The National Surgery Quality Improvement Project- NSQIP: a new tool to increase patient safety and cost efficiency in a surgical intensive care unitReport as inadecuate




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Patient Safety in Surgery

, 8:19

First Online: 24 April 2014Received: 08 December 2013Accepted: 15 April 2014

Abstract

BackgroundThe -National Surgical Quality Improvement Program- NSQIP is a nationally validated, risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonia PNEU and prolonged ventilator days ≥48 hours V48 was observed on the surgical service.

MethodsThe hospital studied is a 500 bed university-affiliated teaching hospital performing approximately 20,000 surgical operations per year. A multidisciplinary team was formed and a series of interventions were implemented to address high pneumonia rates and prolonged intubation. Specific interventions included enforcement of protocols and adherence to the Institute for Healthcare Improvement IHI ventilator bundles, including head of bed elevation, sedation holidays, extubate when ready, and early nutrition. NSQIP collected pre-operative through 30-day postoperative data prospectively on 1,081 surgical patients in the intensive care unit from January 1, 2010 – July 31, 2012. The variables pneumonia and V48 undergo logistic regression and risk adjusted results of observed versus expected are calculated. Mean and confidence intervals are represented in caterpillar charts and bar graphs. Statistical analysis was via Fisher exact t-test.

ResultsProgressive improvements were observed over a two-year period via three semiannual reports SAR. Corrective measures showed a decrease in V48 with an observed to expected odds ratio O: E improving from 1.5 to 1.04, or 1.9% 7-368 patients July 31, 2011 to 1.11% 12-1080 patients July 31, 2012 respectively. Similarly, pneumonia rates decreased 1.36% 5-368 patients July 31, 2011 to 1.2% 13-1081 patients July 31, 2012 with O: E = 1.4 and 1.25 respectively. Statistical significance was achieved p < .05.

ConclusionGiven an estimated annual volume of 20,000 cases per year with a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation greater than 48 hours; a projected 32 avoided episodes of pneumonia and 160 avoided episodes of V48 could be realized with potential savings exceeding $5,000,000.

KeywordsSICU NSQIP Pneumonia Quality Performance improvement Electronic supplementary materialThe online version of this article doi:10.1186-1754-9493-8-19 contains supplementary material, which is available to authorized users.

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Author: John McNelis - Maria Castaldi

Source: https://link.springer.com/article/10.1186/1754-9493-8-19



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