Skarsgard Erik D, Bedford Julie, Chan Tamara, Whyte Simon, Afshar Kourosh
Division of General Surgery, BC Children's Hospital, Department of Surgery, University of BC, Vancouver, British Columbia, Canada.
Department of Quality and Safety, BC Children's Hospital, Vancouver, British Columbia, Canada.
J Pediatr Surg. 2014 May;49(5):682-7. doi: 10.1016/j.jpedsurg.2014.02.047. Epub 2014 Feb 22.
The pediatric NSQIP program is in the early stages of facilitated surgical quality improvement for children. The objective of this study is to describe the initial experience of the first Canadian Children's Hospital participant in this program.
Randomly sampled surgical cases from the "included" case list were abstracted into the ACS-NSQIP database. These surgical procedure-specific data incorporate patient risk factors, intraoperative details, and 30 day outcomes to generate annual reports which provide hierarchical ranking of participant hospitals according to their risk-adjusted outcomes.
Our first risk-adjusted report identified local improvement opportunities based on our rates of surgical site infection (SSI) and urinary tract infection (UTI). We developed and implemented an engagement strategy for our stakeholders, performed literature reviews to identify practice variation, and conducted case control studies to understand local risk factors for our SSI/UTI occurrences. We have begun quality improvement activities targeting reduction in rates of SSI and UTI with our general surgery division and ward nurses, respectively.
The NSQIP pediatric program provides high quality outcome data that can be used in support of quality improvement. This process requires multidisciplinary teamwork, systematic stakeholder engagement, clinical research methods and process improvement through engagement and culture change.
儿科国家外科质量改进计划（NSQIP）正处于促进儿童手术质量改进的早期阶段。本研究的目的是描述加拿大第一家儿童医院参与该计划的初步经验。
从“纳入”病例列表中随机抽取手术病例录入美国外科医师学会-国家外科质量改进计划（ACS-NSQIP）数据库。这些特定手术程序的数据纳入了患者风险因素、术中细节和30天结局，以生成年度报告，根据风险调整后的结局对参与医院进行分层排名。
我们的第一份风险调整报告根据手术部位感染（SSI）和尿路感染（UTI）发生率确定了本地改进机会。我们为利益相关者制定并实施了一项参与策略，进行文献综述以确定实践差异，并开展病例对照研究以了解我们医院发生SSI/UTI的本地风险因素。我们已分别针对普通外科科室和病房护士开展了旨在降低SSI和UTI发生率的质量改进活动。
NSQIP儿科计划提供了高质量的结局数据，可用于支持质量改进。这一过程需要多学科团队合作、系统的利益相关者参与、临床研究方法以及通过参与和文化变革实现过程改进。
