Using the veterans administration national surgical quality improvement program to improve patient outcomes

Background. The primary goal of collecting quality assurance data is to ult imately improve patient care. The VA National Surgical Quality Improvement Program (NSQIP) provides each station with risk-adjusted morbidity and mort ality data on a regular basis. This report of one medical center's use of t he risk-adjusted data shows how it can be used to improve patient care. Materials and methods. Risk-adjusted surgical outcome data for Fiscal Year 1996 (FY96) was received from the NSQIP coordinating center. The Salt Lake City VA medical center was identified as a high outlier for morbidity in ge neral surgery. Patient charts were reviewed and data analyzed to determine practice patterns and to determine if there were any provider issues. Data analysis revealed a large number of wound complications and uncovered a pra ctice pattern of closure of contaminated wounds. Using these data and data from the literature, wound infection and disruption prevention protocols we re instituted in the fall of 1997. Wound complications from January to Dece mber 1996 (preprotocol) and January to December 1998 (postprotocol) were co mpared using Student's t test. Results. The total number of operations in 1998 was 719 compared with 634 i n 1996. Superficial wound infections dropped from 3.6 to 1.7%, while overal l wound complications dropped from 5.5 to 2.9%. None of these changes were statistically significant. Conclusions. Although introduction of wound infection and disruption preven tion protocols did not result in a statistically significant decrease in wo und complication, it did result in a clinically significant improvement in patient care.