1. NSQIP Supports Pneumonia Prevention at Vancouver General Hospital Irene Siu Spotlighting Surgical Improvement in BC November 16, 2012

2. Non-Risk Adjusted Pneumonia Rates May-Dec 2011 VGHSQANNSQIP Overall2.6 1.3 General Surgery3.6 1.91.4 Vascular3.0 3.82.2 ENT4.0 0.51.0

3. July 2012 SAR Risk Adjusted Pneumonia Outcomes Odds RatioDecileStatus ALLCASES1.67 9 High Outlier/Needs Improvement GEN1.55 9As expected VASC1.28 9As expected ENT n/a

5. Pneumonia Working Group Engage manager of General Surgery, Vascular, ENT - units T8/9 Audit of current practice Improvement Charter/SBAR Gather the team What to do?

6. *Rosenkranz et al. (July 24 2011). “ICOUGH”: The Development of a Multidisciplinary Program to Address Postoperative Pulmonary Complications. Powerpoint lecture presented at ACS NSQIP National Conference in Westin Copley Place, Boston MA.

7. I ncentive Spirometer DB+ CO ral Care U nderstand/ Education G et out of bed/Mobility H OB 30˚ Pain Control % Patients17%52%60%21% 17% chair 76% walking48%86% Audit Results

8. PDSA, Improvement Charter… Goal: I ncentive Spirometer DB+ CO ral Care U nderstand/ Education G et out of bed/Mobility H OB 30˚ Pain Control % Patients 17%52% 60% 21% 17% chair 76% walking 48%86%

9. Goal 50% reduction in post-op pneumonia rates in General Surgery, Vascular and Otolaryngology by June 2013

10. Challenges Engagement, Buy-In, Ownership Details, details, details! –Care plans, education materials, staff education

11. Overcoming Challenges Enlist people with expertise and influence TRIZ/TIPS Don’t re-invent the wheel! Best practice guidelines Utilize PDSA, Improvement Charter, SBAR Don’t give up!

13. Going forward… Prep T8/9 units December 2012: In-services, educational materials, care plan GOLIVE January 2013 Ongoing PR Schedule ongoing audits PDSA ongoing Hospital-wide?

14. Thank you!

15. Contacts VCH NSQIP Team: VCHNSQIPCOORDINATORS@VCH.CA