1. Surgical Champion Tool Kit
John M. Morton, MD, MPH, FACS
Associate Professor
Director of Surgical Quality
Stanford University Medical Center

2. Surgery and the Public’s Health
234 m surgeries annually: Exceeds Childbirth
Surgical Complications= 11% of Disease Burden
50% of Surgical Complications Preventable

3. Adverse Events Increasing In Surgery

4. A Success Story American Bariatric Surgery

5. Engaging Your Surgeons
Leadership Commitment
Data Transparency
Target Areas of Improvement

6. Data, Data, Data

7. I’ve Got Friends in High Places

8. I’ve Always Done It This Way

9. I Don’t Have a Problem

10. Aim: Determine Who the Surgical Champion and How Does
Achieves Change
Study Population: All 238 NSQIP
Surgical Champions Surveyed

11. QI Practice Patterns for Surgical Champions
“Veteran” Participation
Meeting With Nurse Abstractor
Presenting Data to Administration
Presenting Data to Surgeons

12. QI Practice Patterns for Surgical Champions
“Veteran” Participation
>2 years
Building Relationships
Cementing Administrative Support
Learning Your Field

13. QI Practice Patterns for Surgical Champions
Meeting With Nurse Abstractor

14. QI Practice Patterns for Surgical Champions
Presenting Data to Administration
Critical
ROI
Create Standing Meeting
Surgical Council- Administration, Nursing, Anesthesiology, All Surgeons, Internists

15. QI Practice Patterns for Surgical Champions
Presenting Data to Surgeons
Maintenance of Certification

16. NSQIP Notification NSQIP Adverse Event Each Surgeon Receives email
Opportunity to further inform
Must Conform to NSQIP Standards

17. QI Practice Patterns for Surgical Champions
More opportunities
Surgical Champions Presented Data to:
Individual Surgeons (44%)
Residents (44%)
Anesthesiologists (37%)
Nursing (20%)

18. Presenting the Data Using Data as Quality Diagnostic Tool
Benchmark to Other Hospitals
Identifying Adverse Events
Peer Review

19. Presenting the Data Using Data as Quality Diagnostic Tool QI Bundles
Central Line
UTI
Pneumonia
SSI
Time Out

20. Presenting the Data Using Data as Quality Diagnostic Tool
Benchmark to Other Hospitals
Identifying Adverse Events
Peer Review

21. Clinical vs. Administrative Data: Clinical Data tends to tell us more…
NSQIP
Admin
% Observed by Admin
Total Complications
28%
11%
39%
SSI
13% 1% 7%
Wound Disruption 6%
17%
UTI 0%
Mortality 3%
100%

22. Presenting the Data Using Data as Quality Diagnostic Tool
Benchmark to Other Hospitals
Identifying Adverse Events
Peer Review

23. NSQIP Notification NSQIP Adverse Event Each Surgeon Receives email
Opportunity to further inform
Must Conform to NSQIP Standards

24. Remaining Challenges Adequate Staffing Surgeon Apathy
Lack of Established QI Programs
Lack of Hospital Support

25. Surgical Champion Cornerstones
Time
Average 10 hours a week
Money
100 vs 73% Participation in CQI for paid vs not
Influence and Authority
Persistence
Passion

26. Identification
Prevention
Collaboration
Elimination

27. Utilizing Hospital Outcomes for Quality Improvement
Utilize resources available from the ACS NSQIP secure website
Best Practices Case Studies
Best Practices Guidelines
Prevention of Catheter-Associated Urinary Tract Infections
Prevention and Treatment of Venous Thromboembolism
Prevention and Assessment of Intravascular Catheter-Related Bloodstream Infections
Prevention of Surgical Site Infections
Monitor the impact of quality improvement initiatives and disseminate those achievements.
All of health care benefits when best practices are identified and shared.

28. Next Steps
Tool Kit
Case Studies
More Hospitals
Mentoring

29. Surgeon Champion Toolkit
Implementation Checklist
Best Practices and Case Studies that will include 10 or so tips for implementation or implementation strategies
Information on how to use the SAR PowerPoint’s

30. Surgeon Champion Toolkit
Recent Literature Review – This tool may include publication/article lists and updates, paper reviews, and some sort of system where SC’s can review and comment on literature
Tips for engaging hospital administration
Tips for engaging other surgeons

31. Surgeon Champion Toolkit
Information on how to utilize ACS NSQIP data for M & M
Information on how to use your online reports
Preop Evaluation
Pulmonary Complications and/or Blood Utilization

32. Quality Is Not a Personal Virtue; Quality is an Expectation of Performance That Is Accountable and Rewarded