Quality Improvement: Tool identifies drivers of 30-day readmission after RP

Kristin L. Chrouser, MD, MPHThe AUA 2017 Quality Improvement and Patient Safety take-home messages also highlighted a QI project that led to reductions in catheter trauma rates and a QI program for robot-assisted radical prostatectomy that uses video clips. The take-homes were presented by Kristin L. Chrouser, MD, MPH, of the University of Minnesota, Minneapolis.

Notable Outcomes and Trackable Events after Surgery (NOTES), a MUSIC tool that identifies drivers of 30-day readmission after radical prostatectomy, found gastrointestinal events resulted in over half of readmissions, suggesting a high-impact opportunity for QI after RP.

Quality improvement (QI) involves the formal analysis of performance and a systematic effort to improve it. The Merit-based Incentive Payment System (MIPS), which marries earlier programs-the Physician Quality Reporting System, Value-Based Payment Modifier, and Meaningful Use-encompasses quality and practice improvement activities that will impact urologists’ bottom line. The MIPS score adjusts physician payment up or down.

American College of Chest Physicians guidelines for venous thromboembolism prophylaxis, which call for 28 days of enoxaparin postoperatively, is safe and effective in high-risk urologic oncology patients, with a 0% VTE rate and no complications after 30 days.

The Foley Project, a QI project that involves key stakeholders in catheter use, led to reductions in catheter trauma rates, need for subsequent procedures, and number of urology consults.

The Michigan MUSIC QI collaborative accrues practices and collects data, but also involves member urologists in meetings and QI initiatives that are integrated back into practice, making it a tool for QI, not just an up-to-date database. Surgeons are given reports on their perioperative outcomes, how they deviate from other surgeons within the collaborative, and their patients’ functional and oncologic outcomes.

Continue to the next page for more take-home messages.

• A QI program for robot-assisted RP that uses video clips found a relationship between skill and outcome, with high-quartile surgeons showing lower rates of catheter placement and less blood loss. Data are used for peer-to-peer coaching to improve the skills of other surgeons, and a metric ultimately allows for selection of the best coaches.

• The AUA’s AQUA Registry is a national safety collaborative that allows for parsing of data in multiple ways by different metrics, providing urologists valuable insight on how their peers practice across the country.

• The majority of urology program directors believe QI methodology should continue to be part of residency training, and 89% say the AUA should offer QI training.

• A panel of residents and QI experts examining what should be involved in a QI curriculum determined the highest-ranked topics were waste identification, high-value health care, and unwarranted variations.

• In the future, look for increased education offerings in the area of QI and patient safety, including AUA patient safety videos, and practical reports of real-world QI projects with scalable potential. Ultimately, these projects will allow urologists to provide better and safer patient care.

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