Raising the Standard: American College of Surgeons Quality and Safety Conference 2018

by Dominick Gadaleta, MD, FACS, FASMBS; and Anthony T. Petrick, MD, FACS, FASMBS

This column is dedicated to highlighting a broad range of quality issues in bariatric surgery.

Column Editors
Anthony T. Petrick, MD, FACS, FASMBS
Quality Director, Geisinger Surgical Institute; Director of Bariatric and Foregut Surgery, Geisinger Health System, Danville, Pennsylvania

Dominick Gadaleta, MD, FACS, FASMBS
Associate Chair, Chief of General Surgery, MBS Director, North Shore University Hospital, Northwell Health, Manhasset, New York

Funding: No funding was provided for this article.

Disclosures: The authors report no conflicts of interest relevant to the content of this article.

Bariatric Times. 2018;15(9):22–23.

The theme of this year’s American College of Surgeons Quality and Safety Conference (ACSQSC), held July 21–24 in Orlando, Florida, was “Partnering for Improvement.” A track dedicated to metabolic and bariatric surgery focused on topics related to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), such as data compiled from its quality improvement programs. There were other new discipline- and theme-based tracks this year as well, including trauma, cancer, geriatric, and “Red Book,” in reference to Optimal Resources for Surgical Quality and Safety Guidebook from the American College of Surgeons (ACS).[1 ]The ACSQSC provides content directed toward all ACSQSC participants, including surgeons, nurses, quality improvement professionals, and surgical perioperative leaders.

There were two MBSAQIP programs in the preconference sessions. These sessions were designed to have practical application for MBSAQIP sites. The course titled “Essential Building Blocks of Accreditation,” chaired by Dr. Wayne English and Ms. Tanya Kimber, was a deep dive into the benefits of MBSAQIP accreditation. The session reviewed the optimal characteristics of a program’s Metabolic and Bariatric Surgery Director, Coordinator, and Clinical Reviewer, and included tools for communicating with administration, initiating a program, and surviving the site visit. A concurrent session, chaired by Dr. Anthony Petrick and Ms. Teresa Fraker, focused on the MBSAQIP Standard 7.2: Quality Improvement (QI) Process. The session provided tools to identify QI opportunities using their semi-annual report (SAR) and other data sources. The complexities of QI tools, such as Define, Measure, Analyze, Improve, and Control (DMAIC), were simplified and the session concluded with interactive workgroups using mock data sets and DMAIC to design and present their own QI projects.

There were several important topics covered in the general sessions. These included a session led by Dr. Patricia Turner titled “Improving Your Emotional Intelligence through Leadership.” Emotional intelligence (EI) was defined as the ability to perceive the emotions in yourself and others. Michelle McGovern, the Director of Human Resources and Operations for the ACS, emphasized the importance of EI as a means toward improved communication and leadership. Presenters proposed that EI can be learned. It starts with knowing your own Meyers-Briggs personality type, as well as that of your team members. EI can be used for both motivation and conflict resolution to get the most out of your team.

Another timely topic was “How to Fix the Opioid Crisis in Your Hospital,” chaired by Dr. David Hoyt. Talks in this session focused on setting patient expectations for postoperative pain and opiate protocols, including regional blocks, and the prescribing of nonopiate medications. The question-and-answer period was lively and well received by an engaged audience.

This meeting is known for an outstanding keynote address. Rolf Benirschke, a former National Football League player, spoke about his struggle with ulcerative colitis. He played in a chronically malnourished state, receiving total parenteral nutrition (TPN) each week prior to his games on Sunday. He nearly died in the prime of his career from complications of a colectomy. After more than a year of recovery, he fought to resume his career and ultimately became an advocate for patients with ostomies.

There were several other sessions dedicated to metabolic and bariatric surgery. Drs. Eric DeMaria and Stacy Brethauer chaired a session updating current research in metabolic and bariatric surgery. The outcomes of the first two MBSAQIP national QI projects, Decreasing Readmissions through Opportunities Provided (DROP) and Employing New Enhanced Recovery Goals in Bariatric Surgery (ENERGY), were presented. Dr. John Morton presented on DROP, reporting that DROP centers reduced readmission by 10.2 percent overall and by almost 20 percent for sleeve gastrectomy patients.[2] Dr. Brethauer presented the latest on ENERGY, whose participants completed data collection June 30, 2018. A bariatric enhanced recovery after surgery (ERAS) protocol was implemented at 36 sites with adherence to 28 discrete process measures monitored. Preliminary data analysis revealed a significant reduction in length of stay, with no change in readmission or complications. As expected, increased adherence correlated with a decreased length of stay. Of note, 27 percent of patients in the protocol used no opioids from post-anesthesia care unit (PACU) through discharge.[3] In addition, Dr. Matthew Hutter presented on future patient-reported outcomes initiatives.

The presentation of original research has become a meeting highlight. There were two bariatric research sessions with many projects using the MBSAQIP Participant Use Data File (PUF). Dr. Ali Aminian led a project identifying which complications contribute most to morbidity and mortality after bariatric surgery. They found that venous thromboembolism (VTE) contributes the most to mortality and readmission after bariatric surgery.[4] Dr. Charles Kenneth Mitchell presented the results of his team’s bariatric enhanced recovery initiative at Bon Secours St. Francis Hospital. Length of stay was significantly reduced for all primary bariatric procedures and postoperative opioid use was reduced from 89 to 9 morphine equivalents after the implementation of the ERAS multimodality pain protocol.[5]

In summary, the ACSQSC continues to grow and showcase the extraordinary quality standards set by the metabolic and bariatric surgery team. This unique meeting provides a practical educational opportunity for all who care for metabolic and bariatric surgery patients. We encourage all MBSAQIP centers to attend ACSQSC 2019 in Washington, DC.

Next month: Eliminating Unjustified Variability: ProvenCare®Bariatric

References

1. Hoyt DB, Ko CY (eds). Optimal Resources for Surgical Quality and Safety 1st edition. Chicago, Illinois: American College of Surgeons; July 1, 2017.
2. Morton JM. Lessons learned from the inaugural MBSAQIP collaborative: DROP. Presented at American College of Surgeons Quality and Safety Conference; 2018 July 22; Orlando, Florida.
3. Brethauer S. Data, outcomes, and key learnings from the second MBSAQIP collaborative: Enhanced Recovery in Bariatric Surgery (ENERGY). Presented at American College of Surgeons Quality and Safety Conference; 2018 July 22; Orlando, Florida.
4. Daigle CR, Brethauer SA, Tu C, et al. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes. Surg Obes Relat Dis. 2018;14(5):652–657.
5. Mitchell CK. Decreasing length of stay and opoid use in bariatric surgery by utilizing multimodal pain control within an enhanced recovery protocol. Presented at American College of Surgeons Quality and Safety Conference; 2018 July 23; Orlando, Florida.

Tags: ACS, Gadaleta, Petrick, Quality, raising the standard

Category: Past Articles, Raising the Standard