5 Steps to Effective Orthopedic Quality & Patient Safety Programs From Dr. Joseph BoscoWritten by Laura Miller | March 06, 2012
Patient safety and quality control is essential among healthcare providers, and particularly important in orthopedics, where some studies show the burden of care for infections could be $1 billion to $2 billion per year.
"Quality and patient safety needs to be a priority for any institution delivering orthopedic care," says Joseph Bosco, MD, associate professor and vice chair for clinical affairs in the department of orthopedic surgery at NYU Langone Medical Center, as well as the director of its outcomes program. "The fact that the number of orthopedic surgeries performed each year is increasing means orthopedists will be under more scrutiny. Payors are really becoming very interested in quality control benchmarks, so physicians must be interested as well."
NYU Langone's Department of Orthopaedic Surgery recently published its 2012 Quality and Outcomes Report, which provides the quality and patient safety data and trends for orthopedic procedures over the past few years. Dr. Bosco discusses how hospital orthopedic centers can excel in infection control.
1. Set a goal to decrease infections. Dr. Bosco and his colleagues have been working on decreasing the infection rate. To meet their goals, the physicians and staff have been taking several extra steps with patients, including:
• Screening everyone for Staphylococcal infections
• When patients do show signs of a Staphylococcal infection, they take antibiotics through their nose to eradicate it
• Sterilize instrumentation properly and institute backup procedures to eliminate the need for flash sterilization entirely
"We have ratcheted up the recognition of cleanliness and infection prevention among our staff," says Dr. Bosco.
2. Empower every member of the team to step up. At NYU Langone Medical Center, every staff member is empowered to bring patient safety and infection control issues to light. "No matter what role a member of the team plays, from surgeon, nurse, imaging tech or surgical resident, they are encouraged to speak up if they something that might jeopardize the sterility or safety of the room, which is something we are proud of," says Dr. Bosco. "If they see a chairman of the department contaminate something, they should speak up. We are empowering our staff to take ownership of these issues."
The leaders empowered their employees by discussing this role and educating them about how to recognize problems. "You can put a million procedures in place to prevent infections, but if your staff isn't empowered to speak up, you will continue to have problems," says Dr. Bosco. "They should be able to point out issues they see and not fear retribution."
3. Conduct an analysis to prevent wrong site surgery. Wrong site surgery is rare for orthopedists, but "near misses" may occur more regularly and are an opportunity to identify holes in the process. A near miss could include:
• Booking the case for the wrong side
• Inaccurate information entered during the scheduling process
• Inappropriate time-outs
"We consider these occurrences near misses and when they happen, we recommend individual counseling to fix the problem," says Dr. Bosco.
4. Compare benchmarks locally and nationally. Dr. Bosco and his colleagues compare local and national benchmarks for infection rate at NYU Langone Medical Center to see where they stand against other institutions. Oftentimes, however, a direct comparison can be deceiving.
"We perform the second most hip replacements in the state, but you have to be careful with comparisons," says Dr. Bosco. "You have to make sure other institutions are correctly identifying all infections and using the same definition of 'infection.' We have to compare the number of infections with the number of cases performed to see where we stand compared to others."
In NYU Langone's Department of Orthopaedics, the physicians and staff conduct a data analysis to find out where the problems are and implement a plan to lower them. For example, they are currently updating the prophylactic antibiotics protocol.
"MRSA has gotten more virulent over the past few years, so we need a higher dose of vancomycin," says Dr. Bosco. "In an era of antibiotics, we are really looking at the data and establishing a plan to measure the effectiveness of our new protocol to see if there is a difference from year to year."
5. Hire a quality organizer. Hiring a quality organizer is an essential investment for hospitals because even though resources might be limited, higher patient safety and quality control leads to better patient satisfaction scores.
"Patient safety and satisfaction is something every hospital is responsible for," says Dr. Bosco. "Three or four years ago, our hospital hired Loraine Hutzler to be our quality project manager. She collects data, crunches the numbers, shares the results with the administration and then helps set the strategies for improvement. It may take extra resources from the institution, but you need someone dedicated to patient safety and infection control to keep up with regulations today."
Investment in the program is important, not just because a bad event may cause unwanted scrutiny and bad publicity for the hospital, but because sustaining quality and a focus on patient satisfaction is at the core of health care today. "For us, this position is an invaluable investment," says Dr. Bosco.
More Articles on Orthopedic Practices:
Surviving a Turbulent Healthcare Market: 7 Points From Dr. Steven Wertheim of Resurgens Orthopaedics
Attracting Patients From Around the World: Q&A With Dr. John Knight of DISC Sports & Spine Center
8 Quick Tips for Orthopedic Practice Revenue Cycle Management
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