HOUSTON – The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) consistently demonstrates low observed-to-expected mortality rates in general surgery, all surgery, and all non-cardiac surgery.
“We are the only VA to have a statistically low mortality for the past ten years,” said David H. Berger, M.D., MEDVAMC Operative Care Line executive. “The entire surgical team, including surgeons, anesthesiologists, nurses, and our support staff, should be proud of their hard work in providing consistent, outstanding care to our Veterans.”
During the mid-to-late 1980s, the VA came under a great deal of public scrutiny over the quality of surgical care. At issue were the operative mortality rates in the VA hospitals and the perception in Congress that these rates were significantly above the private sector norm. To address the gap, Congress passed a law which mandated the VA report its surgical outcomes annually. This included on a risk-adjusted basis to factor in a patient’s severity of illness and compare them to national averages. The only problem was that these “national averages” did not exist.
VA surgeons knew there were no national averages or risk-adjustment models for the various surgical specialties. Looking at their own infrastructure; however, with its advanced information systems and centralized authority and organization of hospitals, they realized they were in a unique position to create these data models.
The success of the initial study encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care across all VA medical centers and the National Surgical Quality Improvement Program (NSQIP) was born.
In 1999, the private sector became interested in the NSQIP. Specifically, they wanted to know if the methodology used in the VA hospitals was applicable outside the VA.
In 2001, the American College of Surgeons (ACS) began to take an active interest in the NSQIP and its results in reducing surgical mortality and morbidity rates. The NSQIP functioned very well in the eighteen private sector hospitals and in October of 2002, the Institute of Medicine named the NSQIP the “best in the nation” for measuring and reporting surgical quality and outcomes.
In October 2004 with six years of private sector experience, the effectiveness of the NSQIP was acknowledged as a quality improvement tool and as a source of new clinical knowledge for hospitals outside the VA system. In October of 2004, the College began enrolling new private sector hospitals into the ACS NSQIP. Hospitals can benefit from participating in the ACS NSQIP for many reasons; most importantly the program can contribute to the reduction of surgical mortality and morbidity. The VA program continues its parallel system and compares its results against the ACS NSQIP private sector data.
“Our surgical service staff and its practices are top-notch. I also want to mention the contributions the staff of our Anesthesiology Service has made toward the care and well being of our Veterans. Their role in our Operative Care Line is critical in reducing mortality rates in our medical center,” said Adam C. Walmus, M.H.A., M.A., F.A.C.H.E., MEDVAMC director. “I am pleased we serve as such a positive example for other hospitals both inside and outside the VA health care system.”
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