HAI at FHA: NSQIP Data Tells the Story November 2010
Mar 18, 2016
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