Improving safety and outcomes
The Department of Surgery continues to strengthen its patient safety and clinical effectiveness programs at Barnes- Jewish Hospital and Barnes-Jewish West County Hospital through workgroups that analyze outcomes data and take steps to improve care.
Two years ago, the department established surgeon-led teams to address surgical-site infections (SSIs), venous thromboembolism events and postoperative heart attacks. As an example of these efforts, for patients undergoing colorectal and urologic surgery, the SSI team developed and implemented a set of standardized protocols that have led to better outcomes. Currently, the team is studying which steps mattered most, with a goal of eliminating ones that made no difference.
“To minimize surgical site infections, our protocol starts at the patient’s home,” says Gerald Andriole Jr., MD, the Robert K. Royce Distinguished Professor of Urologic Surgery and division chief. “Additionally, there are special steps in pre-op, during surgery, and postoperatively. The goal is to minimize SSIs and to enhance early recovery after surgery.”
Andriole, who was recently named the department’s vice chair for patient safety and clinical effectiveness, leads a formal departmental organization charged with assessing and improving quality of care. In the past year, the department also held its First Annual Patient Safety and Clinical Effectiveness Meeting, highlighting projects in which faculty and trainee groups identified clinical problems, outlined steps to address them and reported on outcomes.
Surgeon Bruce Hall, MD, PhD, MBA, serves as vice president for patient outcomes at BJC HealthCare — one of the nation’s largest academic hospital groups. Hall has worked with other department surgeons on the patient safety and quality initiatives and tracks results through the National Surgical Quality Improvement Program of the American College of Surgeons (ACS NSQIP®). He is associate director of the ACS NSQIP nationwide, and has led its implementation at BJC hospitals.
Hall says value-based purchasing and high-risk contracts are realities that encapsulate the future. “The government is now setting the example that it won’t pay for volume of procedures, but for quality. In a high-risk contract, you get paid to take care of a patient for a set period, no matter what happens,” he says.
New appointments support improvement efforts
Urology Division Chief Gerald Andriole Jr., MD, the Robert K. Royce Distinguished Professor of Urologic Surgery, has been named vice chair for patient safety and clinical effectiveness. Andriole also leads the department’s Patient Safety and Clinical Effectiveness Committee.
The department has developed an organized structure to promote patient safety and clinical effectiveness. Each division and section has two surgeons providing leadership, one with responsibility for patient safety and the other for clinical effectiveness. Tracey Guthrie, RN, director of clinical trials, is now also director of clinical effectiveness. Vicky Peck, RN, director of clinical operations for the urology division, coordinates patient safety activities.
The team works with surgeon Bruce Hall, MD, PhD, MBA, BJC HealthCare vice president for patient outcomes, who oversees data collection for the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP®) and leads other quality improvement efforts at BJC hospitals.