National Surgical Quality Improvement Program

Underscoring its commitment to quality and patient safety, Duke's Department of Surgery recently joined the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP).

An initiative first developed and implemented at Veterans Affairs hospitals nationwide beginning in the mid-1990s, NSQIP has only recently moved into the private sector, and Duke is one of 142 participating institutions.

"This is a critically important endeavor for our surgical services as we begin to collect robust data that we can use to improve the quality of care that we provide to our patients," says Danny O. Jacobs, MD, MPH, professor and chair, Department of Surgery.

"The highest quality surgical care is always safer, in my opinion."

NSQIP is a validated, risk-adjusted, outcomes-based program which uses several components, including data collection, analysis, and feedback mechanisms, to quantify quality and safety measures by standardized inter-institutional comparison.

The information generated by the program is designed to foster discussion and improvement at individual participating institutions.

"This program will allow us to discover what we could be doing better and how we compare against VA medical centers and other acute Level I trauma centers," says Matthew Harker, director for information technology for the departments of Surgery and Medicine at Duke.

Currently, the program is in use in vascular surgery at Duke, with the expectation of expansion into other areas moving forward.

In the data collection phase, nurse reviewer Patricia A. Tucker, RN, BSN, who has years of quality improvement experience in Duke's Department of Anesthesia, is responsible for collecting preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for about 40 patients per week. Tucker then enters this data into the NSQIP Web site.

Analyzed data is presented to participating sites through comprehensive semiannual reports and real-time online benchmarking reports.

These reports allow the centers to continually monitor their quality-improvement efforts and to compare outcomes with other participating medical centers and against national averages on a blinded basis.

At Duke, NSQIP represents an important collaborative effort between Duke University Hospital and the Department of Surgery, underscoring the commitment of improving and maintaining the most stringent criteria for patient safety and quality.

"The two entities are sharing the cost of participating in the program, and I think that reflects our shared dedication to this important mission," says Harker.

The useful information generated by the program may be presented at various morbidity and mortality conferences.

"This kind of information will be extremely helpful to us," says William J. Richardson, MD, professor, Division of Orthopaedic Surgery, and vice chair, Clinical Effectiveness, and physician champion of the program.

"It will help us to identify improvement measures to decrease our incidence of complications and improve outcomes," he says.

The program has just gotten under way at Duke, but shows great promise as a quality and safety improvement tool.

"I think it will lead to better quality and safer surgery," says Richardson.

Duke Surgery Patient Safety

Currently in use in the divisions of Orthopaedic Surgery, Neurosurgery, and Urology, Duke Surgery Patient Safety (DSPS) is a mechanism through which clinicians and staff can report adverse events electronically, ensuring timeliness and a streamlined approach to chronicling and acting upon safety and quality concerns within the Department of Surgery.

Through the easy-to-use online system, users can enter information about the division, the surgeon, and the specialty involved, as well as the date, specific complication, and any relevant details.

Users can also rank the severity of the complication on a scale from one to five.

"This system allows us to keep track of complications in a simple, user-friendly manner, and this helps us work toward the goal of continually improving the patient safety and quality measures we have in place here at Duke," says Ricardo Pietrobon, MD, PhD, assistant professor, Division of Orthopaedic Surgery, and director of Biomedical Informatics in the Duke Translational Medicine Institute.