The September 2011 issue of Consumer Reports carries report cards on the quality of CABG procedures performed by 324 groups/hospitals.

Ratings of one, two or three stars,  corresponding to performance below, at and above average, are based on performance in 11 categories (e.g. risk-adjusted mortality after CABG, antiplatelet medication at discharge and percentage of procedures performed using an internal thoracic artery).  A 2010 article in the New England Journal of Medicine (NEJM) describes the program (http://www.nejm.org/doi/full/10.1056/NEJMp1009423).

The rating system was developed by the Society of Thoracic Surgeons (STS) whose web site includes more details on individual ratings (http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online).  The methodology, endorsed by the National Quality Forum, is based on a registry of about 90% of approximately 1100 U.S. cardiac surgery programs.

When Consumer Reports published the first set of ratings in October 2010, the NEJM article, cited above, called the public disclosure “a watershed event in health care accountability.”

I believe that this year’s report, based on data running from July 1, 2009 to July 30, 2010, is particularly significant because the number of groups/hospitals that have chosen to go public has increased by more than 100, and because five groups/hospitals with below-average performance had the courage to disclose their report cards.

My disappointment lies in the absence of reports from many famous institutions – Massachusetts excepted – and the lack of analogous report cards for other specialties, such as orthopedics and vascular surgery.  I had hoped that their respective societies would have followed the lead of the STS.

As a consultancy devoted to helping our clients create high-performing perioperative systems, Twin Peaks Group applauds the initiative of the STS and the two-year trend in public disclosure.  We believe that hospitals should measure and publish risk-adjusted outcomes.

With that in mind, how gratifying would it be if next year’s announcement in Consumer Reports listed report cards for 500 groups/hospitals, and revealed that this year’s one-star performers had added one or more stars?

At the recent meeting of the American Association of Clinical Directors (AACD), I learned that the American Association of Anesthesiologists (ASA) had set up the Anesthesia Quality Institute (AQI) (www.aqihq.org).  The Institute’s vision is to become “the primary source for quality improvement in the clinical practice of anesthesiology,” while its mission is to establish and maintain the National Anesthesia Clinical Outcomes Registry. (I could put in all the acronyms but it would make your eyes glaze over).

If this sounds to you like a cousin of the National Surgical Quality Program (NSQIP), you’d be almost right: Having observed NSQIP, Rick Dutton, MD, AQI’s Executive Director, has taken a different approach to membership and to the collection and analysis of data.

Because storage capacity is infinite and because bandwidth will continue to increase, he decided that the system should collect all reasonably useful data on all cases of participating institutions; moreover, that membership should be almost free.  (It’s subsidized by the ASA).

After you sign up, “pipes” are set up to channel your data – de-identified – into a massive data base.  The choices made by Rick allow for flexible, but potentially complex, analyses.  By contrast – and probably for good reasons – NSQIP collects carefully defined data on selected cases (only), and requires that data be checked by a full-time assessor, who is trained and periodically re-qualified by NSQIP.

It’s gratifying that the ASA has set up the Anesthesia Quality Institute.

When it comes to surgery, anesthesiologists feel particularly responsible for post operative nausea/vomiting, and for pain.  In recognition of this, the data collected and adjusted by the Institute will permit benchmarking on those two quality dimensions.

Now, all that we need is a joint program – one that combines NSQIP and a subset of the data from the Anesthesia Quality Institute.

After all, anesthesiologists’ complications are indistinguishable from those of surgeons from the perspective that matters most: the patient’s.

A few months ago, I was discussing OR metrics with a prospective client, an anesthesiologist.  “Of course, I know that working hard to reduce the first-case, on-time percentage doesn’t make sense,” he observed.  “We’ve known that for some time.”  Unfortunately, he’s in the minority.  Many still behave as though it’s one of the most important metrics to improve.

Here’s why it’s not.

Let’s start with the perspective of a patient who is lucky enough to be the first case of the day.  Although it would be great to be wheeled into the OR right on schedule, being 10 to 15 minutes late would not be too disturbing – “par for the course” when it comes to interactions with medical profession.  I grant you that I would be unhappy if I were delayed for an hour, particularly if I was in for a minor, outpatient procedure.  But we’ll come to that.

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