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Top military hospitals to set bar for surgical care in MHS

Image of surgeons working on a patient. Click to open a larger version of the image. Surgical care within the Military Health System helps build and maintain a ready medical force. Results from the adult ACS National Surgical Quality Improvement Program assist the MHS in creating policy and verifying surgical skills throughout the enterprise's military hospitals. (U.S. Navy photo by Mass Communication Specialist 1st Class Mike DiMestico/Released)

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Readiness in the Military Health System calls for advanced knowledge and skills. Results released Nov. 6, 2019 by the American College of Surgeons recognized 88 U.S. hospitals for "meritorious" surgical patient outcomes. Seven of those 88 hospitals were military, up from four military hospitals the previous year.

Over 700 hospitals were part of the ACS National Surgical Quality Improvement Program, or NSQIP, for 2018. All 46 military hospitals in the continental U.S. that engage in inpatient surgery were a part of that number.

“We always have to keep improving when it comes to patient safety and quality,” said Guy Kiyokawa, deputy director of the Defense Health Agency, when asked why the agency takes part in NSQIP.

NSQIP is a program that measures and improves the quality of surgical care in hospitals while reducing complications and costs.

Hospitals that took part had their surgical programs studied by the ACS. The program also guides surgeons to apply the “best scientific evidence” to surgery. NSQIP measures actual surgical results 30 days after a procedure.

Results were mostly positive for the MHS, but some hospitals did better than others. The April 2019 NSQIP Collaborative Report showed that most military hospitals in the program performed between the 70th and 30th percentiles in the nation, with lower numbers being better scores. This places most MHS hospitals in “neutral, well-performing” territory.

“We have a lot of great performers, but we have those that we can improve upon,” Kiyokawa said. “Even though generally we're doing well, one of the other focuses that we're looking at is how do we reduce the variation.”

This year, 88 hospitals reached meritorious distinction based on strong scores. Risk-adjusted data from the July 2019 ACS NSQIP Semiannual Report was used to show which hospitals had the best outcomes. Hospitals in the survey were recognized for “high-risk” cases, as well as “all cases.”

One of the hospitals honored for both high-risk cases and all cases was the Walter Reed National Military Medical Center in Bethesda, Maryland. WRNMMC has been taking part in NSQIP since 2014. Results from the survey help set policy and care improvements at the hospital.

“It’s a reflection of a lot of pieces that go into providing care,” said Air Force Col. Peter Learn, deputy director of Surgery for Quality at WRNMMC. “We have well-trained personnel who are committed to delivering the best care we can to our service members and their families. It’s always nice to have that external validation.”

WRNMMC uses NSQIP to measure overall surgical care. It’s also used as one of many tools to gauge the effects of policy and practice changes. One NSQIP result that Learn looks at is the surgical site infection rate, which is steadily going down. WRNMMC passed an internal push in 2017 with guidance from the Institute for Healthcare Improvement to prevent surgical site infection. The NSQIP results confirm a decrease in this number.

“To me, this shows our improvements that have come through efforts to improve care,” Learn said. “That’s always reassuring – to see that all the effort is paying off.”

The MHS is looking at these high-performing hospitals to make improvements for those doing less well on the survey.

“We have a lot of great organizations out there,” Kiyokawa said. “The next step is discovering how to mine some of those best practices and use them across the enterprise.”

Military hospitals recognized on the “all cases” meritorious list include:

Military hospitals recognized on the “high-risk” meritorious list include:

  • Brooke Army Medical Center
  • Dwight David Eisenhower Army Medical Center
  • 81st Medical Group (Keesler)
  • Naval Medical Center San Diego
  • Walter Reed National Military Medical Center

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