Home » For Health Care Professionals » Publications » Doctor's Digest » February/March 2011 » Surgical News: SLCH Joins ACS National Quality Improvement Program Focused on Pediatric Surgery
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Surgical News: SLCH Joins ACS National Quality Improvement Program Focused on Pediatric Surgery

St. Louis Children’s Hospital (SLCH) is one of only two pediatric facilities in Missouri to join the pediatric version of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP Peds). The success of the well-established adult NSQIP in providing participants with high-quality surgical outcomes data was a significant factor in SLCH’s decision to enroll in the program.

“Children’s Hospital is committed to quality improvement in the realm of our surgical care. This new program has the capability of providing us with valuable information that will help us identify our best practices, develop quality improvement targets and improve patient care and outcomes,” says Jacqueline Saito, MD, SLCH pediatric surgeon and surgeon champion for NSQIP Peds at the hospital. “Within BJC HealthCare, Barnes-Jewish Hospital and Boone Hospital Center in Columbia, Mo., are participants in the adult NSQIP. We know from their experience that the program offers valuable insight.”

One of the major advantages of the NSQIP surgical outcomes data is that it is risk adjusted to take into account patients’ severity of illness. “Obviously, when you care for higher-risk patients as we do at Children’s Hospital, there are more possibilities for complications developing,” says Dr. Saito. “If the data collected from all the participating hospitals is not adjusted for that risk, then what may look like a problem for us could simply be the result of caring for children who are sicker or who undergo more complex procedures.”

A requirement for enrolling in ACS NSQIP Peds is the addition to staff of a dedicated surgical clinical reviewer to collect and submit data on patients. Janet Adams, RHIA, fulfills that function for SLCH.

“The program requires us to collect approximately 120 data points that are relevant to measuring surgical outcomes in children under 18 years of age and that cover preoperative, intraoperative and postoperative information,” says Adams. “Over the course of eight-day cycles—46 per year—data are inputted from the first 35 surgeries to fit the NSQIP criteria, with follow-up information posted for 30 days following patients’ discharge. Selections are taken from general surgery, vascular, thoracic, orthopedics, neurosurgery, urology, otolaryngology, gynecology and plastics.”

SLCH joined ACS NSQIP Peds and began submitting data a year ago, and the first outcomes reports are expected within about six months. These will include:

  • Semiannual reports comparing SLCH’s risk-adjusted surgical outcomes to other participating centers on a blinded basis for all operations combined and by subspecialty.
  • Online access to daily center-specific reports as well as those comparing SLCH’s metrics to national averages.
  • Monthly data analysis for ad hoc specialized reports.

“These reports will give us valuable information regarding our actual surgical practices and processes, as well as insight into how our risk profiles and outcomes compare to peer medical centers and with national averages,” says Mara Bollini, SLCH patient safety program director. “In total, there are about 30 pediatric facilities participating, including SLCH peers like Cincinnati Children’s Hospital, Children’s Hospital Boston, Children’s Hospital of Philadelphia and Johns Hopkins Hospital.”

As SLCH’s surgeon champion, Dr. Saito will help interpret the data and develop ways to identify strengths and areas for improvement. She also is a member of the NSQIP Peds’ national Data Definition Committee, which is working to refine the program’s parameters.

“Complications after surgery that are tracked in the adult NSQIP such as a heart attack or a blood clot going to the lung are rare in children. But we are concerned about too much pain medication causing breathing problems in patients and about wound infections,” says Dr. Saito. “We are working to ensure NSQIP Peds focuses on pediatric-specific issues so that the information we receive is as relevant and therefore as informative as possible.”