MANKATO — The readmission rate of colorectal surgery patients went from 21 percent to 4 percent.
The sepsis rate for such surgery patients went from 15 percent to 7 percent. The surgical site infection rate went from 17 percent to 6 percent.
“That’s better than 60 percent of other hospitals nationwide,” said Dr. Chad Buhs, chair of the Department of Surgery at Mayo Clinic Health System in Mankato.
These decreases in surgical complications happened in just one year, from Jan. 1, 2016, to Jan. 1, 2017. And such vast improvements in patient care in that short window of time are a testament to the American College of Surgeons National Surgery Quality Improvement Program, which Buhs was largely responsible for implementing at the Mankato hospital several years ago.
“I pushed for that hard,” said Buhs of the program, which allows the hospital to compare its surgery outcomes to that of 700 hospitals around the world.
Mayo enters 1,600 cases each year into the databank. Hospital staff can look at data trends among various aspects of surgery, from mortality rates to wound infections to hospital readmissions due to complications.
“We benchmark that data, and it allows us to see what we’re doing well and what we’re doing poorly,” Buhs said. “One of the best things is it’s never meant to be a punitive program.”
They also can look at the outcomes of many other hospitals, including those regionally at Mayo Clinic Health System in Eau Claire, Wisconsin, or Mayo Clinic Hospital, Saint Marys Campus, for example. If there is a hospital whose data show particularly good outcomes, they can investigate further into what practices are in place and learn from them.
With regard to the colorectal surgery outcomes, Buhs said Mayo initiated a “quality improvement bundle,” changing about eight things during the surgery process, from pre-op to post-op. Patients’ skin is prepped beforehand by washing down with a special antiseptic, for example, and an entirely different set of sterile instruments are used to close an incision than were used during surgery.
“We’ve had tremendous improvement,” Buhs said. “It’s been a combination of things, and it’s been a real team effort.”
Buhs said implementing a bundle of changes like this is referred to as “clumping.” He used the metaphor of trying to figure out why your car isn’t running well. If you only change the oil and it still runs badly, you’ve only isolated one factor. But if you change the oil, change the spark plugs, put air in the tires and get a tuneup and then your car runs better, it could be any one of those things, or more likely a combination of all of those things, that led to the improvement.
The quality improvement program has shown improvements with various other general surgery outcomes as well. But the work never ends, Buhs said. When improvements are made in one area, others may arise, which is why it’s important to continuously study the data for emerging trends.
“We get the data, and what we look for isn’t one blip, but really a trend — something that is high and remains high. Then we really start looking at that,” he said. “Quality improvement never ends. No matter what. Even if you’re the best hospital in the country, you continue to improve, and it’s not one person doing it. It’s not just me. It’s all of us.”
Buhs came to Mayo in Mankato in 2009. He grew up in Albert Lea and attended Texas Lutheran University in Seguin before going to medical school at the University of Minnesota and doing his surgery training at William Beaumont Hospital in Detroit.
Before coming to Mankato, Buhs had been doing private practice in Peoria, Illinois. Mostly due to the difficulty of governmental regulations, private practice was becoming increasingly difficulty. He knew people at Mankato (having worked for Mankato Clinic from 2000-2004) and decided to move his family back to his home turf of southern Minnesota.
Buhs said working at Mayo has been rewarding, and he’s excited about various efforts in the works, including accreditation for the Cancer Center and expanding bariatric surgery (which is in demand).
He’s also pleased with improvements already made, such as the addition of a plastic surgeon, which has been a great help for breast cancer patients who opt for breast reconstruction; and becoming the only Level III trauma center in the state, as verified by the American College of Surgeons for such criteria as prompt assessment, resuscitation, surgery, intensive care and stabilization of patients.
“My vision for this place is that we become more of a regional center,” Buhs said.