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DGMC achieves third meritorious distinction

  • Published
  • By Merrie Schilter-Lowe
  • 60th Air Mobility Wing Public Affairs
The David Grant USAF Medical Center at Travis Air Force Base has been recognized for a third year as a meritorious performing hospital by the American College of Surgeons National Surgical Quality Improvement Program.

DGMC is the only Air Force hospital recognized for surgical patient care and outcomes in 2017 and the only Department of Defense site to win the distinction for three consecutive years.

In a Nov. 1 note to senior leaders, Brig. Gen. James Dienst, Air Force Medical Operations Agency commander, called the recognition “a notable accomplishment for Air Force Medical Service and DOD.”

The goal of ACS NSQIP is to reduce surgical infection, illness and death related to a surgical procedure by helping hospitals better understand the quality of care they provide compared to similar hospitals with similar patients. According to ACS, 708 hospitals participate in NSQIP.

Meritorious recognition is based on a composite score in eight areas, including mortality, renal failure, cardiac incidents, pneumonia, surgical site infections and urinary tract infections.

“High scores, meaning exceptionally low complication and mortality rates, are indicators of significant quality across the broad range of factors that contribute to excellent outcomes for surgical patients,” said Col. (Dr.) Kristen Beals, 60th Medical Group commander. “ACS NSQIP uses a risk-adjusted model to allow hospitals to compare their surgical complication and mortality rates with other institutions through a large, nationally shared database.”

Of the 30 medical hospitals in the DOD, DGMC ranks fifth in patient acuity.

“Every participating hospital works hard to reduce complication rates and the numbers are adjusted to take into account case complexity and any pre-existing illnesses the patient has,” said Lt. Col. (Dr.) Scott McCusker, 60th Medical Group chief of otolaryngology, who heads the NSQIP program at DGMC.

Meritorious performing hospitals need a high composite score in surgical patient care for “all cases” or “high-risk” cases. DGMC was among the 58 hospitals to make both lists “along with notables like the Mayo Clinic, Johns Hopkins University, Duke (University), Massachusetts General and Stanford (Medical Center),” said Dienst.

“Big kudos go out to the DGMC team,” he said.

It takes a team effort to prevent patient harm or complications before and after surgery, according to Beals.

“Obvious things like operating room and anesthesia factors play a part, but so do the many other services within the hospital, including nursing and medical technician expertise, laboratory services, infection control, prosthetics and discharge management, along with pre-and post-operative clinical care,” said Beals.

Hospitals that participate in NSQIP can expect not only to prevent surgical complications, but reduce medical costs and save lives, said Tricia Vadney, DGMC quality manager.

“Surgeries are scary for many people,” she said. “The direct outcomes of patients is what NSQIP is measuring and patients can have confidence that their care is our first priority. The whole team is focused on the patient and strives to improve processes to prevent harm or complications.”

The goal at DGMC is to do zero harm. Toward that end, DGMC collaborates with other military treatment facilities as well as civilian medical centers.

“We not only share what we do, but take their ‘best practice’ examples to implement here,” said Vadney. “It goes both ways.”

By focusing on process improvement, the team can identify and address problems via systematic measures, test solutions, verify improvement and guide sustained improvement.

For example, the surgical staff is working on a plan to reduce the time between the conclusion of one surgery and the beginning of the next.

“If our initiative is successful, we can gain back almost an hour per day that can be put to use doing additional surgeries while maintaining the excellent quality and safety record that we already have,” said McCusker.

As the culture shifts at DGMC, communication between individual staff members, teams and departments has significantly improved during the past few years, said Vadney.

“We hold a patient safety huddle every morning with department representatives. Past and future issues are brought to the attention of the whole group. It is a great example of anticipating and mitigating potential problems for patients and staff,” he said.

DGMC performs about 5,000 surgeries annually, including inpatient and same-day surgery.

“In order for us to ensure that we are providing care that is as good or better than care that patients receive in civilian institutions, we must demonstrate that independent organizations that rate quality of care endorse us as well,” said Beals.

“We are also committed to ensuring we sustain this same level of quality and safety through and beyond our transition to the new electronic health record, MHS Genesis, in late 2019,” she said.