Improving patient outcomes and
achieving national ACS NSQIP recognition
Introduction
By some estimates, seven to 15 percent of patients undergoing major surgery will experience a postoperative complication. At least half of these complications occur after a patient has left the hospital—which is why tracking patients’ preoperative, postoperative, and post-discharge clinical data is so important.
At the Texas-based health system that Q-Centrix partnered with, 11 of its 16 hospitals participate in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), which helps hospitals gauge the quality of their surgical programs, improve surgical outcomes, and reduce complications. Because patient care is a top priority for the health system, clinical staff had limited capacity to engage in activities that diverted their attention away from patients, such as reviewing and submitting data for ACS NSQIP. NSQIP’s eight-day cycle schedule, in which facilities must select and abstract 40 surgical cases from within an eight-day period, posed an added challenge for the health system’s already busy staff.
By 2015, the health system had developed a backlog of 1,500 NSQIP cases. Without the bandwidth to review and assess this backlog of cases, the health system’s clinical staff would not be able to identify areas for quality improvement.
To address this backlog and pave the way for data-driven process improvements, the health system partnered with Q-Centrix to manage NSQIP clinical data for six hospitals with the, greatest need for support. The health system’s leaders hoped this partnership would help hospital staff meet NSQIP deadlines, ensure the integrity of their clinical data, and drive initiatives to make process improvements going forward.
At least half of postoperative complications occur after a patient has left the hospital.
Goals
Clear backlog of NSQIP cases
Develop a regular process for effectively managing data within NSQIP’s eight-day cycle
Facilitate data-driven process improvements
Challenges
Multiple responsibilities
NSQIP requires a surgical clinical reviewer (SCR) to handle a variety of tasks, including selecting cases, abstracting 40 cases per cycle (which involves collecting more than 100 data points for each case), conducting follow-up calls with patients as needed, and overseeing performance improvement projects. Balancing NSQIP tasks with their regular job responsibilities presents a challenge for SCRs to meet all the required duties.
Tight deadlines
Operating on NSQIP’s eight-day cycle schedule can be difficult for busy staff, making it easy to fall behind.
Solutions
The health system partnered with Q-Centrix to develop a standardized process for managing NSQIP cases:
On a weekly basis, the health system assigned NSQIP cases to Q-Centrix’s clinical data experts, who aimed to complete the cycle within 10 days. This involved abstracting all 40 cases for the eight-day cycle and reviewing any cases with occurrences.
Q-Centrix and the health system used a two-person process to validate cases with occurrences and ensure these cases had sufficient supporting documentation.
Q-Centrix entered occurrences into the health system’s reporting tool, and the health system ran an occurrence confirmation to validate the occurrences.
The health system and Q-Centrix met monthly to discuss cases and design process improvements.
The health system distributed results to facilities and physicians monthly.
Q-Centrix also ensured data integrity by performing random inter-rater reliability reviews on the data and making the results available to the health system for review.
Outcomes
Consistency
The health system consistently met internal and external NSQIP deadlines.
Focus
The health system’s SCRs had more time to spend on performance improvement, reviewing cases for occurrences, and other responsibilities.
National recognition
In 2017, four of the health system’s hospitals received national recognition from ACS NSQIP for achieving meritorious outcomes for surgical patient care.
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of the health system’s hospitals received national recognition from ACS NSQIP for achieving meritorious outcomes for surgical patient care.
Conclusion
As the health system found, partnering with a third party for NSQIP clinical data management proved valuable in several ways. After working with Q-Centrix to develop a standardized process for managing NSQIP cases, the health system was able to meet deadlines consistently and free up staff time, allowing SCRs to spend more time on follow-ups, occurrences, and process improvement opportunities. Further, Q-Centrix’s quality review process enabled the health system to have the utmost confidence in the integrity of its clinical data.
NSQIP participation is tied to many benefits, including fewer complications, better patient outcomes, and lower costs. But without a process in place for managing and reviewing cases—or a way to ensure SCRs have the bandwidth needed to complete their on-site NSQIP duties in addition to their regular responsibilities—facilities may struggle to meet deadlines and fulfill NSQIP participation requirements. By partnering with a third party, facilities can most effectively ensure meaningful NSQIP participation and enable SCRs to work top-of-license driving performance improvement initiatives and improving quality of care.