View
0
Download
0
Category
Preview:
Citation preview
PEDIATRIC NSQIPINTERNAL QUALITY ASSESSMENT
THINGS YOU CAN DO AT HOMESALT LAKE, 2012
IT ALL BEGINS WITH
ACCURATE AND CONSISTENT DATA
INTERNAL QUALITY AUDIT
INTERNAL QUALITY AUDIT
WHAT DO YOU KNOW ABOUT YOUR OWN DATA?
NSQIP IS NOT THE ONLY PROGRAM ANALYZING YOUR PERFORMANCE
SPEAK A COMMON LANGUAGE AT HOME CPT CODING CHART REVIEW, DESCRIPTIVE DATA
INTERNAL QUALITY AUDIT
WHO DOES IT?
IF THE SURGEON DOES IT, DOES EVERYONE DO IT THE SAME?
IF THE SURGEON DOESN’T DO IT, HOW IS THE DECISION MADE?
WHICH SOURCE IS USED FOR NSQIP SELECTION?
CPT CODING
CPT CODING FOR APPENDECTOMYPROCEDURE 44950 44955 44960 44970 444979
App with open Ladd’s
8
Acute pain, neglap app
1 7Lap app, not ruptured
8
Lap app ruptured
3 5Open app, not ruptured
8
Open app, ruptured
8Lap interval app
8
INTERNAL QUALITY ASSESSMENT
WOUND CLASSIFICATION CLEAN IS CLEAN BUT WHAT IS DIRTY?
HOW IS WOUND CLASS ASSIGNED AT YOUR INSTITUTION? COMPUTER- BASED ON PREOP CPT NURSE ASSESSMENT SURGEON ASSESSMENT
HOW DOES IT COMPARE WITH YOUR SCR ASSESSMENT?
515 PEDIATRIC SURGERY CASES
REVIEWED
481 CASES (93%) HAD A CORRECT
WOUND CLASSIFICATION
34 CASES (7%) HAD AN
INCORRECT WOUND
CLASSIFICATION
ALL THE WOUND CLASSIFICATION
ERRORS WERE AN UNDER ESTIMATE OF
THE CORRECT WOUND
CLASSIFICATION.
DISCOVERY OF A PROBLEM
9
• Lack of understanding of correct wound classification and its importance.
• Lack of awareness that wound classification discrepancies exist in the electronic charting.
• Auto population contains intrinsic errors
• Premature placement of wound classification data in computer flow algorithm.
• Auto population of wound classification produces errors.
PEOPLE TECHNOLOGY
OPERATIVE FINDINGS
CLEAN CLEAN‐CONTAMINATED
CONTAMINATED DIRTY
Ladd’s procedure 8Acute pain, negative appendix
8Edema, inflamed 4 4Edema, inflamed with cloudy fluid
2 6Edema, Inflamed with gross pus
2 6Acute inflam with exudate on appendix
1 6 1
Gangrene 2 6rupture 8Interval appendix 7 1
WOUND CLASS ASSIGNMENT FOR APPENDECTOMY BASED ON INTRAOPERATIVE FINDINGS
HEIGHT AND HEIGHT
WHY DOES IT MATTER?
INTERNAL QUALITY AUDIT
HEIGHT AND WEIGHT
IMPORTANT FOR PATIENT CARE IN DETERMINING MEDICATION DOSING
POTENTIAL VALUE FOR NSQIP TRANSFUSION VOLUMES RELATED TO WEIGHT RISING INCIDENCE OF PEDIATRIC OBESITY
Outcomes of perforated appendicitis in obese and nonobese children.Garey CL, Laituri CA, Little DC, Ostlie DJ, St Peter SD.J Pediatr Surg 2011 Dec:2346
Childhood obesity: a risk factor for injuries observed at a level-1 trauma center.Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP.J Pediatr Surg 2009 Aug:1601
Determination of risk factors for deep venous thrombosis in hospitalized children.Vu LT, Nobuhara KK, Lee H, Farmer DL.J Pediatr Surg 2008 June:1095
CHILDHOOD OBESITY-A RISK FACTOR FOR SURGICAL MORBIDITY?
Abstract(text)Abstractabstractabstractabstract2020
RUPTURED APPENDIXPatient DemographicsJuly-December 2011
(35 Total Patients)
CHARACTERISTIC NUMBER
MALES 23
FEMALES 12
MEAN AGE(2-16 yr)
5
MEAN BMI (reported in 9/35 patients)
23.4
BMIsBEYOND BELIEF
Review of all pt BMI greater than 40 Range 41.7 to 152.6 22 patients
Data review 13 pts correct (BMI 41.7 to 57.3) 3 error due to data download 3 error due to typing entry 3 error due to height entered by nurse in inches but
recorded as cm
WEIGHT VARIABLE
NEONATES GROW QUICKLY EXAMPLE: 2 KG PTGROWS 15-20 GRAMS/DAY 7 X 20 = 140 2.14 KG 7% WT CHANGE IN ONE WEEK
SICK PATIENTS DON’T GROW WELL
SICK PATIENTS GET EDEMATOUS MAY DOUBLE OR TRIPLE WT DUE TO RETAINED FLUID
“WEIGHT FOR CALCULATION”
PEDIATRIC NSQIPINTERNAL AUDIT
PILOT PROJECTS REVIEW REPORT AND SEE WHAT CASES ARE MOST
COMMON REVIEW OCCURRENCE REPORTS BY COMMON CPT
AND SEE IF THERE ARE PROBLEM AREAS CHOOSE AN AREA OF LOCAL INTEREST TO VALIDATE
SAMPLING
CUSTOM FIELD DATA POINTS
ENLIST A SUBSPECIALIST FOR EACH SURGICAL SPECIALTY UROLOGY ENT PLASTICS NEUROSURGERY ORTHOPEDICS
INTERNAL QUALITY AUDITAT HOME
SHOW THEM WHAT WE COLLECT
DESCRIBE HOW IT MAY IMPACT THEM
ASK THEM HOW WE COULD DO MORE WITH THE DATA
INTERNAL QUALITY AUDITENLIST A SUBSPECIALIST
Laminectomy for Tethered CordPatient Demographics NSQIP Sample
July-December 2011
CHARACTERISTIC NUMBER
MALES 15
FEMALES 18
MEAN AGE(0-18 yr)
8
MEAN BMI (reported in 24/32 patients)
18
Laminectomy for Tethered CordJuly-Dec 2011
TOTAL CASES COMPARED TO NSQIP SAMPLE
Data Element All 33 Cases NSQIP 21 Cases
Primary Surgery 26 (79%) 15 (71%)
Reoperative Surgery 7 (21%) 6 (29%)
Mean Length of Surgery
(minutes)218 256
Mean LOS (days) 3 4
HOW TO MAKE IT WORK FOR YOU
ENGAGE A SUBSPECIALIST IN EACH AREA
LOOK FOR CONSTRUCTIVE PROJECTS
SHOW HOW GOOD DOCUMENTATION HELPS
FIND AREAS WHERE YOU CAN DO BETTER
Recommended