KNC surgery
Overall, UHN’s National Surgical Quality Improvement Program has helped improve stewardship of resources, enhance the patient experience and mapped where surgical teams can work to prevent and reduce surgical site infections. (Photo: UHN)

We live in a world where data is available for almost everything.

According to Eric Schmidt, the former CEO of Google, the data generated over the next 48 hours will be more than the data generated between the dawn of human time and 2003.

Data is everywhere, but is all of it useful? And, once we figure out what data is relevant, how do we use it in a way that is helpful?

In 2012, the General Surgery Department at Toronto Western Hospital (TW) was looking for ways to measure and improve surgical performance and signed up for the National Surgical Quality Improvement Program (NSQIP).

The program, managed by the American College of Surgeons in the United States, collects surgical outcomes data through a standardized approach and provides timely, audited reports that identify rates of surgical complications such as surgical site infections (SSIs), urinary tract infections, pneumonia, readmission and many more.

The program quickly showed promise and, after it was also implemented in General Surgery at Toronto General Hospital (TG), prompted UHN Surgeon in Chief, Dr. Shaf Keshavjee, to expand it to all eligible divisions of surgery at UHN.

Data pooled with hundreds of institutions around the world

UHN's National Surgical Quality Improvement Program (NSQIP) is overseen by co-leads Dr. Timothy Jackson, General Surgeon at TW, and Mary Ann Neary, Senior Clinical Director, Surgical Services at TG, with Joe Brubaker, nurse manager of TW's 9B Fell surgical unit, acting as NSQIP program manager.

Not only does NSQIP provide UHN's surgery divisions with their own data, but it also pools it with data from hundreds of institutions all over the world that participate in the program to provide statistics for comparisons which helps to benchmark our performance versus other reputable care centres, and can help identify ways to improve surgical outcomes.

"Data is really shaping a new way of doing business in healthcare," says Dr. Jackson. "Hospital funding models are changing with more focus on the quality and outcomes of the procedures that our institutions provide.

"Programs like this help us measure the value we provide to our patients and whether we're doing everything we can for them."

(L to R) Surgical Clinical Reviewers Amit Thakker, Rona Sales, Laavanyah Vigneswaran, Alvina Tse, April Krikke and NSQIP Manager Joe Brubaker work on quality improvement projects to improve surgical outcomes across TG, TW and PM. (Photo: UHN)

​​UHN's NSQIP initiative showed so much promise that the team put together a proposal for the Ministry of Health and Long-Term Care to encourage other hospitals to join the program. In 2015, the Ministry agreed and provided funding to establish a network of surgical quality improvement among 29 other hospitals across Ontario.

In November, Health Quality Ontario released the most recent report of Ontario Surgical Quality Improvement Network which showed that Ontario hospitals performed just as well or better than international peers.

So how does data drive better healthcare?

Amit Thakker is a Surgical Clinical Reviewer with UHN's NSQIP team which devotes five staff to work on surgical quality improvement projects across three sites. This past summer, Amit presented a poster of his recent project at the American College of Surgeons Quality and Safety Conference in New York that looked at how to reduce post-surgical Emergency Department (ED) visits.

Patients, who'd recently undergone certain orthopedic surgeries, were visiting the ED for follow up wound concerns instead of going to their family doctor or making an appointment at the fracture clinic.

UHN's NSQIP data from early 2016 showed that 11 per cent of patients who'd undergone an elective joint replacement therapy or hip fracture repair returned to the ED within 30 days of their surgery and, of those returns, close to half were related to wound concerns which would have been better managed outside of the ED.

Patients get checklist before leaving the hospital after surgery

By July 2016, the team had revised their post-operative patient education for these patients. Amit's team updated the existing brochure to provide patients with a checklist before leaving the hospital after surgery, how to care for their wound at home, and when and where to seek medical attention along with the contact numbers for the unit and the fracture clinic.

They also organized a discussion with TW's surgical unit nurses to update the discharge education. Nurses now read the brochure together with the patient before they leave the hospital to make sure they understand how to best care for their wound and how to seek help if they need it.

"These changes alone have shown many positive benefits," says Amit. "We save resources in the ED, patients are more likely to receive appropriate management of their issue and are less likely to end up on antibiotics, which is how wound concerns are often managed, and this also lowers UHN's surgical site infection rate in orthopedic patients."

Since the project has been implemented, ED visits related to wound concerns have decreased by about 20 per cent.

Overall, UHN's NSQIP has helped improve stewardship of resources, enhance the patient experience and mapped where surgical teams can improve SSIs. For the latter, the team had already begun work on projects to help prevent and reduce SSIs.

So when UHN's Caring Safely initiative was launched in 2015 and adopted SSIs as its Surgical Quality Improvement Plan, the work already done through NSQIP aligned well to support the initiative. Data from NSQIP provided the groundwork needed to organize projects to improve SSIs which were made part of the six Hospital Acquired Conditions (HACs) that Caring Safely seeks to address.

The SSI projects were arranged into eight bundles to implement across UHN's Surgical Services of which seven have been realized to date.

"It's really, in my opinion, such a common sense approach to healthcare," says Dr. Jackson. "Find out where you can do better, and do what you can to change it.

"The data we get now through this program is clearly identifying the opportunities for targeted improvement and showing us how we can make a difference." ​

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