ACS NSQIPConference 

2012

Salt Lake City

ACS NSQIP Conference 2011 in Boston

New York Times article about the 2011 NSQIP Conference

NSQIP is one of the mostfar-reaching efforts…and is transforming surgery.

ACS NSQIP Conference 2011 in Boston

ACS NSQIP7thAnnual Conference

Largest NSQIP Conference Yet

This year’s conference…

• Quality improvement topics (in depth)–Several preconference courses

• Clinical topics (more topics/sub‐specialties)• New findings (investigative work)• Targeting multiple levels of experience• More time to network

Utah Olympic Park (Monday night)

Numerous Ancillary Meetings• Collaboratives• Pilots• Specialty Groups• Hospital Systems• Etc…

Keynote Speakers

• Carolyn Clancy

• Don Berwick

• Mark Chassin

• Lucien Leape

• Peter Pronovost

• Atul Gawande

Brent James, MD, MStat• Institute of Medicine • University of Utah School of Medicine • Harvard School of Public Health • Univ of Sydney School of Public Health

• Chief Quality Officer, and Executive Director, Institute for Health Care Delivery Research at Intermountain Healthcare

“First, Do No Harm: Profession Values Drive Business Success”

Wisdom of Crowds

i‐clickers

Practice QuestionShould NSQIP try to bring back caterpillar plots?

A.Yes, definitelyB.Yes, but not for every modelC.Definitely notD.Don’t feel strongly either wayE.Go back to drawing board and think of something totally new and unique

:‐)   and   :‐(

•CEUs/CMEs•Speaker Presentations

or   :‐O

Update: NSQIP Numbers

NSQIP Participation

0

100

200

300

400

500

600

2004 2005 2006 2007 2008 2009 2010 2011 2012

500+ hospitals in NSQIP

ProcedurePercent of U.S. cases

performed in NSQIP hospitals

Pancreas resection 53%

Liver resection 53%

Gastrectomy 34%

Small Bowel Rx 26 %

Colectomy 24%

Proctectomy 30%

Appendectomy 22%

Cholecystectomy 20%

Ventral Hernia 25%

Even though NSQIP is in approximately ~10% of hospitals in the US…

ProcedurePercent of U.S. cases

performed in NSQIP hospitalsAAA 37%

EndoAAA 34%LEB 33%

Breast Recon/ 40%Abdominoplasty 37%Thyroidectomy 30%

Lung Rx 37%Esophagectomy 57%Hysterectomy 29%

Prostatectomy/Nephrectomy 36%/37%Hip Replacement/Laminectomy 25%/28%

NSQIP may be the best single source for evaluating surgical care across specialties

Update: NSQIP Modules

CLASSIC

ESSENTIALS

SMALL/RURAL

TARGETED

MEASURES

Procedure Targeted: Hospitals Participating by Procedure

Pancreatectomy 84Colectomy 126Proctectomy 85VHR 89Bariatric 64Hepatectomy 68Thyroidectom 66Esophagectomy 59Appendectomy 62CEA 83CAS 38AAA 80AAA EVAR 80Aortoiliac (open)   57Aortoiliac (endo)  41LE Bypass (open) 80LE Bypass(endo) 48

Hysterectomy 69Reconstruction 31Spine 69Brain Tumor Rx 44TURP 39Bladder Susp 43Prostatectomy 68Nephrectomy 62Cystectomy 46TKA 75THA 73Hip Fx 57Breast Flap 39Breast Reduc 39Breast Recon 47Abdplasty 35Lung Rx 47

Pediatric NSQIP

•Almost 50 hospitals•SAR release

Regional Collaboratives

*

* *

*

**

* **

*

*****

*

**

Regional Collaboratives• CanadianNational Surgical Quality Improvement Collaborative (CAN‐NSQIP)• ConnecticutSurgical Quality Coalition (CTSQC)• FloridaSurgical Care Initiative (FSCI)• Illinois Surgical Quality Improvement Collaborative (ISQIC)• MaineHealth Collaborative• Northern CaliforniaSurgical Quality Collaborative (NCSQC)• NebraskaCollaborative• Oregon NSQIP Consortia• PennsylvaniaNSQIP Consortia• Tennessee Surgical Quality Collaborative (TSQC)• Upstate New YorkSurgical Quality Initiative• VirginiaCollaborative• IndianaCollaborative (Pending)• GeorgiaCollaborative (Pending)• MarylandCollaborative (Pending)• TexasCollaborative (Pending)• WisconsinCollaborative (Pending)

Complication % ImprRenal Failure 25%Cardiac 7%Vent time 15%Super SSI 19%Deep SSI 18%Nerve inj 28%Sepsis 10%

A countdown of what’s new in NSQIP

• Elevate the awareness within the surgical community about achieving quality ‐ and its necessity.

David Hoyt, MD, FACSExecutive Director ACS

10. Advancing Our Message: Raise Community Consciousness

9. Clinical Support FAQs

8. AHRQ SUSP Project(Surgical Unit-based Safety Program)

8. National SUSP CRS SSI• Sign up sheet at registration desk• Contact: Lisa Lubomski, PhD• Phone: 410.614.4037 | Fax: 410.502.3235• lluboms1@jhmi.edu

Lisa Lubomski, MDSean Berenholtz, MD

Who can join SUSP?• Participation in the program is available to any hospital

in any state, as well as hospitals in the District of Columbia and Puerto Rico.

• Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group.

