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Er= nest Armory Codman
(1= 869-1940)
•<= /span>Harvard College 1887-1891, honors
•<= /span>Harvard Medical School 1891-1895, honors
•<= /span>internship/surgical resident
•Massachusetts General 1895-1899
•<= /span>Harvard faculty 1899
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Ea= rly Accomplishments
•<= /span>X-ray Atlas
•<= /span>orthopedic disorders, esp. shoulder
•<= /span>systematic medical records
•<= /span>first bone tumor registry
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Founding Membe= r
•<= /span>American College of Surgeons 1912
•first committee chairman for standardization of hospitals
•foreru= nner to Joint Commission on   &= nbsp; Accreditation of Healthcare
Organizations (JC= AHO)
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Pr= omoter of
&#= 8220;End Results System”
–analysis of long-term results for all surgical= operations
•identification of medical error
•outcomes measures
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1915
•<= /span>“riffed” vs. resigned from Harvard
•<= /span>surgical privileges revoked from
– Mass. General
<= span style=3D'mso-special-format:bullet;position:absolute;left:-3.69%'>•<= /span>attempted censorship, revoking license
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Codman Hospital
–~ 1/3 of patients reported openly to = have medical error
–error analysis
•<= /span>technical
•<= /span>judgment
•<= /span>diagnostic
•<= /span>equipment
public notice of outcomes
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Ernest A. Codm= an Award
•annual JCAHO award for = use of outcome measures to advance quality and safety in patient care=
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National Quality Initiatives=
SCIP — process measures
NSQIP — outcome measures
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Surgical Care Improvement Project (SCIP)
•measures of several “processes” that are considered best practice standards in patient care = ;
•initiated by Joint Commission/Medicare= Service 2003=
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Compliance with Performance = Measures
•accountability
•payment
•quality improvement =
•accreditation
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Prophylactic Antibiotic Received<= br> wi= thin 1 h prior to Incision
Ta= rget >90%
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
Overall
100%
n =3D 23
100%
n =3D 9
100%
n =3D 20
100%
n =3D 19
100%
n =3D 11
100%
n =3D 18
100%
= CABG
100%
n =3D 2
100%
n =3D 2
100%
n =3D 4
100%
n =3D 5
100%
n =3D 2
100%
n =3D 3
100%
= Colon
100%
n =3D 4
NA
n =3D 0
100%
n =3D 1
100%
n =3D 1
NA
n =3D 0
100%
n =3D 22
100%
= Vascular
NA
n =3D 0
100%
n =3D 1
100%
n =3D 3
100%
n =3D 1
NA
n =3D 0
NA
n =3D 0
100%
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3D"PowerPoint3D"PowerPoint
Prophylactic Antibio= tic Selection
<= span style=3D'mso-spacerun:yes'> Target >90%
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
Overall
91%
n =3D 23
100%
n =3D 9
100%
n =3D 20
100%
n =3D 20
100%
n =3D 11
100%
n =3D 20
99%
= CABG
100%
n =3D 2
100%
n =3D 2
100%
n =3D 4
100%
n =3D 6
100%
n =3D 2
100%
n =3D 3
100%
= Colon
75%
n =3D 4
NA
n =3D 0
100%
n =3D 1
100%
n =3D 1
NA
n =3D 0
100%
n =3D 2
94%
= Vascular
NA
n =3D 0
100%
n =3D 1
100%
n =3D 3
100%
n =3D 1
NA
n =3D 0
100%
n =3D 1
100%
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3D"PowerPoint3D"PowerPoint
Prophylactic Antibiotic Discontinued within 24 h Post-procedure
<= span style=3D'mso-spacerun:yes'> Target >90%
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
Overall
100%
n =3D 21
100%
n =3D 8
94%
n =3D 18
95%
n =3D 19
100%
n =3D 11
87% =
n =3D 15=
96%
= CABG
100%
n =3D 2
100%
n =3D 2
100%
n =3D 4
100%
n =3D 5
100%
n =3D 2
50%
n =3D 2
94%
= Colon
100%
n =3D 2
NA
n =3D 0
100%
n =3D 1
100%
n =3D 1
NA
n =3D 0
100%
n =3D 1
100%
= Vascular
NA
n =3D 0
100%
n =3D 1
50%
n =3D 2
0
n =3D 1
NA
n =3D 0
NA
n =3D 0
50%
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3D"PowerPoint3D"PowerPoint
 
