Surgical quality collaborative saves $75 million in lower costs
Ten hospitals in the Tennessee Surgical Quality Collaborative (TSQC) have reduced surgical complications by 19.7% since 2009, resulting in at least 533 lives saved and $75.2 million in reduced costs, according to new results presented at the recent national conference of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).
The hospital collaborative was formed in 2008 as a partnership of the Tennessee chapter of the American College of Surgeons and the Tennessee Hospital Association’s (THA) Center for Patient Safety, with support from Blue Cross Blue Shield’s Tennessee Health Foundation. ACS NSQIP is a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. The program provides a prospective, peer-controlled, validated database of preoperative to 30-day surgical outcomes based on clinical data. Through the ACS NSQIP program, TSQC hospitals collected clinical 30-day outcomes data from 10 participating hospitals to examine and identify trends in and evaluate best practices. Between 2009 and 2012, participating hospitals collected data on more than 55,000 surgical procedures, and researchers examined rates of 17 types of surgical complications.
Compared with complication rates in 2009, participating hospitals in 2012 achieved 19.7% fewer postoperative occurrences (p < 0.001), and the postoperative mortality rate dropped 31.5% (p < 0.001). Hospitals prevented an estimated 3.75 deaths per 1,000 surgical procedures and avoided $75.2 million in excess costs.
13 of 17 complications improved
The collaborative saw improvements in 13 of the 17 types of complications, and nine improved significantly (p < .05).
The areas of most improvement included all types of surgical site infections, pneumonia, and urinary tract infections, which all dropped by approximately one-third.
"Our results show not only have Tennessee hospitals improved care, but we’ve been able to sustain those improvements over time," said Brian Daley, MD, MBA, FACS, lead author of the study and professor of surgery and chief of the Division of Trauma and Critical Care at the University of Tennessee Medical Center, Knoxville. "Our collaborative approach and use of robust clinical outcomes data through ACS NSQIP is an effective model for quality improvement across our state and nationally."
An earlier study based on TSQC data was published in the Journal of the American College of Surgeons in 2012. It showed the 10 TSQC members reduced complication rates and saved more than $8 million in excess costs from 2009 to 2010. This new study shows TSQC hospitals continued to improve in the years after the program was launched. In 2012, the collaborative expanded and now includes 22 Tennessee hospitals.
Oscar Guillamondegui, MD, MPH, FACS, chair of TSQC’s leadership committee, said, "Participation in an ACS NSQIP collaborative is helping Tennessee hospitals accelerate their improvements by sharing data, comparing results, and evaluating best practices among peers." Guillamondegui is an associate professor of surgery and director of the Vanderbilt multidisciplinary traumatic brain injury clinic at Vanderbilt University Medical Center in Nashville, TN.
Craig A. Becker, THA president, said, "The TSQC has helped align the efforts of hospitals and surgeons around quality improvement, which supports the THA board’s commitment toward zero incidents of preventable harm in our state’s hospitals. This collaborative is an excellent example of how the hospital association, physicians, hospitals, and payers can work together to improve care using clinically valid measures in a cooperative way."