Armstrong Institute for Patient Safety and Quality 30

8b. NSQIP CUSP Working Group• For those who cannot join AHRQ/SUSP • We are assembling a smaller group within NSQIP who want to learn and perform CUSP

• Sunday Breakfast session (Project Scope)– 7am Riviera Room (3rd Floor)

• Monday Breakfast session (Next Steps)– 7am Riviera Room (3rd Floor)

7. Preoperative Risk CalculatorCPT 44140 Description Colectomy, partial; with anastomosis Age 65Sex 0 (0 = Male, 1 = Female) Smoker 0 (0 = No, 1 = Yes) BMI 25 Functional Status 0 (0 = Independent, 1 = Partially Dependent, 2 = Totally Dependent) DYSPNEA 0 (0 = No, 1 = With Moderate Exertion, 2 = At Rest) COPD 0 (0 = No, 1 = Yes) Ascites 0 (0 = No, 1 = Yes) CHF 0 (0 = No, 1 = Yes) History of MI 0 (0 = No, 1 = Yes) Previous Cardiac Intervention 0 (0 = No, 1 = Yes) PVD 0 (0 = No, 1 = Yes) Dialysis 0 (0 = No, 1 = Yes) Stroke or TIA 0 (0 = No, 1 = Yes) Disseminated Cancer 0 (0 = No, 1 = Yes) Steroid 0 (0 = No, 1 = Yes) Weight Loss 0 (0 = No, 1 = Yes) Bleeding Disorder 0 (0 = No, 1 = Yes) Creatinine 0 (0 = unknown) Albumin 0 (0 = unknown) 

1%

9%

20%

1%

7%

16%

4%

16%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mortality Serious Morbidity Overall Morbidity

Colectomy, partial; with anastomosis

Blue: Low Risk Patient

Green: High RiskRed: Your Patient

Preoperative Risk CalculatorCPT 44140 Description Colectomy, partial; with anastomosis Age 80 Sex 0 (0 = Male, 1 = Female) Smoker 1 (0 = No, 1 = Yes) BMI 30 Functional Status 2 (0 = Independent, 1 = Partially Dependent, 2 = Totally Dependent) DYSPNEA 2 (0 = No, 1 = With Moderate Exertion, 2 = At Rest) COPD 0 (0 = No, 1 = Yes) Ascites 1 (0 = No, 1 = Yes) CHF 0 (0 = No, 1 = Yes) History of MI 0 (0 = No, 1 = Yes) Previous Cardiac Intervention 0 (0 = No, 1 = Yes) PVD 0 (0 = No, 1 = Yes) Dialysis 0 (0 = No, 1 = Yes) Stroke or TIA 1 (0 = No, 1 = Yes) Disseminated Cancer 0 (0 = No, 1 = Yes) Steroid 0 (0 = No, 1 = Yes) Weight Loss 0 (0 = No, 1 = Yes) Bleeding Disorder 0 (0 = No, 1 = Yes) Creatinine 0 (0 = unknown) Albumin 1 (0 = unknown) 

1%

9%

20%

47%

52%

69%

4%

16%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mortality Serious Morbidity Overall Morbidity

Colectomy, partial; with anastomosis

1%

9%

20%

1%

7%

16%

4%

16%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mortality Serious Morbidity Overall Morbidity

Colectomy, partial; with anastomosis

6. Toolkits

•Surgeon Champion•Administrator•SCR (in development)

Teamwork and communications between the SCR and SC

Engaging surgeons

Using online reports

Engaging administrators

Implementing NSQIP

Using the semiannual report

ROI: Case Study

5. Two New “Virtual”Collaboratives In Development

1. Quality in Training–Meeting: Sunday 7:00am Belvedere (3rd Floor)

2. Electronic Health Record Automation

New “virtual” collaborative: Electronic Health Record/Automation

• Session: Breakout 6 (Sunday) 130pm• Ancillary Meeting: Monday morning AND Monday lunch – discussion of the pilot. – 7:00 am:  Fountainbleau 3rd Floor– 12:15 pm:  Fountainbleau 3rd Floor

• If you/your hospital is interested in participating in a pilot that will aim to automate data into NSQIP, please attend these sessions.

4. Newest Guideline: Surgery in the Elderly – Preoperative Assessment

3. CMS believes registries are a good thing…

2. Public Reporting on Hospital Compare

2. Public Reporting on Hospital Compare

1. Real-time, risk-adjusted outcome reports

New Things in ACS NSQIP

10. Raising the community consciousness9. Clinical Support FAQs8. SUSP/NSQIP CUSP 7. All procedure risk calculators6. Toolkits5. Virtual Collaboratives (Training, EHRs)4. Elderly Surgery Guidelines3. CMS Rule on Clinical General Surg Registry2. NSQIP on Hospital Compare1. Real‐time, risk‐adjusted reports

NSQIP Staff

Thank you

• Expansion Working Committee (Mike Henderson)• SCR Advisory Committee (Karen Richards)• Methods and Evaluation Committee (Bruce Hall)• Pediatric Committees (Peter Dillon/Keith Oldham)• Surgeon Champion Group (John Morton)• Best Practices (Nestor Esnaola)

Thank you

• Conference Speakers/Moderators

• Hospitals that have lead the way with vision• SCRs, Surgeon Champions, QI personnel…the entire team

New York Times article about the 2011 NSQIP Conference

“There isn’t anyone who isn’t a part of the QI process”

Thank you