Identifying Adverse Events in Pediatric Surgery: Comparing Morbidity and Mortality Conference with the NSQIP-Pediatric System

Cromeens, Barrett P.; Lisciandro, Richard E.; Brilli, Richard J.; Askegard-Giesmann, Johanna R.; Kenney, Brian D.; Besner, Gail E.

doi:10.1016/j.jamcollsurg.2017.02.008

Cited by 16 publications

(15 citation statements)

References 30 publications

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“…There is a growing body of literature, including in pediatric surgery, which compares the value of M&M conferences to standardized outcomes databases, such as NSQIP, as tools to measure M&M to drive quality improvement. 6–8 Surgical M&M relies on voluntary reporting and as such are subject to inadequate and biased sampling. 9 Surgeons might be unwilling to report all of their complications for fear of ridicule by their peers, combined with fear of litigation and possible institutional constraints, namely a “shame and blame” ethos.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Surgeon Perceptions of Participation in External Patient Safety Programs: impact on Patient Safety

Berman¹,

Rangel²,

Tsao³

2018

Pediatric Quality &Amp; Safety

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Introduction: Surgeons play a crucial role in preventing harm and contributing to the safety culture of their institutions. External safety data programs are designed to review adverse events and provide performance benchmarks to ameliorate future adverse events. The extent to which pediatric surgeons are aware of these programs, utilize data from these programs, and believe that they improve patient safety, is unknown. Methods: A cross-sectional survey of the American Pediatric Surgical Association membership was conducted to evaluate participation in and attitudes toward national safety benchmark programs (eg, National Surgical Quality Improvement Program). Surgeons’ perceptions of these activities, including barriers to participation and utilization of safety data, were measured. We performed standard frequency analyses and tests of associations between surgeon characteristics and the likelihood of utilizing safety data. Results: The response rate was 38% (353/928). Seventy-two percentage of respondents reported institutional participation in external safety benchmark programs. Of those, only 68% utilized data to improve or monitor patient safety. Surgeon-reported barriers to this process included lack of knowledge, time, and institutional resources. Conclusions: Many pediatric surgeons are aware of institutional participation in external safety data programs, but only a portion are involved in the utilization of these data. We have identified several barriers to participation and data utilization. These findings can help direct educational efforts to optimize our ability to learn from adverse event benchmarking and improve pediatric surgical care.

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Section: Discussionmentioning

confidence: 99%

“…An approach to adverse event review that blends M&M and NSQIP can harness and integrate the benefits of both systems. 6…”

Section: Discussionmentioning

confidence: 99%

Pediatric Surgeon Perceptions of Participation in External Patient Safety Programs: impact on Patient Safety

Berman¹,

Rangel²,

Tsao³

2018

Pediatric Quality &Amp; Safety

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“…After title, abstract, and reference review, 3 SRs and 14 additional studies were included for synthesis, covering a total of 79 unique studies (Table 2). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The 14 additional studies included 1 singleinstitution prospective analysis, 12 single-institution retrospective reviews, and 1 mixed-methods study.…”

Section: Case Review Definitionmentioning

confidence: 99%

“…The most commonly identified characteristic contributing to effective case reviewddefined as more morbidity events detected leading to more action items and systemwide changedwas a structured method of case identification and discussion. [2][3][4][5] Five studies also defined this as a data-driven identification of complications based on predefined criteria rather than voluntary report. 2,4,[6][7][8] Use of clinical registry or other predefined case criteria for case review input resulted in more adverse outcomes identified and more actionable items than traditional self-report case review processes.…”

Section: Characteristics Of Effective Case Review Processesmentioning

confidence: 99%

Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement

Fischer¹,

Hu²,

Wescott³

et al. 2021

Journal of the American College of Surgeons

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After decades of experience supporting surgical quality and safety by the American College of Surgeons, the American College of Surgeons Quality Verification Program was developed to help hospitals improve surgical quality, safety, and reliability. This review is the second of a 3-part review aiming to synthesize the evidence supporting the main principles of the American College of Surgeons Quality Verification Program. Evidence was systematically reviewed for 5 principles: case review, peer review, credentialing and privileging, data for surveillance, and continuous quality improvement using data. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 9,098 studies across the 5 principles were identified. After exclusion criteria, a total of 184 studies in systematic reviews and primary studies were included for assessment. The identified literature supports the importance of standardized processes and systems to identify problems and improve quality of care.

