Clifford Y. Ko, MD MS MSHS FACS Director, Division of Research and Optimal Patient Care

1. Intersection of Surgical Outcomes and Medical Education: The ACS Perspective(Division of Research and Optimal Patient Care) Clifford Y. Ko, MD MS MSHS FACS Director, Division of Research and Optimal Patient Care American College of Surgeons Professor of Surgery David Geffen School of Medicine at UCLA

2. No Disclosures

3. Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment

4. Four Guiding Principles of Continuous Quality Improvement • 2. Right Infrastructure • Staffing level/Specialists • Equipment • Checklists • The Quality Processes • Standards • Individualized by patient • Backed by research 3.Rigorous Data • From medical charts • Backed by research • Post-discharge tracking • Continuously updated • Verification • External peer-review • Creates public assurance

5. ACS: 100 Years of Quality Improvement Bench to Bedside to Policy SSR Minimum Standard for Hospitals 1917 1951 2004 2011 1998 1913 1922 2005 1950 COMMITTEE ON TRAUMA

6. Current Issues in Surgery • Understanding the Metrics in Quality • Transparency/Public Reporting of Quality • Patient Experience • Real Data • Appropriateness • Sustained Quality Improvement • QI Process • Leadership/Team/Culture

7. Metrics: SCIP 1: Prophylactic antibiotic received within one hour prior to surgical incision 2: Prophylactic antibiotic selection for surgical patients 3: Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac patients) 4: Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose 5: Surgery patients with appropriate hair removal 6: Colorectal surgery patients with immediate postoperative normothermia

8. Current Metrics Don’t Work So Well: SCIP has little correlation with Risk Adjusted Clinical Outcomes

9. “All Cause Harm”: Readmissions • 11%, if no complications • 36%, if complications

10. Readmission Rates Within 30 days for Colectomy SSI Org Renal Insuff Dehis PE SSI Sup No Cx No Cx

12. Measuring Patient Experience with S-CAHPS Consumers Assessment of Healthcare Providers and Systems Surgical Patient Experience (6) 1.      Surgeon Communication Before Your Surgery2.      Surgeon Communication After Your Surgery3.      Surgeon Care Before Your Surgery4.      Surgeon Care on the Day of Your Surgery5.      Surgeon Care After Your Surgery6.      Clerks and Receptionists at Surgeon’s Office www.cahps.ahrq.gov

13. REAL DATA Rates of Complications (w/o publication bias)

14. Following our patients for 30 days

15. Appropriateness: Essential for the Patient Provider Discussion

16. Surgeons Leading QI High Quality Surgical Care Best Practices/ Standards/ Implementation Data Collection/ Analysis Feedback and Planning

17. Scoring Teamwork:Teamwork in the Eye of the Beholder

18. A Start… • “Quality in Training” Collaborative Pilot in NSQIP . • A pilot project designed to bring together Training Facilities within ACS-NSQIP. • Enable easy manipulation of data to provide standardized resident reports. • Build ways to include quality evaluation, patient safety, and performance improvement that teach to real world use • Start to live it and understand it in training.

19. For more information on this ACS NSQIP Pilot Breakfast meeting tomorrow (Thursday) Time: 630-800AM Room: Aqua 312

20. Thank You

21. Intersection of Surgical Outcomes and Medical Education: The ACS Perspective(Division of Research and Optimal Patient Care) Clifford Y. Ko, MD MS MSHS FACS Director, Division of Research and Optimal Patient Care American College of Surgeons Professor of Surgery David Geffen School of Medicine at UCLA