Beating nsqip s lock date
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Beating NSQIP’s Lock date. April 2012. Cases by Cycle. INTRODUCTION. Presentation:. Our Struggle and Triumphs with ACS NSQIP -Kelli Jennison-Gustafson RN SCR. Our Struggles and Triumphs with ACS-NSQIP. Nanaimo Regional General Hospital Kelli Jennison-Gustafson RN SCR. NRGH.

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Beating NSQIP’s Lock date

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Beating nsqip s lock date

Beating NSQIP’s Lock date

April 2012


Introduction

Cases by Cycle

INTRODUCTION


Presentation

Presentation:

Our Struggle and Triumphs with ACS NSQIP

-Kelli Jennison-Gustafson RN SCR


Our struggles and triumphs with acs nsqip

Our Struggles and Triumphs with ACS-NSQIP

Nanaimo Regional General Hospital

Kelli Jennison-Gustafson RN SCR


Beating nsqip s lock date

NRGH

  • Acute Care Facility and Trauma Center

    234 acute care beds

    22 long tem care beds.

  • Population: over 300,000 residents

  • Busiest ER in Vancouver Island

  • We employ over 1,700 individuals locally


Nsqip at nrgh

NSQIP at NRGH

  • Classic Multispecialty

  • 2 FT SCRs


In the beginning

In the beginning…

  • July 2011

    1st day on the job - Boston conference

  • August 2011

    Office set-up

    2 weeks of full time online training and learning

  • Sept 2011

    Ramp-up


Unfamiliar territory

Unfamiliar territory

  • CPT and ICD Codes

  • Data cleaning


Recipe for disaster

Recipe For Disaster

  • 1 cycle = 1 month

  • OR log procedure ≠ OR report procedure

    - days to pick cases

  • Paper-based and electronic charts

  • Waiting Game: Data entry to workstation until all information is complete

  • Continue with the above process knowing that the system won’t work!


Angela to the rescue

Angela to the rescue

  • First site visit on December 5.

  • Tips and tricks :

    - at a “glance” when selecting cases

    - use oversampling for excluded cases

  • CPT coding techniques

  • Data cleaning template


Rescue continues

Rescue continues!

  • Open the EMR/paper chart, start the case in the workstation.

  • No more paper reviews: saves time and reduces data input errors

  • “Tips and tricks” for post op occurrences:

    - check labs, diagnostics, surgeons notes and discharge summaries

  • Vacation cycles-spaced, watch lock out dates


More changes

More changes

  • New OR form- “Report of Operations”

    -accurate OR procedure by surgeon

  • Cheat sheet of CPT and ICD-9 codes commonly used at our hospital

  • New “pre-op admission form” being created; NSQIP friendly history questions


How are we doing now

How are we doing now?

  • Up to date with our cycles

  • 89% 30 day follow up on all cases

  • Data cleaning – watch lock out dates

  • Looking at our “raw data”

  • Created a custom field, preoperative antibiotics vs. incision time


Then and now

Then and Now


Our current cycle tree

Our Current Cycle Tree


What if we fall behind again

What if we fall behind again?

  • Raw reports will not be “real time”

  • Difficult to tell if new QI initiatives are working or need tweaking

  • No time for follow up and data cleaning

  • Missed cases

  • Stressed SCR’s again


You can do it too

You can do it too!

Thank you


Advantages of being at least 60 days behind lock date

Advantages of being at least 60 days behind lock date:

*Holidays/sick time – you can use vacation cycles anytime!

*Report back to teams- real-time reports

*Time to find missing data

*Verify/Confirm data with SC and anesthesia

*Clean and discuss interesting cases

*Act on unusual trends timely


Taking advantage of your vacation cycles

Taking advantage of your vacation cycles:

Using vacation cycles need a little bit of planning

When do you plan to use it?

- SCR holidays

- catch up with lock date

- Short/Difficult cycles


Taking advantage of your vacation cycles1

Taking advantage of your vacation cycles:

SCR Holidays:

You can use vacation cycles anytime if you are working on cases that are at least 60 days to lock date

- Can somebody take over your cases?

- What is your status? how far behind are you?

- Can you use your vacation cycle without compromising your 30-day follow-up ?

- Is there a potential that you will abandon charts while you are away?


Taking advantage of your vacation cycles2

Taking advantage of your vacation cycles:

SCR Holidays:

When you come back, you want to make sure that you have enough time to work on your cases that are close to lock date

- review, ff-up and clean


Taking advantage of your vacation cycles3

Taking advantage of your vacation cycles:

Catch up with lock date:

- What is your status? how far behind are you?

- What format do you use to report back to teams? Run charts, SPC charts, bar charts

Interval? Monthly, Quarterly

- What is the impact of using vacation cycle in your data?


Taking advantage of your vacation cycles4

Taking advantage of your vacation cycles:

Short/Difficult Cycles

– not enough cases (cycle 46, easter weekend)

46 cycles – 4 vacation cycles = 40 cycles

42 cycles x 40 cases = 1680 cases/year

If: 40 cycles x 40 = 1600

and: 2 cycles x 15 = 30 (cycle 46 and easter)

so: 1600 + 30 = 1630 (short 50 cases)

– Cycle includes difficult cases

Goal: Find areas for improvement

We want these cases!!!


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