RT Journal Article
SR Electronic
T1 Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E353
OP E359
DO 10.9778/cmajo.20170166
VO 6
IS 3
A1 Timothy Jackson
A1 David Schramm
A1 Husein Moloo
A1 Lee Fairclough
A1 Azusa Maeda
A1 Tricia Beath
A1 Avery Nathens
YR 2018
UL http://www.cmajopen.ca/content/6/3/E353.abstract
AB Background: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals.Methods: All Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools. Outcome measures included the level of quality-improvement capacity, collaborative-wide aggregate data on postoperative complications, and self-reported rates of surgical site and urinary tract infections.Results: Eighteen hospitals that enrolled in the ON-SQIN in 2015 reported an increase in their capacity for quality improvement after 18 months. Analysis of the collaborative-wide aggregate data in a 6-month period (14 748 surgical cases) revealed a substantial reduction of acute renal failure (relative risk 0.48, 95% confidence interval 0.25–0.95) and urinary tract infection (relative risk 0.77, 95% confidence interval 0.61–0.97). Most hospitals that targeted prevention of surgical site infection and urinary tract infection reported reduction of these occurrences during a 1-year period.Interpretation: The ON-SQIN supported the uptake of the NSQIP in Ontario hospitals and promoted targeted surgical quality-improvement initiatives, resulting in increased quality-improvement capacity and development of the community of practice. Furthermore, our early experience suggests that improvements in surgical care are being realized.