Operationalizing quality improvement in a pediatric surgical practice.
OBJECTIVE
Quality improvement (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one's institution and practice, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our practice.


METHODS
We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our practice. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5-7days. Outcomes such as complications, deaths, and "occurrences" (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives.


RESULTS
In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place.


CONCLUSIONS
Data on procedures and outcomes can be collected effectively in a pediatric surgery practice to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria.
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI. Electronic address: marca@chw.org.
Marjorie J
MJ
Arca
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Jessica
J
Enters
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Melissa
M
Christensen
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Paul
P
Jeziorczak
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Thomas T
TT
Sato
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Robert
R
Thielke
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Keith T
KT
Oldham
D000359:Aftercare / Q000706:statistics & numerical data; D002568:Certification / Q000592:standards; D002648:Child; D003226:Congresses as Topic; D016208:Databases, Factual; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005246:Feedback; D005568:Forms and Records Control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D009819:Office Visits / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration*; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D020399:Practice Management / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D013043:Specialties, Surgical / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*
Case log; Maintenance of certification; Pediatric; Quality improvement; Surgery