Z. Li1, J. Coleman1, D. Naanaa1, C. D’Adamo2, V. Ahuja1 1Sinai Hospital of Baltimore,Surgery,Baltimore, MD, USA 2University Of Maryland,Surgery,Baltimore, MD, USA
Purpose: The validity of outcomes data depends on the consistency of documentation of reported measures. Resident understanding of diagnostic criteria may influence correct documentation and quality outcomes. This study aims to evaluate whether surgical resident education concerning definition and documentation of ACS NSQIP (American College of Surgeons- National Surgical Quality Improvement Program) cardiac occurrences affects the quality of data in the NSQIP database.
Methods: Data were obtained using NSQIP morbidity report for all elective general surgery and vascular surgery procedures at a single institution. Post-operative myocardial infarction (MI) incidences were reviewed from the NSQIP semiannual report from January to June 2015. Individual cases from 2015 were independently reviewed by a hospital cardiologist to evaluate accuracy of diagnosis. Data from January to June 2017 was then reviewed and compared to data from 2015 using Fisher exact test to evaluate whether education leads to better documentation and improved accuracy of NSQIP data.
Results: Approximately 1,000 surgical procedures in 2015 and 2017 were examined. There were 12 post-operative MIs in the 2015 period and 3 post-operative MIs in the 2017 period. A hospital cardiologist review of documented 2015 postoperative MI cases by residents raised concerns as these cases were troponin rise which did not meet myocardial demand ischemia criteria. NSQIP definition allows MI occurrence to be based solely on physician documentation of MI, irrespective of the electrocardiogram changes. A false elevation of MI due to physician’s documenting the diagnosis in their progress note incorrectly showed our hospital to be a high outlier in MI. Education was then provided to surgical residents regarding documentation of postoperative MI only by cardiologist or based on the NSQIP definition. After education, Fisher exact test showed the odds of having documented post-operative MI within the NSQIP database in 2017 was significantly lower (Odds Ratio = 0.2, p = 0.0346, 95% CI = [0.072, 0.92]) than in 2015.
Conclusions: Correct diagnosis of post-operative MI by surgical residents may significantly impact quality of NSQIP data. This study shows surgical residents’ education can improve correct diagnosis and documentation of post-operative MI leading to better hospital NSQIP outcomes.
