The hospital collaborative was formed in 2008 as a partnership of the Tennessee Chapter of the American College of Surgeons and the Tennessee Hospital Association's (THA) Center for Patient Safety, with support from Blue Cross Blue Shield's Tennessee Health Foundation. Through the ACS NSQIP program, TSQC hospitals collected clinical, 30-day outcomes data from 10 participating hospitals to examine and identify trends in and evaluate best practices.
Between 2009 and 2012, participating hospitals collected data on more than 55,000 surgical procedures and researchers examined rates of 17 different types of surgical complications. Compared with complication rates in 2009, participating hospitals in 2012 achieved 19.7 percent fewer postoperative occurrences (p<0.001), and the postoperative mortality rate dropped 31.5 percent (p<0.001).
Hospitals prevented an estimated 3.75 deaths per 1,000 surgical procedures and avoided $75.2 million in excess costs. The collaborative saw improvements in 13 of the 17 types of complications, and nine improved significantly (p<.05). The areas of most improvement included all types of surgical site infections, pneumonia and urinary tract infections, which all dropped by approximately one-third. "Our results show not only have Tennessee hospitals improved care, but we've been able to sustain those improvements over time," said Brian Daley, MD, MBA, FACS, lead author of the study and professor of surgery and chief of the division of trauma and critical care at the University of Tennessee Medical Center, Knoxville. "Our collaborative approach and use of robust clinical outcomes data through ACS NSQIP is an effective model for quality improvement across our state and nationally." An earlier study based on TSQC data was published in the Journal of the American College of Surgeons
in 2012; it showed the 10 TSQC members reduced complication rates and saved more than $8 million in excess costs from 2009 to 2010. This new study shows TSQC hospitals continued to improve in the years after the program was launched.
In 2012, the collaborative expanded and now includes 22 Tennessee hospitals. "Participation in an ACS NSQIP collaborative is helping Tennessee hospitals accelerate their improvements by sharing data, comparing results, and evaluating best practices among peers," said Oscar Guillamondegui, MD, MPH, FACS, chair of TSQC's leadership committee and an associate professor of surgery and director of the Vanderbilt multidisciplinary traumatic brain injury clinic at Vanderbilt University Medical Center. "The TSQC has helped align the efforts of hospitals and surgeons around quality improvement, which supports the THA board's commitment toward zero incidents of preventable harm in our state's hospitals," stated Craig A. Becker, THA president. "This collaborative is an excellent example of how the hospital association, physicians, hospitals and payers can work together to improve care using clinically valid measures in a cooperative way." ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. The program provides a prospective, peer-controlled, validated database of pre-operative to 30-day surgical outcomes based on clinical data, not claims data.