(Press-News.org) A group of pediatric surgeons at hospitals around the country have designed a system to collect and analyze data on surgical outcomes in children – the National Surgical Quality Improvement Program (NSQIP) is the first national database able to reliably compare outcomes among different hospitals where children's surgery is performed. The effort could dramatically improve surgical outcomes in children, say the initiative's leaders, who published their findings online August 5, 2013 in the journal, Pediatrics.
The model is based on a similar effort adopted nationwide nearly a decade ago for adult surgery that resulted in reduced mortality and dramatic decreases in post-surgical complications. These efforts, led by the American College of Surgeons (ACS), are being driven not by a federal mandate, but by a desire to improve patient care, says R. Lawrence Moss, MD, corresponding author of this new study and surgeon-in-chief at Nationwide Children's Hospital.
"The real impetus is that people want their patients to do better," said Dr. Moss, who has been involved with the initiative since its inception. "This was a surgeon-directed effort and the ultimate goal is to improve quality of patient care."
The ACS NSQIP-Pediatric began as a pilot in 2008 with four hospitals. The program now has 43 participating institutions that perform children's surgery. The August study is the third published by the group and details how a new statistical model designed specifically for children can be used to reliably discriminate performance among hospitals.
Historically, U.S. hospitals didn't track this kind of information in children or adults, because there was simply no way to collect, analyze and interpret the data in a way that made sense. For example, comparing outcomes of bypass surgery in a cardiac unit at an urban facility performing thousands of the procedures per year to those of an under-staffed rural hospital that rarely does the operation would be comparing apples to oranges, Dr. Moss said. A key component of NSQIP is its ability to accurately adjust outcomes for patient risk factors. This means NSQIP is able to compare hospital performance even when the institutions see different patient populations.
When the ACS implemented its model for measuring surgical outcomes in adult surgery in 2004, it quickly became clear that, while that system would be useful in an adult setting, it couldn't be used by pediatric surgeons. Not only does the adult model include surgeries that aren't performed in children, but the range of post-surgical complications is also different, Dr. Moss, said. Adults often suffer complications as a result of diabetes, smoking-related respiratory problems or coronary disease – comorbidities a surgeon wouldn't often see in a pediatric patient. Pediatric patients are more affected by congenital abnormalities and comorbidities specifically related to the diagnosis for which they are having surgery.
Procedures, comorbidities and potential complications are more specific to the pediatric population in the new model. In addition, this new program focuses more on morbidity as a measure of surgical outcomes, rather than mortality, which Dr. Moss said better encompasses the specific nature of pediatric surgery.
Furthermore, creating a "risk-adjusted" model allows pediatric surgeons to avoid the apples to oranges comparison, Dr. Moss said. Such elements as surgical case load, complexity of cases, patient demographics and other categories are factored into a highly precise algorithm. The resulting model allows a children's surgical department in a small-town hospital to meaningfully compare its outcomes with a large institution such as Nationwide Children's.
"In the unique world of children's surgery, we can now accurately obtain and share risk-adjusted outcomes in a way that will allow institutions to take actions that are going to improve patient care," said Dr. Moss, who also is the E. Thomas Boles Jr. Professor of Surgery at The Ohio State University College of Medicine.
Participating institutions employ a full-time surgical clinical reviewer who collects data in nearly 100 different categories, ranging from patient demographics to specific post-surgical complications patients experience within 30 days of surgery. Each institution submits its data, then receives a report that shows how they rank in the different categories. These rankings are blind, in that the only institution named in a report is the one receiving the report.
In the Pediatrics study, the new model was used to analyze data on 46,281 patients under the age of 18 who underwent surgery at 43 participating institutions in 2011. It's a proof-of-concept that the model works, said Jacqueline M. Saito, MD, MSCI, assistant professor of Surgery at Washington University and St. Louis Children's Hospital.
"An important milestone for the program is the ability to analyze hospital performance in multiple outcomes and by surgical specialty," said Dr. Saito, who is the lead author of the study. "Hospitals with below expected performance may use the information yielded from this analysis to improve surgical outcomes locally. Eventually, best practice guidelines will be developed using processes from hospitals with better than expected outcomes."
Now that the model has been tested, the ACS is inviting other institutions to join. The ACS program for adult surgery has hundreds of participating hospitals, and Dr. Moss predicts the pediatric program will also see a surge in participation. To share best practices, those institutions that have the best outcomes will be asked to share details of their programs at the ACS annual meeting.
INFORMATION:For more information on the American College of Surgeons National Surgical Quality Improvement Program-Pediatric, visit http://www.pediatric.acsnsqip.org/.