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“…21,29 Publications resulting from the PSS study mainly compared surgical outcomes from the 14 ACS-NSQIP PS hospitals with the outcome from the 128 VA hospitals with already long-term established ACS-NSQIP initiatives. 8,[16][17][18] Almost all investigators used the ACS-NSQIP data base to extract data for their outcome measures, supplemented by local or hospital finance departments 21,23,26,30 or other clinical data bases, such as morbidity and mortality (M&M) conference 31,32 and Agency for Healthcare Research and QualityePatient Table 6) No difference (see Table 6) Thanh et al, 2019 23 Orthopaedic Cost savings (see Table 6) Cost savings (see Table 6) e Nimeri et al, 2018 24 Venous Table 6) Cost savings (see Table 6) e *Data for Etzioni et al 29 Safety Indicator (AHRQ-PSI). 33 The latter studies compared outcomes reported using ACS-NSQIP with outcomes reported in M&M conference or AHRQ-PSI, respectively.…”

Section: Characteristics Of All Selected Papersmentioning

confidence: 99%

Does the Introduction of American College of Surgeons NSQIP Improve Outcomes? A Systematic Review of the Academic Literature

Beesoon

Sydora

Thanh

et al. 2020

Journal of the American College of Surgeons

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Surgery is a central part of healthcare. It is estimated that approximately 11% of the global burden of diseases can be addressed wholly or partly by surgical care. 1 By its very nature, surgery is considered an invasive procedure and therefore carries inherent risks for patients. Based on World Health Organization data, the crude death rate after major surgery is 0.5% to 5%; up to 25% of surgical inpatients experience post-surgery complications, and surgical care accounts for almost half of all adverse events for inpatients in western countries. 2 There is no shortage of data to document the significant costs associated with surgical complications. 3-5 The World Health Organization estimated that half of surgery-associated harm is preventable. 2 Since its creation in 1913, the American College of Surgeons (ACS) has been relentless in its pursuit of the improvement of health outcomes of patients undergoing surgery. One of the major achievements of the ACS was the creation, testing, and validation of a system that captures and reports risk adjusted outcomes of surgical interventions: The National Surgical Quality Improvement Program (NSQIP). The trigger for the creation of the initial version of NSQIP was a mandate in 1985 from the US federal government (US Congress of Public Law No. 99-166) to monitor surgical outcomes in 133 Veterans Affairs Hospitals. 6 In collaboration with the ACS, the Department of Veterans Affairs conducted the National Veterans Administration Surgical Risk Study between October 1, 1991 and December 31, 1993, with the goal to define performance indicators and clinical variables and delineate how risk adjustment would be conducted. In 1994, the first version of NSQIP was introduced only in Veteran Affairs hospitals, which enabled riskadjusted comparison of surgical complications to be made across 133 hospitals. 7 This original version of NSQIP collected information on post-surgical outcomes and provided surgeon-and hospital-specific scorecards based on objective and rigorous analysis of the data. In light of the patient outcomes data generated by NSQIP, a number of quality improvement initiatives were put in place that led to reductions in mortality and morbidity in the VA hospital system, by 27% and 45%, respectively. 8 Subsequently, the NSQIP program was expanded to include private sector hospitals, with the Patient Safety in Surgery (PSS) study, which ran in parallel in the VA and a set of non-VA hospitals in 2001 to 2004, and showed clear and definite improvements in patient outcomes in both systems. 8 In 2004, NSQIP was officially branded as ACS-NSQIP. In 2005, participation in the private sector program sponsored by the American College of Surgeons (ACS-NSQIP) became available by subscription, while at the same time, the VA program separated from the private sector program and became the VA-sponsored version: VA-SQIP. Since then, the number of hospitals adopting the program has increased on a yearly basis. Over the past 13 years, the number of surgical sites that have adopted ACS-NSQIP...

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Identifying Adverse Events in Pediatric Surgery: Comparing Morbidity and Mortality Conference with the NSQIP-Pediatric System

Cited by 16 publications

References 30 publications

Pediatric Surgeon Perceptions of Participation in External Patient Safety Programs: impact on Patient Safety

Pediatric Surgeon Perceptions of Participation in External Patient Safety Programs: impact on Patient Safety

Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement

Does the Introduction of American College of Surgeons NSQIP Improve Outcomes? A Systematic Review of the Academic Literature

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