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Building a business case for colorectal surgery quality improvement
Ken K H Lee1, Sean M Berenholtz, Deborah B Hobson
11 Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland 2 The Johns Hopkins Hospital, Baltimore, Maryland 3 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 4 Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Background:
Improving surgical quality is a priority, but building a business case for the efforts could be challenging. Bridging the gap between the clinicians and hospital leaders is the first step to align quality and financial priorities within health care.
Objective:
The aim of this study was to evaluate the financial impact of the surgical comprehensive unit-based safety program on colorectal surgery procedures.
Design:
This a retrospective cohort study.
Setting:
This study was conducted at a university-based tertiary care hospital.
Patients:
All patients undergoing colectomy or proctectomy between July 2010 and June 2012 were included.
Intervention:
A comprehensive unit-based safety program focused on colorectal surgical site infection reduction was implemented. Three surgeons participated in the program in year 1, and 5 surgeons participated in year 2. Patients were categorized as participating or nonparticipating based on the surgeon who performed the procedure.
Main Outcome Measures:
Resource utilization and cost were the main outcome measures.
Results:
During the 2 years, there were 626 patients who met the selection criteria. Participating surgeons operated on 444 patients (70.9%), and the nonparticipating surgeons operated on 182 patients (29.1%). After adjusting for covariates, the variable direct cost was significantly lower for the participating surgeons in laboratory work by $191 (p = 0.009), operating room utilization by $149 (p = 0.05), and supplies by $615 (p = 0.003). The surgical site infection rates, need for an intensive care unit stay, and length of stay were not significantly different between the 2 groups.
Limitations:
The multiple biases related to surgeon self-selection for program participation and surgeon training and clinical skills were not addressed in this study owing to the limitations in sample size and data collection.
Conclusion:
A comprehensive unit-based safety program implementation, including dedicated frontline providers who focused on the standardization of protocols, was able to reduce the variation in resource utilization and costs in comparison with a control group.
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