HAI at FHA:NSQIP Data Tells the StoryNovember 2010

• NSQIP at FHA• Rates – SSI, UTI and Sepsis• O/E – SSI and UTI • Process + Outcomes Measure• How NSQIP can help your team• Future of NSQIP at FHA

NSQIP

*National Surgical Quality Improvement Program

*Data-driven, risk-adjusted, outcomes-based surgical quality improvement program

-systematic sampling process-30-day outcome-robust data collection-data validity-report flexibility

NSQIP at FHA2006 Royal Columbian Hospital

Surgeon Champion: Dr. Peter BlairSCR: Betty Allan

Surrey Memorial HospitalSurgeon Champion: Dr. Peter DorisSCR: Angela Tecson

2009 Burnaby HospitalSurgeon Champion: Dr. JeanNoel MahySCR: Darlene Jager

NSQIP Director: Lorraine Gillespie

FHQC- Fraser Health Quality CollaborativeCan-NSQIP – Canadian NSQIP Collaborative

HAI Rates

Surgical Site Infection

Annual Incidence of Surgical Site Infection from Fiscal Year 2005 to 2009

0

5

10

15

2005 2006 2007 2008 2009

Fiscal Year

Rate

/100

Sur

gica

l pr

oced

ures

BH

RCH

SMH

HAI Rates

Urinary Tract Infection

Annual Incidence of Urinary Tract Infection from Fiscal Year 2005 to 2009

0

1

2

3

4

2005 2006 2007 2008 2009

Fiscal Year

Rate

/100

Sur

gica

l Pr

oced

ures

BH

RCH

SMH

HAI Rates

PneumoniaAnnual Incidence of Pneumonia from

Fiscal Year 2005 to 2009

0

1

2

3

4

5

2005 2006 2007 2008 2009

Fiscal Year

Rate

/100

Sur

gica

l Pr

oced

ures

BH

RCH

SMH

Series5Series6

Sepsis/Septic Shock

HAI Rates

Annual Incidence of Postoperative Sepsis/Septic Shock from 2006 to 2009

0

2

4

6

8

10

2006 2007 2008 2009

Year

Rate

/100

Sur

gica

l Pr

oced

ures

BH

RCH

SMH

O/E Ratio• Observed to Expected Ratio

“O” = number of observed events“E” = number of expected eventson the basis of risks and complexity

• Risk Adjustment – “levels the playing field”

• Outlier – statistically “better” or statistically “worse” than expected

Overall Surgical Site InfectionsRCH and SMH – GS and VSBH – Multispecialty (Initial Year)

2007 2009

SMH Reduction Rate: 49%RCH Reduction Rate: 29%

Overall* Surgical Site Infections

* Includes General and Vascular Surgery Cases

SMH

Overall* Surgical Site Infections

* Includes General and Vascular Surgery Cases

SMH

RCH

RCH

BH

Overall Urinary Tract InfectionsRCH and SMH – GS and VSBH – Multispecialty (Initial Year)

2007 2009

SMH Reduction Rate: 54%RCH Reduction Rate: 24%

SMH

Overall* Urinary Tract Infections

* Includes General and Vascular Surgery Cases

Overall* Urinary Tract Infections

* Includes General and Vascular Surgery Cases

SMH

SMH

RCHRCH

BH

NSQIP Data at FHA

• 30-day outcomes collected – phone calls, letters and surgeons office visits

• Preoperative data is limited to chart and EMR information

• No risk-adjusted report on postoperative sepsis/septic shock

• O/E reports – twice a year

• Are we really doing what we said we are doing?

• Is what we are doing creating an impact?

Example:Dec 2009-Jan 2010

176 Cases General and Vascular Surgery

Process and Outcomes Measure

Process and Outcomes MeasureExample: SSI Infection Reduction StrategiesPreop Antibiotic Compliance – 87.5%

No SSI SSI

No Preop Antiobiotics

14 (8%)

8 (4.5%)

Preop Antibiotics Given

141 (80%)

13 (7.4%)

P-value: .001Odds Ratio: 6.1

No SSI SSI

No Preop Antiobiotics

24 (13.6%)

12(6.8%)

Preop Antibiotics Given within 1hr

131(74.4%)

9(5.1%)

P-value: .00008Odds Ratio: 7.2

How can NSQIP help?

Data Definition Support– SSI, UTI and SepsisReports:

– Monthly rates – Benchmark– Risk-adjusted data – Semiannual Report– SPC Charts – specific cause variation

NSQIP’s SPC Chart

Average Monthly Surgical Site Infection with Control Limits

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Average Daily ImperfectionsSample MeanLower Control LimitUpper Control Limit

Preop ABX

Abx Timing

Normothermia

Limit OR traff ic

Review of Risks

Example

Future of NSQIP at FHA

• Multispecialty Targeted Procedure Module • Risk calculators – pre-admission• Partnership with UBC statisticians • Partnership with BCPSQC• Increase site enrollment• Continue to share evidence-based

practices

Thank you!

Email: .FHA surgical clinical reviewerWebsite: www.acsnsqip.org