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Patient Safety in Action: Cutting through Challenges to Improve Surgical Quality Outcomes in the MHS

Doctors perform surgery in an operating room. The Military Health System has formed Surgical Quality Learning Partnership teams and with the guidance of the Institute for Healthcare Improvement is identifying ways to improve surgical team processes and reduce incidences of surgery-related complications.

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Surgical site infections, urinary tract infections, post-operative readmissions and venous thromboembolism are some of the challenges 22 surgical teams across the services and National Capital Region are focused on reducing. To improve operating room processes and reduce the incidences of these and other surgical complications, the Military Health System has partnered with the Institute for Healthcare Improvement and formed Surgical Quality Learning Partnerships.  

The Need for Surgical Quality Improvement

The participating SQLP teams identified specific areas to improve based on data from the American College of Surgeons National Surgical Quality Improvement Program. Surgical quality clinical reviewers abstract data from patient records, which is entered into an ACS workstation, risk-adjusted and compared to data from other participating military treatment facilities and civilian and military hospitals. From this comparison, MTFs can see how they ranked among more than 600 health care facilities.

“The treatment of surgical complications, which can delay patient healing and require additional staff and medical resources can add up,” said Lt. Col. Kelli Lorenzo, an inpatient quality manager at the Air Force Medical Operations Agency and quality advisor for the NSQIP.  “Decreasing these incidents moves us closer to our Trusted Care goal of ‘zero harm,’ improves patient outcomes, preserves resources and can mean significant cost savings.”

The Impact of the Learning Partnership

Among the SQLPs are seven Air Force teams that are progressing well with their projects, according to Col. Gregory York, the surgical services consultant to the Air Force surgeon general and program lead for the learning partnership. 

MTFs across the MHS are already using evidence-based patient safety communication tools such as SBAR (Situation Background Assessment Recommendation), briefs and debriefs. But to move toward becoming a high reliability organization and support MHS strategic goals, the IHI is helping the services and NCR take things to the next level.

“The biggest way this learning partnership is helping is by providing the surgical community with the education they need to address surgical quality and process improvement,” York said. “The IHI faculty are providing very upfront and personal education to our teams through regular follow-up and weekly huddles.”

The partnership is having an impact on facilities like the Mike O'Callaghan Military Medical Center at Nellis Air Force Base in Nevada that implemented an enhanced recovery after surgery program after noticing an increase in surgical site infections. Today, they are now among the top 10 percent nationally-ranked health care facilities for surgical site infection rates.

“By decreasing surgical site infections, they have dropped their readmission and morbidity rates as well and sustained these numbers for about two years,” Lorenzo said. “They used NSQIP data findings to focus their process improvement efforts, selecting specific strategies that were effective in making things better.”

York said it usually takes a while for a change like this to take effect, but he believes the teams are seeing a change in culture because they are tackling an issue on a weekly basis. 

Lorenzo added, “IHI is growing this group of surgeons, nurses and support members who are going to start looking at things differently in their facilities and ask ‘What can I do to effect change?’ IHI has given a lot of guidance on how to figure out what change needs to happen and how to measure it to see if it was successful.” 

Standardizing New Processes

There are a few ways the participating MTFs are sharing their lessons learned with other health care facilities outside the learning partnership program.

“The MHS Surgical Quality Consortium involves representatives from every department of every MTF,” York explained.  “It’s a fairly large consortium that meets a couple times a year. We are using this venue to pass along lessons learned.”

Lorenzo acknowledged collaboration across the services has improved and she is in contact with her tri-service colleagues almost daily. “When this project is completed, there may be certain processes we want to standardize across all the services,” she said. 

In the next iteration of this IHI partnership, next year, it is anticipated all MTFs will participate and focus on one topic that will be tackled enterprise-wide, measured and standardized.


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