Foot & Ankle International - July 2016 - (Page 801)

610772 FAIXXX10.1177/1071100715610772Foot & Ankle InternationalPinzur research-article2015 FootForum The Evolution of Patient Safety Foot & Ankle International® 2016, Vol. 37(7) 801 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100715610772 fai.sagepub.com Michael S. Pinzur, MD1 The birth of the Patient Safety Movement in orthopedic surgery was with the development of the American Academy of Orthopaedics Sign your Site initiative.1 Healthcare organizations began to learn that utilization of decision support analysis methodology, adopted from industry, was very effective in avoiding the occurrence of untoward events. Whether we use Six Sigma, Total Quality Management (TQM), or Design Measure Analyze Improve Control (DMAIC), the process involves (1) defining a problem, (2) collecting objective data, (3) analysis of that data, and (4) the initiation of a change in process directed at implementing a positive, clearly defined endpoint.2,3,5 Once implemented, we re-collect the data and repeat the objective analysis to learn whether our intervention led to the desired effect. We learned that this methodology was very effective at developing process change to decrease the occurrence of untoward occurrences. The development of the Patient Safety movement in modern American health care coincided with the development of orthopedic subspecialization and programs developed to treat specific disease entities. The early adopters of this methodology implemented patient care pathways, structured order sets, and algorithms to efficiently care for patients undergoing hip and knee arthroplasty. We learned that structured processes of patient care led to uniformity of clinical results and decreased rates of complications. We learned that the most effective methodology to decrease hospital length of stay was to avoid an outlier complication. Over time, we learned that the use of these initiatives not only decreased the risk and rate of complications, it improved the financial metrics of health care. The Mortality and Morbidity Conference, which focused on the identification of blame, morphed into the Quality Improvement Conference. Instead of assigning blame for an untoward event, the Quality Improvement methodology focuses on identifying the procedural flaw that allowed this event to occur. Rather than simply assigning blame, the process was used to identify a process improvement that, when implemented, was likely to decrease that event from occurring on a subsequent patient. The next horizon in Patient Safety is evolving in organizations that are developing methodologies of population management. Our joint arthroplasty colleagues have taught us that there are several risk factors that lead to poorer outcomes and higher rates of complications in hip and knee arthroplasty patients. These include morbid obesity as defined by body mass index (BMI) greater than 40, poorly controlled diabetes, as defined by hemoglobin A1C greater than 8%, and anemia.4 Rather than simply denying surgical reconstruction to these high-risk patients, best practice organizations are developing programs to improve the risk status of patients undergoing surgery. Although a BMI of 42 is not optimal, it is far better than a BMI of 52. A hemoglobin A1C of 8.2% is far better than 10%. Optimization of modifiable risk factors in high risk patients will allow these patients to obtain the services that we have been trained to provide, with a more accepted risk tolerance. Patient Safety has come full circle. The movement was initiated to avoid the occurrence of untoward events. We learned, over time, that improved patient care practices decrease the occurrence of those untoward events. And finally, we are learning that making patients healthier before we perform surgery is the best tactic to decrease the rate of complications following the surgery. Improved health system population management has the greatest potential to decrease risk of complication, decrease cost of care, and ultimately improve patient care outcomes in high-risk patient populations. The FootForum is interested in your comments. Please contact us at mpinzur@aofas.org. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author received no financial support for the research, authorship, and/or publication of this article. References 1. AAOS. Sign your sight. www.AAOS.org. January 1, 2003. 2. ASQ. The Define Measure Analyze Improve Control (DMAIC) Process. http://asq.org/learn-about-quality/six-sigma/overview/ dmaic.html. Accessed September 14, 2015. 3. iSixSigma. What Is Six Sigma? http://www.isixsigma.com/ new-to-six-sigma/getting-started/what-six-sigma/. Accessed September 14, 2015. 4. Moucha CS, Clyburn T, Evans RP, Prokuski L. Modifiable risk factors for surgical site infection. J Bone Joint Surg. 2011;93(4):398-404. 5. TechTarget, SearchCIO. Total Quality Management (TQM) definition. http://searchcio.techtarget.com/definition/Total-QualityManagement. Accessed September 14, 2015. 1 Loyola University Health System, Maywood, IL, USA Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA. Email: mpinzur@aofas.org http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com http://www.AAOS.org http://www.asq.org/learn-about-quality/six-sigma/overview/dmaic.html http://www.asq.org/learn-about-quality/six-sigma/overview/dmaic.html http://www.isixsigma.com/new-to-six-sigma/getting-started/what-six-sigma/ http://www.isixsigma.com/new-to-six-sigma/getting-started/what-six-sigma/ http://searchcio.techtarget.com/definition/Total-Quality-Management http://searchcio.techtarget.com/definition/Total-Quality-Management

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016