Florida hospitals link to improve surgical care

ACS program adapted for state use

The Florida Hospital Association (FHA) has partnered with the American College of Surgeons and its National Surgical Quality Improvement Program (NSQIP) to improve the care surgical patients get through increased use of data. The data used will not come from insurance claims, but will be abstracted directly from charts by clinical personnel. The data will also be risk-adjusted and will include evaluations of the patient's status after 30 days.

The Florida effort will be smaller than the national one, which may make it more amenable to cash-strapped hospitals. However, its creators say it will still lead to "actionable quality outcomes information." Rather than the 20 measures in the national program, the state endeavor will focus on four measures:

  • surgical-site infection;
  • urinary tract infection;
  • colorectal surgery outcomes;
  • outcomes for elderly surgical patients.

The FHA chose these four data points because they are associated with high morbidity and mortality, and are applicable even to smaller hospitals. The association hopes that if these four outcomes are chosen by the National Quality Forum — the American College of Surgeons has submitted them for endorsement — then Florida hospitals participating in the program will have a leg up in addressing the concerns these measures raise.

The goals of the program include not just getting hospitals to participate — and more than 100 have already signed up — but to reduce complications and save lives of surgical patients by 2013, says FHA president Bruce Reuben. The initial group of 61 hospitals has received training and is collecting data. The second group is being organized.

After the data are collected, they will be analyzed by the ACS, says Reuben. Participants can then look at where they stand compared to others, find anomalies, and develop protocols for improvements. "This works the same as the NSQIP program, but allows a broader range of participants in terms of size and scope."

When Reuben came to his position in 2008, the association board was concerned that the talk about geographic disparity in costs and quality would create "a big target on Florida's back. We had higher cost and a perception of lower quality. So we wanted to look at some strategic efforts to change the benchmarks and make it clear that we are as committed to quality and good outcomes as any other state. But what could we do that would have a big positive impact that we could measure, and who is doing something that we could leverage from?"

The NSQIP program came up in conversation, but Reuben says it demanded a lot in terms of time, personnel, and financial commitment. "We wanted a way to help hospitals get into it quicker with lower up-front costs. And we wanted to have a statewide impact."

Focusing on these four areas allows pretty much any hospital with an OR suite to take part. And if you have an OR suite, then chances are, you have these issues, Reuben says. It did not hurt that there was an increasing emphasis on hospital-acquired infections such as UTIs and SSIs.

The first data should be out at the start of 2012. Efforts to improve that data will take up the second year of the program. Just seeing where you are should be enough to get some facilities to work hard to improve, he says. "For some, just having data helps to eliminate outliers. But there will be other challenges. We will have to figure out best practices. But I think the hospitals will come together as a group to drive that change and create the programs that address the outliers."

Diffused efforts will not create the change the association and its members want, so the participants will be brought together frequently to talk. "The appeal is working together, and I think that the FHA is leading this will help create that collective mentality." Issues of proprietary information likely will drop if everyone understands that it is in no hospital's interest to have issues of geographic disparity and that patient safety is paramount.

This distillation of a national project is something of interest all by itself, Reuben adds, noting that there are other states who are watching this Florida endeavor with interest and considering following its lead.

  • For more information on this topic, contact Bruce Reuben, President, Florida Hospital Association, Tallahassee, FL. Telephone: (850) 222-9800.