SCIP
Measure
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
Cardiac = patients with controlled  post-op glucose
100%
n =3D 2
67%
n =3D 3
88%= 3;
n =3D = 8
80%= 3;
n =3D = 10
100%
n =3D 2
50%
n =3D 4
79%
Colorectal patients with post-op normothermia =
75%
n =3D 4
NA
n =3D 0
100%
n =3D 2
100%
n =3D 2
NA
n =3D 0
50%
n =3D 2
80%
Target <= span style=3D'font-size:200%;color:#FFC000'>>90%
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3D"PowerPoint3D"PowerPoint
 
SCIP
Measure
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
Appropriate <= /span>hair removal<= /span>
97%
n =3D 32
100%
n =3D 16
100%
n =3D 29
100%
n =3D 28
100%
n =3D 21
100%
n =3D 30
99%
Appropriate pre-op
β-blockade
100%
n =3D 13
100%
n =3D 2
91%
n =3D 11
100%
n =3D 12
100%
n =3D 7
100%
n =3D 12
98%
Target <= /span>>90%
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3D"PowerPoint3D"PowerPoint
 
SCIP
Measure
Sep-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
YTD
VTE prophylaxis <= /span>ordered
96%
n =3D 23
100%
n =3D 11
100%
n =3D 7
92%
n =3D 12
100%
n =3D 7
100%
n =3D 10
97%
VTE prophylaxis given
91%
n =3D 23
100%
n =3D 11
86%
n =3D 7
83%
n =3D 12
100%
n =3D 7
100%
n =3D 10
93%
Target <= span style=3D'font-size:200%;color:#FFC000'>>90%
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3D"PowerPoint3D"PowerPoint
New SCIP Measures Starting Octob= er
•urinary catheter removal by POD #2 = ;
•maintenance of normothermia for all surgical procedures (≥36.0°C)
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3D"PowerPoint3D"PowerPoint
SCIP Measure
F= oley Discontinued by POD#2
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3D"PowerPoint3D"PowerPoint
SCIP Measure
= Foley Discontinued by POD#2
3D"May
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3D"PowerPoint3D"PowerPoint
Exclusion for Remova= l of Urinary Catheter POD#1
= 1.patient with infectious disease
 (ie, sepsis)
2.urologic, gynecologic, perineal procedures
3.documentation from MD as to reason f= or continued urinary catheter
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file:///C:/A399DE39/NSQIPDGore082609_files/slide0197.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
3D"PowerPoint3D"PowerPoint
SCIP Measure
 Perioperative Temperature Management
G= oal is ><= /span> 36.0°C
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3D"PowerPoint3D"PowerPoint
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SCIP Measure
<= b> Perioperative Temperature Management
= Goal is ><= /b> 36.0°C
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3D"PowerPoint3D"PowerPoint
Exclusions for Normothermia
<= span style=3D'font-size:88%;color:white;mso-color-index:0'>•length of anesthesia= < 60 min
<= span style=3D'mso-special-format:bullet;position:absolute;left:-4.21%'>•<= /span>documentation of “intentional hypothermia” for procedure
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file:///C:/A399DE39/NSQIPDGore082609_files/slide0030.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
3D"PowerPoint3D"PowerPoint
National Surgical Q= uality Improvement Program
•nation wide outcomes database
•risk-adjusted
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file:///C:/A399DE39/NSQIPDGore082609_files/slide0032.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
3D"PowerPoint3D"PowerPoint
1st<= /b> Instituted in VA Hospitals in 1991=
next 10 years
•27% decline in post= -op mortality
•45% decline in post-op morbidity <= /span>
•median post-op length of stay fell from
9 to 4 days
•improved patient satisfaction
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file:///C:/A399DE39/NSQIPDGore082609_files/slide0033.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
3D"PowerPoint3D"PowerPoint