3/23/2018 https://icongresso.mcibrazil.itarget.com.

br/estacao/trabalhos/exibir-trabalho/id/6673

Work code : 6673

Title:
Novel Process for inpatient and operative gynecology quality assurance and quality improvement

Authors:
JUAN APARICIO, MD; JOY UNGARETTI, MD; ASHLESHA PATEL, MD, MPH.
JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY, CHICAGO - UNITED STATES OF AMERICA.

Presentation format: ORAL PRESENTATION

Theme: AB 04 OPERATIVE GYNECOLOGY

Sub-Theme: AB 4.4 SAFE SURGICAL TECHNIQUES AND PRACTICES

Objectives:

Quality assurance (QA) and quality improvement (QI) has been demonstrated to have a place in the modern
practice of medicine. Many models of self-review, peer-review, and quality assurance exist, however no
clear ideal model exists. These models rely in being able to identify cases with complications or from which
processes could be improved. We describe a novel method to screen, review, and longitudinally follow
patients and cases for quality assurance and improvement purposes and how it compares to the prior
institutional QA/QI system.

Method:

John H Stroger Hospital has around 600 admissions to the general gynecology service and >250 outpatient
operative cases per year. Utilizing the electronic medical record a trained practitioner reviewed cases
immediately after the day of discharge. This review includes demographics, medical history, reason for
admission, and outcomes including complications. This was done in parallel to the traditional system of
review for 2 months after which the cases which were identified were compared and reviewed. The
traditional mechanism of QA involved multiple attendings reviewing every operative case.

Results:

In a total of 89 inpatient admissions and 55 outpatient operative cases, the immediate review (IR) identified
15 cases as requiring further review. The traditional review(TR) model flagged 12 cases. A total of 23
patients were identified through both mechanisms, only 4 cases were individually identified by both. The
most common indication for review in patients solely identified through IR (5/11) were due to high blood
loss without receiving a transfusion. Most of the patients (4/8) solely flagged through the TR were included
due to wound complications detected at postoperative visits.

Conclusions:
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These two quality assurance monitoring systems are able to detect unique patient cases that warrant
additional review. An integration of both systems hold significant potential to develop an encompassing and
comprehensive way to quickly identify patients with complications during their admissions and those who
present with problems remote from discharge. An amalgamation of both and a unified criteria would be able
to reduce the time from the event to review while still being able to capture complications outside of the
admission but within the postoperative period to maximize opportunities for quality improvement.

Keyword 1: Quality Improvement Keyword 2: Safety Keyword 3: Quality Assurance

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