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Summer 2009: Surgical Complication Costs |
| Summer 2009 | In This Issue | | Message from the CEO Surgical complications are almost never the result of malicious human neglect, but rather all too often result from the fallibility of the human factor in high stress environments. The tragedy of preventable complications such as surgical site infections or wrong site/side surgeries is that they stem from simple cognitive failures such as forgetting, misunderstanding, being unaware, or missing an item of information. The complexity of the OR environment—where good processes and effective communication can make all the difference in reducing complications—has prompted many hospitals to explore innovative patient safety solutions. However, the difficulty in quantifying the problem of medical error and patient safety creates a challenge when it comes to justifying the expenditure. In this issue, we share the results of some of our own experience in delving into the true cost of complications. The results are somewhat surprising and show that a judicious expenditure is in fact justified.
Jeffrey Robbins
| CEO's Message | | | | | | | Website Quicklinks | | | | | | | | The Challenge of Calculating the True Cost of Surgical Complications 
As covered in our winter issue of LiveData Healthcare inSights, the results of a recent World Health Organization study published in the January issue of the New England Journal of Medicine indicate that a checklist designed to promote team communication and consistency of care is associated with a reduction in the rate of surgical complications from 9.3% to 6.6% in high-income countries. The study is groundbreaking in that it makes inroads into the problem of quantifying the impact of a solution for patient safety, increasing the likelihood that a method demonstrated to improve outcomes—the surgical safety checklist—will make its way into more and more hospitals. Is the upper end rate of complication reported in the study, 9.3%, a “typical” benchmark that can be applied across the board for surgical complications? We posed this question as part of a project aimed at developing a business model for LiveData OR-Dashboard and arrived at the same challenge that faces hospitals, patients, and the public at large: it is very difficult to pinpoint a complication rate with the existing data, and thus calculate its overall impact on such areas as patient safety, hospital revenue or margin, and insurance rates. Recent literature indicates that complication rates vary widely from study to study. For example, in one study, the complication rate was found to be 3%, and of these, approximately 50% were deemed preventable. A second study revealed a 2.85% rate of “Patient Safety Indicators.” However, since the method was not based on the NSQIP categories, used in the WHO study, it was not possible to compare the complication rates with those of the first study. By contrast, another study that classified complications according to NSQIP categories showed a complication rate of 13.3%.* Identifying the impact of surgical complications on the hospital’s bottom line was another challenge we encountered. Our initial assumption was that hospitals lose opportunities for reimbursement from CMS as a result of surgical complications. However we learned that under current policy, hospitals are typically still reimbursed for the extra care required due to complications. Nevertheless, data indicates that the profit margin of a busy hospital decreases in proportion to an increased rate of surgical complications. We therefore focused on this aspect of foregone revenue in presenting the business model, which provides hospitals with a method to calculate OR-Dashboard’s return on investment. *For more details on the LiveData business model and related studies, contact Terry Bowman at (617) 576-6902; or send an email to
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| Conference Update Joint Commission Annual Conference on Quality and Safety
The objectives of this year’s conference, September 14–16, include being able to differentiate changes in patient safety efforts over the past 10 years and identifying how technology will contribute to medical error reduction and improvement in quality and safety. Managing Today's OR Suite Conference
Join us in Las Vegas on Oct. 7–9. LiveData and KARL STORZ will be presenting the Patient-Aware OR, which combines LiveData OR-Dashboard™ with KARL STORZ OR1® for the ultimate Wall of Knowledge. We’ll be demonstrating the latest additions, including control point applications and alert tools for ensuring full compliance with regulatory agencies like the Joint Commission and SCIP. | LiveData Milestones Active Time Out The July/August issue of Healthcare magazine features an article by LiveData Director of Human Factors, Gabriel Spitz, ScD, MSIE, describing how Active Time Out provides hospital's with a failsafe method for ensuring compliance with the Joint Commission Universal Protocol. Read article... In recognition of National Time Out Day, KARL STORZ and LiveData sponsored a webinar, “Transforming Patient Safety with Active Time Out,” on June 17. Speakers Christine Zambricki, CNO, COO, Henry Ford West Bloomfield Hospital, and LiveData VP of Healthcare Phil Brzezinski presented Henry Ford’s innovative approach toward ensuring full compliance with the World Health Organization Surgical Safety Checklist. View slideshow… New Installations
At The Johns Hopkins Hospital, LiveData OR-Dashboard has been up and running for the past several months and is currently under evaluation. As a KARL STORZ Center of Excellence, the hospital fosters and facilitates the company’s advances in technologies that improve patient safety. Henry Ford West Bloomfield Hospital continues toward full implementation of the KARL STORZ Patient-Aware OR, at the heart of its patient safety program. Recent milestones include integrating the hospital’s HIS, Surgical Information Systems (SIS), into OR-Dashboard. St Joseph Mercy Hospital, Ann Arbor, has deployed LiveData OR-Dashboard in 5 of 18 operating rooms, ending phase one of the broader rollout scheduled for completion over the next few months. The hospital is the first to implement LiveData’s innovative tool for SCIP compliance. St. Joseph Mercy Hospital, a 529-bed teaching hospital that is part of the Trinity Health network, has been named as a US News and World Report Top 100 Hospital. Advances in LiveData Solutions
LiveData is working with several hospitals to outline a comprehensive Perioperative Services Workflow system. Building upon OR-Dashboard and its underlying RTI technology, the PSW extends LiveData dashboards, control point applications, and notification and reporting systems beyond the OR, to encompass all perioperative departments, systems, and devices into one integrated system. Designed to efficiently manage the entire perioperative workflow, the PSW will also provide a foundation for enabling hospitals to develop and refine practices that improve patient care and staff satisfaction. |
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