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Dr. Joshua Tepper and Dr. Tim Jackson

Measure – Change – Improve: Better Surgical Care in Ontario

Simply measuring quality doesn’t make health care better. But transforming that data into opportunities for improvement can have a very real impact on patients and their health and safety.

This is demonstrated in the recent Quality Surgery: Improving Surgical Care in Ontario report released by Health Quality Ontario.

That report documents how 29 Ontario hospitals participating in an international quality improvement program for surgery are making inroads into improving patient safety in key areas such as post-operative infections.

The international program involves nearly 700 hospitals around the world and collects and compares surgical data in 14 key areas. The program also provides hospitals with best practices and programs to reduce the risks of complications specific to their data, and to make every stage of surgery as safe as possible.

Making surgery as safe as possible can have a huge impact on patient safety in hospitals. As Drs. Ross Baker and Peter Norton and colleagues demonstrated in their ground-breaking Canadian Adverse Events Study in 2004, adverse events related to surgery were the most frequent type of adverse events in hospitals.

Measuring key parameters of surgical care are important because, without reliable and comparative data, it can be hard to determine whether your hospital has a problem that needs to be addressed.

What is very positive is the new Health Quality Ontario report demonstrates that all, or the majority of the 29 Ontario hospitals in the network, are doing as well or better than comparable hospitals worldwide on a number of important surgical measures. But the report also demonstrated the hospitals could do better, especially when it comes to surgical site infections (SSIs), the rate of urinary tract infections, and the overall rate of common complications.

One Ontario institution has shown how belonging to the network can be useful and can have a significant impact on reducing SSIs.

As Dr. Duncan Rozario from Oakville-Trafalgar Memorial Hospital demonstrated in a recently published study, a series of measures implemented simultaneously can significantly reduce the number of such infections. These measures are wide-ranging and include preoperative showering and hair clipping for the patient and minimizing the traffic of people through the operating room during the procedure.

What is important is that all of these measures were based on best practices, available studies and an understanding of disease pathophysiology, and had been recommended to improve complication rates.

As Dr. Rozario notes, being part of the Ontario surgical collaborative “allows the sharing of information and quality-improvement measures to allow all participants access to each other’s insights, regardless of success.”

Other focused efforts by certain Ontario hospitals have shown similar positive results. What is interesting is that improving communications and changing the culture in the operating room can have as big a positive impact as more clinical or technical changes.

What has been established in Ontario is a strong network of hospitals committed to surgical quality improvement, now with 31 hospitals as part of the network, and more to hopefully come on board soon.

To quote what Dr. Andy Smith, president and CEO of Sunnybrook, told a recent meeting about surgical quality in Ontario: “There’s absolutely no reason that surgical quality in Ontario can’t aspire to be the best in the world.”

To learn more about this program visit https://www.facs.org/quality-programs/acs-nsqip
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