Mutual reporting of process and outcomes enhances quality outcomes for colon and rectal resections

This report describes the favorable results of mutual reporting of process and outcome of care for major resections of the colon and rectum, one of six focal points for the Center for Medicare Services studies seeking to broadly reduce death and complications and enhance consistency of care.

A group of 66 surgical specialists in 9 cities in Kentucky reported cases to a quality improvement network over the past 5 years, and these data were supplemented by chart verification and patient satisfaction surveys. Consecutive colon and rectal resections (N=309) were reported by 23 general and colorectal surgeons. Eighty percent of the operations were performed by 4 surgeons.

Forty-four percent of the patients had colorectal cancer, and 27% had diverticulitis; 84% of colon resections were performed by general surgeons whereas 77% of rectal resections were performed by colorectal specialists. Audit showed 6 leaks/fistulas and 16 patients who required unscheduled readmissions. Eleven patients had prolonged ileus. Only 2 patients died. Consensus among network surgeons included the following: 1. Mutual reporting led to a narrowing of choices and improved timing for antibiotic prophylaxis. 2. Standard order sets in one hospital led to a shortened duration of stay. 3. Surgeon participation in a quality improvement network led to a safe reduction in preoperative cardiology consultation. 4. More patients arrive with all evaluations complete due to increased utilization of preoperative anesthesiology clinics. 5. Enhanced operating room throughput has been achieved by joint anesthesia/surgery reporting and includes reduced time to induction of anesthesia and in the Post-Anesthesia Care Unit and lessened use of expensive postoperative antiemetics. 6. Reported medication errors were reduced by standard order sets, as were other reported adverse events.

Practicing surgeons meet and/or exceed published benchmarks for colorectal resections and can further improve their outcomes by standardization and refinement of orders and procedures and improved collaboration with anesthesiologists.