Surgical Quality Improvement: Local Quality Improvement

Abstract

The quality movement has dramatically changed both the practice and perception of healthcare over the last 30 years. In surgery, the unique details of any particular patient’s case may have made comparative quality reporting and benchmarking more challenging, but these obstacles should not let the surgical care of patients to be omitted from quality movement. The variation in outcomes following standardized surgical procedures has been recognized for many years. The Northern New England Cardiovascular Disease study group first reported regional variations in mortality following coronary artery bypass procedures that were attributable to different processes of care rather than underlying patient factors in 1996 (O’Connor et al. JAMA 275:841–846, 1996). Since then, a plethora of national and regional collaboratives have been organized to identify outperforming and underperforming institutions in an effort to highlight best practices for improving patient outcomes. Some of the most successful registry-based quality improvement efforts include the Society for Vascular Surgery Vascular Quality Index, Washington state’s Surgical Care and Outcomes Assessment Program, the Michigan Surgical Quality Collaborative, and the Tennessee Surgical Quality Collaborative. These collaboratives have identified important areas of improvement for enhanced patient outcomes and have disseminated their findings into everyday surgical practice (Englesbe et al. Ann Surg 252:514–519, 2010; Guillamondegui et al. J Am Coll Surg 214:709–714, 2012; Kalish et al. J Vasc Surg 60:1238–1246, 2014; Simianu et al. Ann Surg 260:533–538, 2014).