Collaborating to Improve Surgeries

The South Carolina Surgical Quality Collaborative Seeks Data-Driven, Patient-Centered Improvements in General Surgery

It’s not something we like to think about, but surgical complications happen.

In fact, up to 17 percent of surgeries performed in the U.S. each year go less-than-perfect, despite the best intentions of hospitals and surgeons. Major mistakes like operating on the wrong part of the body or the wrong person still happen, although things are improving in South Carolina thanks to 100% participation in implementing a Safe Surgery Checklist in every hospital in the state.

But other mistakes can occur across the spectrum of care. A patient could receive inadequate instruction or assistance in order to take care of themselves after surgery, or might have missed a crucial step in the hours and days before entering the operating room.  

Clearly something can and must be done to bring that number down, which is why South Carolina began its Surgical Quality Collaborative (SQC). Modeled after similar highly successful programs in Michigan and Tennessee and funded by a three-year, $3.8 million grant to Health Sciences South Carolina (HSSC), the SQC works to improve surgical safety and truly provide the best level of surgical care.

HSSC and the South Carolina Hospital Association are the lead organizations, with BlueCross BlueShield South Carolina and the Medical University of South Carolina Department of Surgery serving as key collaborators. By focusing on 15 of the most common general surgical procedures and gathering comprehensive, near real-time data from participating hospitals, the Collaborative hopes to establish benchmark surgical outcomes statewide and find new approaches to improving quality and patient safety on a hospital-by-hospital basis.

“A highly skilled and trained nurse collects 240 different variables on each operation,” said SQC Program Director Larry Adams. “So they actually go through each chart, all the way through the 72 plus hours of the [system] experience. It goes through the pre-op phase, the inter-op phase, and the post-op phase, and includes a 30-day follow-up with the patient. Each variable will help us drive improvement on the specific operation.”

While many of these metrics are similar to those used by Michigan and Tennessee, South Carolina’s efforts stand apart for a number of reasons including a more holistic approach that incorporates general surgery residents and specifically trained nurses, as well as a genuine commitment to patient engagement as part of process improvement.

“South Carolina will be the first surgical collaborative to involve patients that in-depth,” said Adams. “We think we’re doing good pre-op teaching, but we want to know if we really are. What’s the patient’s perspective on surgical care, surgical quality? What can the patient teach surgeons and hospitals so that they can provide better care?”

To gather all those variables across various platforms, SQC uses nurse abstractors like Stephanie Webster, a Surgical Clinical Quality Reviewer at Spartanburg Regional Healthcare System.

“I get a list of patients that meet the criteria of the Collaborative and I just comb through the charts pulling out the variables that are required,” she said. “Everything from demographics and general information and insurance to any complications they have post-operatively within the 30-day timeframe.”
 
Webster’s job is to find the data wherever it might be—in progress notes, lab reports, operation notes, post-op follow-ups, outpatient records, or any other documents that data might be extracted from. That data is then fed through a platform developed by QCMetrix that helps consolidate, validate and integrate the surgical outcome information to allow easy benchmarking and analysis.

QCMetrix originally developed their program as a vendor for the Michigan Surgical Quality Collaborative, which they worked with for over a decade before signing on to South Carolina’s initiative.

“We know how to capture the right data and how to make sure that data is of the utmost quality," explained Babar Rao, Director and Technical Lead at QCMetrix. Rao is excited by what he sees as a different set of goals in South Carolina’s SQC, including a focus on patient engagement and cost to insurers.

The state’s initiative is already off to a strong start. The SQC came into existence in October 2015 and in its first six months proved to have a robust system in place to capture and respond to the data it’s collecting.

“We really needed significant buy-in from the administration and the surgeons,” said Dr. Prabhakar Baliga, Chief of Surgery at MUSC and one of the project’s leaders. “The surgeons are really the boots on the ground at the end of the day. They needed to own it, to be willing to have uncomfortable conversations and to make changes. [And] the amount of progress we’ve seen in such a short period is phenomenal.”

The SQC hopes to see this first iteration evolve into a larger endeavor that moves their efforts statewide. Dr. Baliga sees this as likely, given the success the Michigan effort had in bringing down errors and netting the state $50 million in savings.

“It’s more of a pilot program here to prove the benefits [at this point],” he said. “We’ll be looping more hospitals in. Six months in, this is a runway success.”