Joseph Bozzay, MD, Matthew Bradley, MD, Angela Kindvall, BSN, Ashley Humphries, MD, Elliot Jessie, MD, MBA, Judy Logeman, MSN, Jeffrey Bailey, MD, Eric Elster, MD, Carlos Rodriguez, DO, MBA. Walter Reed National Military Medical Center
INTRODUCTION: Combat trauma volume brought to our American College of Surgeons’ level 2 verified trauma center has decreased substantially. As such, opportunities to maintain a robust trauma Process Improvement (PI) program and corresponding institutional readiness have also decreased. Since emergency general surgery (EGS) and trauma patients utilize similar hospital resources, we developed an EGS PI program based on trauma PI principles. As a method to maintain the readiness of our Acute Care Surgery system, we merged our trauma and EGS PI programs to allow for new or earlier identification of opportunities for improvement. We present an analysis of the first 18 months of combined ACS PI data.
METHODS AND PROCEDURES: A formal EGS registry and PI program was established on January 1, 2016. Registry entry criteria were based on published AAST recommendations and PI filters were based on our existing trauma PI program. Dedicated coordinators made inpatient rounds and reviewed patient charts daily. Deviations from standard practice patterns, unplanned interventions, and adverse outcomes were abstracted, categorized, and evaluated through levels of review similar to accepted trauma PI principles. Data for the first 6 quarters was collated and trends were analyzed. Findings were addressed in appropriate multi-disciplinary meetings or morbidity and mortality conferences. Resulting data and projects developed from analysis of integrated PI data are reported.
RESULTS: From January 1, 2016 – June 30, 2017, 696 EGS patients met registry inclusion criteria, with 468 patients (67%) undergoing operative intervention. Over the same time, 353 trauma patients were admitted with 158 undergoing operative intervention (56.4%). Of the 696 EGS patients and 226 trauma patients, 226 (32%) and 243 (69%) experienced PI events, respectively. New and existing PI initiatives amongst the trauma and EGS cohorts are shown in figure 1. Non-surgical admissions and unplanned therapies were the most common PI events for the trauma cohort while unplanned therapies and re-admissions were the most common events for the EGS cohort, which were identified as new PI initiatives. In addition, unplanned ICU admissions and incidental imaging findings were also new EGS PI events.
CONCLUSION: In an 18 month period, our integrated ACS PI program uncovered an additional 226 PI events, developed 4 new PI initiatives, and provided a substrate for continued improvements in patient care, which are vital components for maintenance of readiness to our military trauma center. Other programs may realize a similar benefit from developing an integrated ACS PI program.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87030
Program Number: S007
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium