, 210(4):503-508.
• [5]American College of Surgeons: ACS NSQIP Classic- Definitions and Variables. 2010, 4–1-4–33.
• [6]Cook DJ, Walter S, Cook RJ: The incidence and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1999, 129(6):433-440.
• [7]Rello J, Ollendorf DA, Oster G, VAP Outcomes Scientific Advisory Group: Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002, 122(6):2115-2121.
• [8]Acevedo F, DeMuro J, Hanna A, McNelis J: Evaluation of twenty-four hour compliance of head of bed elevation. Crit Care Med 2011, 12:A797.
• [9]Meselli DJ, Restrepo MI: Strategies in the prevention of ventilator-associated pneumonia. Ther Adv Resp Dis 2011, 5(2):131-141.
• [10]Rowell KS, Turrentine FE, Hutter MM: Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg 2007, 204(6):1293-1300.
• [11]The Business Case for NSQIP http://site.acsnsqip.org/about/business-case/ webcite
• [12]Berenguer CM, Ochsner MG, Lord SA, Senkowski CK: Improving Surgical Site Infections: Using National Surgical Quality Improvement Program Data toInstitute Surgical Care Improvement ProjectProtocols in Improving Surgical Outcomes. J Am Coll Surg 2010, 210(5):737-740.