“Show me the Data”: A Recipe for Quality Improvement Success in an Academic Surgical Department

Abstract

Background Surgeons in academic medical centers have traditionally taken a siloed approach to reducing postoperative complications. We initiated a project focusing on transparency and sharing of data in order to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive Department Quality Dashboard and the creation of a Clinical Operations Council that oversaw quality. The purpose of this study was to assess the impact of those efforts.

Study Design We compared inpatient outcomes before and after our intervention, allowing one quarter as the diffusion period. The outcomes analyzed were: risk-adjusted length of stay (LOS), mortality and direct cost and unadjusted incidence of complications and 30-day all-cause readmissions, as determined by the Vizient Clinical Database. We examined the outcomes of three groups: Group 1 (Surgery), Group 2 - all other surgical departments (Other Surgery) and Group 3 - all other patients (Non-Surgery). Two-tailed Students’s t-test was used for analysis and a p value of <0.05 considered statistically significant.

Results Group 1 demonstrated statistically significant improvements in mortality (p=0.01), LOS (p=0.002), cost (p=0.0001) and complications (p=0.02) while the all-cause readmission rate was unchanged, resulting in mean decrease of 0.55 LOS days and direct cost savings of $2300 per surgical admission. The comparison groups had only modest decreases in some of the analyzed outcomes and an increase in complication rates.

Conclusions These data suggest that a collaborative, data-driven and transparent approach to assessing the quality of surgical care can yield significant improvements in patient outcomes.