Improving patient care through the development and implementation of the Thoracic Surgery, Quality Monitoring, Information Management and Clinical Documentation System (TSQIC)
Patient Safety and Quality of Care
We created and implemented a standardized system for capturing all adverse events (AEs) after all thoracic surgeries at The Ottawa Hospital (TOH) since 01/2008. With this TOHAMO grant support, we expanded to an iPad optimized system that includes facilitated point-of-care clinical documentation, recording of AEs, and automated reporting of quality, referred to as Thoracic Surgery Quality Monitoring, Information management, and Clinical documentation (TSQIC) system. Since, we have used this system to reduce AEs locally through innovative surgeon self-assessment and positive deviance, our AE classification system has become an international gold standard, adopted by groups in China, Italy, and Russia, disseminated through multiple published papers, and local, national and international presentations. We are currently underway to expand the TSQIC system to other Canadian thoracic surgery centers, and to other TOH surgical divisions.
BACKGROUND: Objective reporting of post-operative adverse events (AEs) is a cornerstone of surgical quality assurance. In 2008, we developed a paper-based standardized classification to identify presence and severity of Thoracic Morbidity & Mortality (TM&M). With TOHAMO funding support, our objectives were to create a software tool to record and report AEs integrated with process-of-care.
METHODS: The TM&M system (www.ottawatm&m.org), rooted in on Clavien-Dindo classification, records presence and severity of AEs. The TSQIC software tool (www.tsqic.org) facilitates a process of data entry of all surgeries and all AEs, with daily recording, weekly conformation, and periodic review. The analysis is to evaluate longitudinal change over time, recognizing the limitations of such analyses.
RESULTS: Our experience demonstrates that in addition to the software, clear accessible AE definitions that facilitate discussion and editing if required, and whole divisional surgical system buy in and support, are essential for adoption. TSQIC enables (i) recording of all AEs; (ii) reporting monthly rates at M&M rounds and case discussion resulting in recommendations; (iii) surgeons self-assessment (compared to anonymous peers); and (iv) positive deviance (highlighting best performers). This process appears to have reduced prolonged air leak, atrial fibrillation and esophageal anastomotic leak, with ongoing evaluation.
CONCLUSIONS: Innovation in evaluating and improving surgical quality lies in information management. The vision is to improve care by facilitating accountable, effective care guided by transparent, standardized data collection (all surgeries, AEs and outcomes), with automated regular reporting of individual and collective performance.