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Report provides transparency on patient safety and quality initiatives
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The Department of Orthopaedic Surgery at NYU Langone Medical Center recently published its 2012 Quality and Outcomes Report, which promotes transparency in administrative processes and improvement all aspects of the patient experience.
It is the department’s second annual analysis of quality and patient satisfaction data for orthopedic procedures at the hospital.
“Readmissions, length of stay, communication with doctors, pain management, communication with nurses — all of these are important outcome measures somewhat different than what orthopedists are used to,” Joseph D. Zuckerman, MD, chair of the Department of Orthopaedic Surgery at NYU Langone Medical Center, told Orthopedics Today. “As orthopedists, we are used to reporting the outcomes of hip replacements, patient satisfaction 2 years afterward, hip scores, knee scores and such, but this goes beyond that.”
“Quality means reporting the outcomes of what we do as well as the patient experience,” he added. “It is a bit of a road map for us, and what we have to do to keep ourselves ahead of the curve.”
A collaborative effort
According to their news release, the report represents a collaborative effort across the medical center to identify, evaluate and enhance the quality of orthopedic care provided across the institution.
“When you spend the time and effort to analyze what you are doing after actually putting it together, you are able to step back and see the entirety of it — and most importantly, you can see how you need to improve,” Joseph Bosco, MD, the department’s vice chair of clinical affairs and lead on the development of the report, told Orthopedics Today.
According to the release, the outcomes data are measured against benchmarks established by internal medical center quality teams and the University Health System Consortium — an alliance of 115 academic medical centers and their affiliated hospitals.
“We are going to be judged by our performance across national standards, so we are competing with each other and being compared with each other. We want to know where we stand and what we have to do to get better,” Zuckerman said. “We are putting a lot of resources, time and effort into making sure we can provide our patients with the best experience.”
Findings
The report focuses on clinical factors — such as the prevention of venous thromboemboli and prophylactic control of methicillin-resistant Staphylococcus aureus (MRSA) prior to surgery — as well as other factors such as length of patient stay and decrease of overall readmission rates.
One study in the report revealed that a screening and decolonization program for methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus, which included a 5-day course of nasal mupirocin, vancomycin perioperative prophylaxis and a preoperative chlorhexidine shower, was able to decrease infection rates for primary total knee and hip surgery. Another study found that rapid rehabilitation started in the recovery room resulted in a statistically significant drop in total length of stay for patients who underwent total joint replacement compared to therapy started on the first postoperative day.
Surgical site infection (SSI) rates across several procedures during the previous five quarters were also included, with the report listing an SSI rate of 0.74% for primary total knee, 2.16% for spine, 0.68% for shoulder arthroplasty (including reverse shoulder) and 0.32% for primary hip procedures.
Average length of stay for primary total hip and knee procedures, the report also noted, dropped from 5.12 days in late 2008 to 4.02 days in mid-2011.
Helping institutions improve
“We improved the quality of care for our patients, but more importantly, I think as leaders in the field of orthopedics and musculoskeletal medicine, we have put it out there for other people to read and understand,” Bosco said.
“Hopefully, they can learn from our mistakes and what we have done well and improve the quality of their own patients to create more robust care,” he added.
According to Zuckerman, the report is a step toward what will be the future of outcomes reporting — an all-encompassing look at health care, not just through the eyes of physicians and administrators, but patients as well.
“The parameters we are going to be judged on are changing,” he said. “We need to be just as good outside the operating room as we are inside of it.” – by Robert Press
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For more information:
- Joseph Bosco, MD, can be reached at 301 East 17th St., New York, NY 10003; 212-263-2192; email: joseph.bosco@nyumc.org.
- Joseph D. Zuckerman, MD, can be reached at NYU Hospital for Joint Diseases, 301 East 17th St., Suite 1402, New York, NY 10003; 212-598-6674; email: joseph.zuckerman@nyumc.org.
- Disclosures: Zuckerman has no relevant financial disclosures. Bosco has sponsored research from 3M Corp.