An innovative, data-driven approach to tracking, monitoring and improving surgical outcomes has changed how Duke Health’s head and neck surgeons define quality and safety success in surgery.

Traditionally, quality improvement and patient safety processes in surgical specialties are reactive, according to Jeffrey Cheng, M.D., medical director of Quality and Safety for the Department of Head and Neck Surgery and Communication Sciences.
“An event occurs,” he says, “and then there’s an event review, like an M&M, about who did what and when. Changes are made to try and prevent the next event. To be more proactive, we’ve adopted an improvement science-based approach that focuses on processes, not people.”

Using that improvement science framework, the team has created standard work based on evaluating data sources that may identify opportunities for improvement in patient quality and safety. Specific metrics have been identified for constant tracking and regular reporting. These include: unplanned returns to the operating room, unplanned readmissions, unplanned returns to the Emergency Department and surgical site infections.

These types of outcome measures allow for evaluation and monitoring of quality and safety rapid improvement projects. This tracking can potentially be leveraged in areas identified as quality improvement opportunities by major national organizations like the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), which has listed postoperative pain opioid stewardship and pediatric tonsillectomy postoperative hemorrhage as two such areas.

Instead of reporting an annual event rate, ongoing tracking for related metrics may allow for better evaluation in the context of the care delivery system. Understanding variation from year to year, identifying special variation upper control limits, and identifying targets can help identify when and if a larger concern develops.

Within the Department of Head and Neck Surgery and Communication Sciences, a dashboard tracking predetermined metrics is continually updated and analyzed. This constant monitoring allows the team to monitor progress and identify areas of opportunity for process improvement.

Measurement of clinical outcomes is the hallmark of an improvement science focused approach. Process changes are driven by what the data trends show, with a goal to decrease variation in patient care pre-operatively, during surgery and post-operatively. That way, Cheng notes, “People are able to do the right things at the right time with less likelihood of deviation or failure.”

Datasets could be a powerful tool in long term public health efforts, too, Cheng says. For example, value-based care is an evolving approach to health care reimbursement. Instead of how many procedures are being done, the program is moving towards measures of how well these procedures are being done. Measurement of clinical outcomes is integral to gauging performance in a particular area. 

As the team continues to collect data and study the trends, Cheng hopes more departments, hospitals and health systems will consider adopting these approaches. This information would give referring physicians and potential patients more tangible, data-driven measures to compare care management across institutions for specific conditions or procedures.