Visualizing our surgical outcomes data blind spot

In the U.S. health care system, we now have many more surgical procedures being performed in the outpatient setting than even a decade ago. The push to migrate certain procedures from the resource-intensive hospital setting to the outpatient setting - whether in a center attached to an acute hospital or in an independent ambulatory surgery center (ASC) - is motivated by many factors. The outpatient space is generally less costly and less risky, at least in terms of exposure to infection. And who would not prefer to heal in their own bed the night after surgery, versus the hospital bed with its ambient bright lights and obnoxious beeping?  

With advancing technology and improved surgical practices, this all sounds like a no-brainer. But there is still a looming blind spot: outcomes data. Sure, the ambulatory space is cheaper and decreases the exposures to infectious threats, but is the outcome from the total knee replacement in the ASC of the same quality as that same intervention performed in the hospital operating room (OR)? 

How do we ensure these procedures are safe to be performed outside the hospital? How can we anticipate which patients will have a favorable outcome with an ambulatory procedure vs. an inpatient procedure? 

Having this kind of data could help patients make informed decisions about where to have their surgery (both which organization and which setting), it could help physicians decide which patients to schedule for the hospital OR vs. their ASC, and it could point quality improvement and safety teams more quickly to the starting point for their investigations into upstream processes that impact population health outcomes, closing invaluable feedback loops necessary to bolster performance. 

Fortunately, the clinical and economic research team within 3M’s Health Information Systems Division is tackling just such a problem. I interviewed Dr. Miki Patterson, an orthopedic nurse practitioner, to discuss her work on this team, the current state of surgical quality and safety, and to reminisce on our consulting days. I hope all of our listeners and readers will at some point have the chance to work with a teammate such as Miki; she is a leader, a friend and a mentor to many. Enjoy the conversation!

Dr. Travis Bias is a family medicine physician and chief medical officer of clinician solutions at 3M Health Information Systems.