BEATING NSQIP’S LOCK DATE

APRIL 2012

INTRODUCTIONCases by Cycle

Total Incomplete Follow-Up < 30 days

43: 12/03-12/10/11 40 0 0

44: 12/11-12/18/11 40 0 0

45: 12/19-12/26/11 40 0 0

46: 12/27-12/31/11 0 0 0

01: 01/01-01/08/12 0 0 0

02: 01/09-01/16/12 0 0 0

03: 01/17-01/24/12 0 0 0

04: 01/25-02/01/12 0 0 0

05: 02/02-02/09/12 0 0 0

06: 02/10-02/17/12 0 0 0

07: 02/18-02/25/12 0 0 0

08: 02/26-03/04/12 0 0 0

09: 03/05-03/12/12 0 0 0

10: 03/13-03/20/12 0 0 0

11: 03/21-03/28/12 0 0 0

12: 03/13-03/05/12 0 0 0

Presentation:

Our Struggle and Triumphs with ACS NSQIP -Kelli Jennison-Gustafson RN SCR

Nanaimo Regional General Hospital Kelli Jennison-Gustafson RN SCR

Our Struggles and Triumphs with ACS-NSQIP

NRGH

Acute Care Facility and Trauma Center 234 acute care beds 22 long tem care beds.Population: over 300,000 residentsBusiest ER in Vancouver IslandWe employ over 1,700 individuals locally

NSQIP at NRGH

Classic Multispecialty2 FT SCRs

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 learningSept 2011

Ramp-up

Unfamiliar territoryCPT and ICD CodesData cleaning

Recipe For Disaster1 cycle = 1 monthOR log procedure ≠ OR report procedure

- days to pick casesPaper-based and electronic chartsWaiting Game: Data entry to

workstation until all information is complete

Continue with the above process knowing that the system won’t work!

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

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 summariesVacation cycles-spaced, watch lock out

dates

More changes New OR form- “Report of Operations” -accurate OR procedure by surgeonCheat sheet of CPT and ICD-9 codes

commonly used at our hospitalNew “pre-op admission form” being

created; NSQIP friendly history questions

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

Then and NowThen Now

SCRs Stressed…. Happy and excited….

Admin Concerned…. Happy and excited….

Case Selection 3 days …hours

Completed Cycle 1 month 5 work days

Workstation TINY LAPTOP Dual Screens

Our Current Cycle Tree

What if we fall behind again?Raw reports will not be “real time”Difficult to tell if new QI initiatives are

working or need tweakingNo time for follow up and data cleaningMissed casesStressed SCR’s again

You can do it too!Thank you

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

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

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?

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

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 chartsInterval? Monthly, Quarterly

- What is the impact of using vacation cycle in your data?

Taking advantage of your vacation cycles:Short/Difficult Cycles

– not enough cases (cycle 46, easter weekend)46 cycles – 4 vacation cycles = 40 cycles42 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 casesGoal: Find areas for improvementWe want these cases!!!