The practicing surgeon as a member of the quality-safety team.

The practicing surgeon is a valuable member of the quality-safety team and is often an underutilized data source for quality initiatives. The authors describe how their efforts in Kentucky, during a 10-year period, encouraged surgeons to become leaders in the quality initiative. Their experience began with the establishment of an organization of surgeons devoted to quality health care and cost control. As their efforts expanded and they gained experience, they were well prepared to transition to a regional and national quality initiative as part of a collaborative effort with the Centers for Medicare and Medicaid Services in the 2004 Surgical Care Improvement Project pilot. As a result of this ongoing experience, the authors we have been able to affect the quality of health care and have a positive influence on health care cost. They have demonstrated that surgeons will participate in and lead quality initiatives, and that these efforts foster an environment of cooperation between surgeons and hospitals.

Practicing surgeons lead in quality care, safety, and cost control.

OBJECTIVE: To report the experiences of 66 surgical specialists from 15 different hospitals who performed 43 CPT-based procedures more than 16,000 times. SUMMARY BACKGROUND DATA: Surgeons are under increasing pressure to demonstrate patient safety data as quantitated by objective and subjective outcomes that meet or exceed the standards of benchmark institutions or databases. METHODS: Data from 66 surgical specialists on 43 CPT-based procedures were accessioned over a 4-year period. The hospitals vary from a small 30-bed hospital to large teaching hospitals. All reported deaths and complications were verified from hospital and office records and compared with benchmarks. RESULTS: Over a 4-year inclusive period (1999-2002), 16,028 elective operations were accessioned. There was a total 1.4% complication rate and 0.05% death rate. A system has been developed for tracking outcomes. A wide range of improvements have been identified. These include the following: 1) improved classification of indications for systemic prophylactic antibiotic use and reduction in the variety of drugs used, 2) shortened length of stay for standard procedures in different surgical specialties, 3) adherence to strict indicators for selected operative procedures, 4) less use of costly diagnostic procedures, 5) decreased use of expensive home health services, 6) decreased use of very expensive drugs, 7) identification of the unnecessary expense of disposable laparoscopic devices, 8) development of a method to compare a one-surgeon hospital with his peers, and 9) development of unique protocols for interaction of anesthesia and surgery. The system also provides a very good basis for confirmation of patient safety and improvement therein. CONCLUSIONS: Since 1998, Quality Surgical Solutions, PLLC, has developed simple physician-authored protocols for delivering high-quality and cost-effective surgery that measure up to benchmark institutions. We have discovered wide areas for improvements in surgery by adherence to simple protocols, minimizing death and complications and clarifying cost issues.