National surgical quality improvement program (NSQIP) improvements: A case study

This project sought to implement standardized reporting procedures to maximize NSQIP quality results at an academic medical hospital on Long Island, New York. We used outlier analysis to determine areas that had poor NSQIP performance. We then implemented a set of strategies to address poor NSQIP results for four procedures: catheter associated urinary tract infections, prolonged intubation/re-intubation, surgical site infections, and perioperative myocardial events. We developed a balanced feedback loop analytic dashboard system to monitor and iterate our progress. At the first year of measurement we found no significant change to NSQIP metrics. We took this insight and modified our strategy by adding the feedback loop analytic dashboard. We are currently waiting for the second round of results. We believe that the lack of positive results after 1 year was due to a combination of three factors. First, we experienced difficulty moving clinicians to adopt the strategies that we laid out to improve NSQIP ratings because some clinicians had to adopt new and unfamiliar clinical methods. A second and critical observation was that we were taking steps to change our strategy without receiving feedback from NSQIP. We developed the analytic dashboard to give us the ability to iterate in a timely manner. The last observation was that the case types that we chose to measure were prone to producing poor NSQIP ratings despite risk adjustment. NSQIP is a practical toolbox for creating system wide change in surgical practice. Tracking progress requires strict protocol for documentation. This study observes the rollout of standardized protocol and documentation in an academic hospital on Long Island, New York.