Best Practice Adherence
The ISQIC Solution
While ACS NSQIP is a tremendous outcomes-driven registry, the collaborative felt it was important to additionally focus on best practice measures. Thus, we worked with collaborative members to find out what issues were most important. Based on the results of our discussions, we developed novel best practice measure bundles to address the suggestions raised by the group. We created abstraction guidelines, piloted the measures at 2-3 member hospitals, and implemented the measures across the state at all 51 ISQIC hospitals.
To facilitate acting on areas of poor performance identified by the process measures, ISQIC hospitals are going through formal quality and process improvement training methods such as DMAIC. They are also learning when and how to do a Root Cause Analysis or a Failure Modes and Effects Analysis. Finally, we have developed toolkits to assist hospitals in creating effective interventions based on the types of issues uncovered by their process measure performance. Importantly, ISQIC has facilitated statewide and local efforts to work on the issues most important to ISQIC collaborative members.
Selected Best Practice Measure Bundles
Ensuring Comprehensive VTE Prophylaxis – Composite post-operative VTE prophylaxis measure consisting of early ambulation, SCD use, and chemoprophylaxis at the correct dose and frequency throughout hospitalization.
Post-Discharge VTE Prophylaxis – Measure evaluating whether or not post-discharge VTE prophylaxis was ordered and for how many days.
Appropriateness of Blood Transfusions – Measure utilized to collect information on blood transfusions performed throughout hospitalization allowing hospitals to analyze whether or not transfusions are being performed for appropriate indication.
Surgical Site Infection Bundle – Packaged measures implemented to decrease surgical site infection rates in patients undergoing colorectal surgery throughout the perioperative period.
Glycemic Control – Trio of measures evaluating adherence to preoperative screenings for patients with known diabetes or who are at risk for diabetes or pre-diabetes.
Quality of Colonoscopy – Measure assessing whether colonoscopy benchmarks are met, including adequacy of bowel preparation, visualization of the ileocecal valve, withdrawal time, adverse event occurrence, and appropriateness of colonoscopy follow-up interval.