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The Business Case for Surgical Quality—Using a Multidisciplinary Team to Drive Pediatric Surgery Quality Improvement

Wolcott, Kori, BSN, RN; Schriefer, Jan, MSN, MBA, DrPH; Michels, Julie, MS, RN-BC; Meyers, Jeffrey, MD; Hilt, Suzanne, RN, MS, CPNP; Gitzelmann, Christopher, MD; Pegoli, Walter Jr., MD; Caserta, Mary, MD; McGuire, Anna, MD; Thirukumaran, Caroline, MBBS, MHA, PhD; Pulhamus, Marsha, CPNP, RN; Foito, Theresa, FNP-BC, RN; Sanders, James, MD

Journal of Pediatric Surgical Nursing: January/March 2019 - Volume 8 - Issue 1 - p 15–20
doi: 10.1097/JPS.0000000000000197
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Background Quality improvement efforts in pediatric surgery can positively impact both outcomes and cost.

Purpose The use of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP)–Pediatrics was essential in determining where to focus our efforts.

Methods Utilizing risk-adjusted outcomes data is the key driver behind our successes as a multidisciplinary team. This team, which now includes a parent representative, meets at least monthly to review data, identify trends and problems, propose new change ideas, identify barriers to change, and celebrate success. Detailed agendas and minutes are circulated to all team members to ensure a shared mental model.

Results Since initiation in 2011, our efforts have resulted in a decrease in multiple morbidities, including surgical site infections, blood transfusions, preoperative Computerized Tomography use for patients undergoing appendectomy, unplanned reintubations, shorter lengths of stay, and fewer readmissions. Our improvement efforts resulted in an estimated cost savings of $1.5 million over a 2-year period (2015–2016).

Conclusions Our team used NSQIP data to direct and guide quality improvements in patient care.

Implications The business case for surgical quality comes from getting a return on investment in NSQIP with multidisciplinary teams led by surgeons and nurses.

Kori Wolcott, BSN, RN Surgical Case Reviewer, Department of Surgery, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Jan Schriefer, MSN, MBA, DrPH Associate Professor, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Julie Michels, MS, RN-BC Quality Assurance Performance Improvement Specialist, Pediatric Quality Improvement, Department of Nursing, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Jeffrey Meyers, MD Associate Professor, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Suzanne Hilt, RN, MS, CPNP Nurse Practitioner, Department of Nursing, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Christopher Gitzelmann, MD Associate Professor, Department of Surgery, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Walter Pegoli Jr., MD Professor, Department of Surgery, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Mary Caserta, MD Professor, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Anna McGuire, MD Resident, Department of Surgery, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Caroline Thirukumaran, MBBS, MHA, PhD Assistant Professor, Department of Orthopedics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Marsha Pulhamus, CPNP, RN Nurse Practitioner, Department of Nursing, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Theresa Foito, FNP-BC, RN Nurse Practitioner, Department of Nursing, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

James Sanders, MD Professor, Department of Orthopedics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY.

Dr. Schriefer is a consultant at Vermont Oxford Network.

Correspondence: Jan Schriefer, MSN, MBA, DrPH, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, 601 Elmwood Ave., Box 667, Rochester, NY 14642. E-mail: jan_schriefer@urmc.rochester.edu

Copyright © 2019 American Pediatric Surgical Nursing Association
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