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Surgical Performance Improvement in a Health System - ACS NSQIP and a System Surgical Council as a Driver for Change
Rekha K Singh1,2, Orlando Kirton1,3, *Patricia Sobieski1, *Cynthia Ross-Richardson1,2, *Jay Encarnacion1,3, *Mary Beland1,4, *Linda Wood1,5, *Samantha Grable1,3, *Patricia Blake1,6, *Joseph Portereiko1,3, Rocco Orlando1
1Hartford Healthcare, Hartford, CT;2The Hospital of Central Connecticut, New Britain, CT;3Hartford Hospital, Hartford, CT;4MidState Medical Center, Meriden, CT;5Windham Hospital, Willimantic, CT;6Backus Hospital, Norwich, CT

Objective: To drive surgical quality and process improvement in a five hospital system.
Design: A Surgical Council, an interdisciplinary group of surgical, quality and administrative leaders, was formed with a vision to assure a single standard of surgical care. ACS NSQIP was implemented as the main vehicle for measuring outcomes.
Setting: At the inception of the Surgical Council, each of the five hospitals, ranging from small community to tertiary care centers, had variable approaches to data, processes and culture.
Patients: Council members included system medical and quality leaders, surgical chiefs, surgeon champions and surgical clinical reviewers. Embedded support from IT and Supply Chain guided domains of work.
Interventions: The initial focus involved onboarding of SCRs and surgeons champions, followed by system-wide education of surgeons and staff. NSQIP reports were analyzed at each hospital. Initiatives and process improvement projects were developed to address local needs, and presented up to the system Surgical Council.
Main Outcome Measures: NSQIP data, augmented with Premier Quality Advisor, allowed rapid process improvement. Collaboration with Supply Chain and a Peri-Operative Council identified optimal resource utilization.
Results: This system initiative has demonstrated the following early results: Interaction with the Epic implementation team to develop a standard approach to the EHR, including peri-operative standards, order sets and protocols. Product standardization to produce high quality outcomes at lower costs. Identification of "hot spots" needing focused quality improvement, including post-op cardiac occurrences.
Conclusions: As the system Surgical Council has matured, opportunities for continued improvement are being realized on a larger scale. Local initiatives gain a step-up, with the advantage of system wide lessons and shared solutions, and the goal of achieving best practice standards for all.


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