Every year at least 100,000 Americans die undergoing inpatient surgical procedures. Wide variation in mortality rates across hospitals suggests substantial opportunities for improvement. Payers and professional organizations are hoping that checklists, pay for performance programs, and national outcomes registries will reduce rates of surgical complications and ultimately mortality. However, recent research suggests that high mortality and low mortality hospitals are distinguished less by their complication rates than by how successfully they recognize and manage complications once they occur. Thus, minimizing failure to rescue (i.e., death following a major complication) may be essential in efforts to reduce surgical mortality. Successful rescue hinges on early recognition and timely management of serious complications once they occur. Focusing on the clinical deterioration of patients during the early golden hours of decline may yield valuable insights into how some hospitals achieve exemplary outcomes. Unfortunately, previous work does not identify actionable insights into how hospitals can improve their rescue rates. A better understanding of how interactions and relationships within hospital micro-systems could be even more crucial to improving rescue through practical and effective interventions. To explore these issues, we propose a study designed to assess such factors and to develop and implement an intervention in Michigan hospitals aimed at improving overall safety culture, communication, and rescue rates. The specific research aims are (i) to develop an in-depth understanding of the key elements, such as teamwork and communication, necessary for complication rescue; (ii) to design an intervention that promotes key elements for improving rescue; and (iii) to pilot an intervention aimed at improving hospital rescue rates. This work will shed light on how healthcare organizations can be engaged to better sense, cope with, and respond to the unexpected and changing demands presented by clinically deteriorating post-surgical patients with life-threatening complications. This project will have direct, population-level impact to inform interventions aimed at reducing mortality in surgical patients in Michigan, and ultimately elsewhere. Results from this study will also inform large payer (including CMS) and regulators (particularly JCAHO) as they set incentives and standards for enhancing the safety of inpatient surgery in the United States. Further, the research project, highly experienced multidisciplinary mentorship team, and unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate, Amir A. Ghaferi, MD, MS. The proposal includes a detailed educational plan with training that will be essential both for successful completion of this research and toward Dr. Ghaferi's career development. The training includes graduate level courses in organizational management, behavior, and theory, qualitative research methods, and implementation science. This career development award will lay the groundwork for Dr. Ghaferi to perform ongoing, innovative health services research, and to become an independent investigator and national leader in patient safety and quality improvement.

Public Health Relevance

This project will assess the key elements, such as teamwork and communication, necessary for effective rescue from major postsurgical complications. This work will shed light on how healthcare organizations can be engaged to better sense, cope with, and respond to the unexpected and changing demands presented by clinically deteriorating post-surgical patients with life-threatening complications. The results will have direct, population-level impact to inform interventions aimed at reducing mortality in surgical patients in Michigan, and ultimately elsewhere.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
1K08HS023621-01A1
Application #
8967514
Study Section
Healthcare Patient Safety and Quality Improvement Research (HSQR)
Program Officer
Willis, Tamara
Project Start
2015-07-01
Project End
2020-06-30
Budget Start
2015-07-01
Budget End
2016-06-30
Support Year
1
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Macht, Ryan; Cassidy, Ruth; Cabral, Howard et al. (2017) Evaluating organizational factors associated with postoperative bariatric surgery readmissions. Surg Obes Relat Dis 13:1004-1009
Jacobs, Bruce L; He, Chang; Li, Benjamin Y et al. (2017) Variation in readmission expenditures after high-risk surgery. J Surg Res 213:60-68
Ghaferi, Amir A; Friese, Christopher R (2016) Revisiting Nursing's Effect on Surgical Quality and Cost. JAMA Surg 151:536-7
Ghaferi, Amir A; Lindsay-Westphal, Carol (2016) Bariatric Surgery--More Than Just an Operation. JAMA Surg 151:232-3
Pradarelli, Jason C; Healy, Mark A; Osborne, Nicholas H et al. (2016) Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue. JAMA Surg 151:e163340
Waljee, Jennifer F; Ghaferi, Amir; Cassidy, Ruth et al. (2016) Are Patient-reported Outcomes Correlated With Clinical Outcomes After Surgery?: A Population-based Study. Ann Surg 264:682-9
Ghaferi, A A; Dimick, J B (2016) Importance of teamwork, communication and culture on failure-to-rescue in the elderly. Br J Surg 103:e47-51
Sheetz, Kyle H; Dimick, Justin B; Ghaferi, Amir A (2016) Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery. Ann Surg 263:692-7
Ibrahim, Andrew M; Ghaferi, Amir A; Thumma, Jyothi R et al. (2016) Hospital Quality and Medicare Expenditures for Bariatric Surgery in the United States. Ann Surg :
Nagendran, Myura; Dimick, Justin B; Gonzalez, Andrew A et al. (2016) Mortality Among Older Adults Before Versus After Hospital Transition to Intensivist Staffing. Med Care 54:67-73

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