END
CINCINNATI—Screening everyone for HIV in the emergency department may be superior to testing only those with apparent risk, when trying to identify patients with undiagnosed HIV infection, according to a new results by researchers at the University of Cincinnati (UC).
Though the U.S. Centers for Disease Control and Prevention and national research organizations have recommended universal HIV screening, lead author Michael Lyons, MD, says there is still disagreement among physicians on how to implement screening in the nation's already busy emergency departments. Lyons, ...
PITTSBURGH—Molecules could soon be "scanned" in a fashion similar to imaging screenings at airports, thanks to a detector developed by University of Pittsburgh physicists.
The detector, featured in a recent issue of Nano Letters, may have the ability to chemically identify single molecules using terahertz radiation—a range of light far below what the eye can detect.
"Our invention allows lines to be 'written' and 'erased' much in the manner that an Etch A Sketch® toy operates," said study coauthor Jeremy Levy, professor in the Department of Physics and Astronomy within ...
Using infrared data from the Subaru Telescope in Hawaii, an international team of astronomers has imaged a giant planet around the bright star GJ 504. Several times the mass of Jupiter and similar in size, the new world, dubbed GJ 504b, is the lowest-mass planet ever detected around a star like the sun using direct imaging techniques.
"If we could travel to this giant planet, we would see a world still glowing from the heat of its formation with a color reminiscent of a dark cherry blossom, a dull magenta," said Michael McElwain, a member of the discovery team at NASA's ...
LA JOLLA, CA ---- Proteins are the workhorses of cells, adopting conformations that allow them to set off chemical reactions, send signals and transport materials. But when a scientist is designing a new drug, trying to visualize the processes inside cells, or probe how molecules interact with each other, they can't always find a protein that will do the job they want. Instead, they often engineer their own novel proteins to use in experiments, either from scratch or by altering existing molecules.
Engineered proteins can be drugs that turn on or off signaling pathways ...
Tropical Depression Gil has been weakening for a couple of days, while Tropical Storm Henrietta appears to be strengthening in the Eastern Pacific Ocean. NOAA's GOES-15 satellite captured both storms in one image that clearly showed Henrietta was the larger storm, and NASA's Aqua satellite peered under Henrietta's clouds to reveal a developing eye.
Tropical Depression Gil is more than halfway to Hawaii from Mexico and continues to hold onto depression strength. Meanwhile, NOAA's GOES-15 satellite captured both storms in one image on Aug. 5 at 1200 UTC (8 a.m. EDT). The ...
A new analysis has found that mothers who are more extroverted and less anxious are more likely to breastfeed and to continue to breastfeed than mothers who are introverted or anxious. Published early online in the Journal of Advanced Nursing, the study indicates that new mothers with certain personalities may need additional support and education to help them feel confident, self assured, and knowledgeable about breastfeeding.
Breastfeeding is important for the health of both mother and baby: breastfed babies have lower levels of infections and allergies and are less ...
A recent study compared the differences between novice and experienced drivers using a driving simulator and modeled the difference using computational cognitive models. The method and results provide important cognitive-psychological bases for developing intelligent driver training and driving assistance systems.
The study titled "Modeling the effect of driving experience on lane keeping performance using ACT-R cognitive architecture," authored by Shi Cao, Yulin Qin, and Mowei Shen, has been published on CHINESE SCIENCE BULLETIN, 2013.
Driving experience is a critical ...
People who walk to work are around 40 per cent less likely to have diabetes as those who drive, according to a new study.
Researchers at Imperial College London and University College London examined how various health indicators related to how people get to work, using data from a survey of 20,000 people across the UK.
They found that cycling, walking, and using public transport were all associated with lower risk of being overweight than driving or taking a taxi. People who walk to work were also 17% less likely than people who drive to have high blood pressure. Cyclists ...
Scientists from the Department of Forensic Medicine at the University of Copenhagen have examined the bodies of three 500-year-old Inca children along with scientists from Bradford University in England. This has given new, detailed knowledge about the old Ince ritual 'capacocha' which also involved sacrificing humans. The results were published recently in the journal PNAS.
One of the examined mummies is the 13-year-old girl, 'The Llullaillaco Maiden', named after the 6,379 meters tall volcanic mountain, Llullaillaco, where she was found frozen close to the mountain's ...
Working at a clean and prim desk may promote healthy eating, generosity, and conventionality, according to new research. But, the research also shows that a messy desk may confer its own benefits, promoting creative thinking and stimulating new ideas.
The new studies, conducted by psychological scientist Kathleen Vohs and her fellow researchers at the University of Minnesota are published in Psychological Science, a journal of the Association for Psychological Science.
"Prior work has found that a clean setting leads people to do good things: Not engage in crime, not ...
