nsqip supports pneumonia prevention at vancouver general hospital irene siu spotlighting surgical...
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NSQIP Supports Pneumonia Prevention at Vancouver General Hospital
Irene SiuSpotlighting Surgical Improvement in BC
November 16, 2012
Non-Risk Adjusted Pneumonia Rates May-Dec 2011
VGH SQAN NSQIP
Overall 2.6 1.3 1.3
General Surgery 3.6 1.9 1.4
Vascular 3.0 3.8 2.2
ENT 4.0 0.5 1.0
July 2012 SAR Risk Adjusted Pneumonia Outcomes
Odds Ratio Decile Status
ALLCASES 1.67 9High Outlier/Needs
Improvement
GEN 1.55 9 As expected
VASC 1.28 9 As expected
ENT n/a n/a n/a
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?
*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.
PDSA, Improvement Charter…
• Goal: Incentive
SpirometerDB+C Oral Care Understand/
EducationGet out of
bed/MobilityHOB 30˚
Pain Control
% Patients 17% 52% 60% 21%17% chair
76% walking 48% 86%
Goal
50% reduction in post-op pneumonia rates in General Surgery, Vascular and Otolaryngology by June 2013
Challenges
• Engagement, Buy-In, Ownership
• Details, details, details!– Care plans, education materials, staff education
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!
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?
Thank you!
