Group PQI Project

Diplomates within a practice may wish to complete a quality improvement initiative as a group. A Group PQI project shared among thoracic surgeons should have the potential to impact their individual practice behavior and/or system environments within the confines of their group practice.  Group participation can also be more convenient and manageable for administrative purposes.

Group PQI projects may be self-designed by Diplomates or selected from a variety of existing projects sponsored by national organizations and societies. The goals and measures of any project should be relevant to each diplomate’s practice, with the potential to improve care.

Group-designed PQI projects are conceived and formatted by the group to address a quality or safety gap in the group’s practice. Such projects do not require review or approval by the ABTS.

A major distinguishing feature of Group PQI, as compared to Individual PQI, is the requirement of group meetings to ensure meaningful engagement of participants in the process.  Group meetings also promote productive interactions among the participants in performing quality measurements and assessments and implementing practice-improvement actions relevant to the system in which the participants practice.

What Constitutes a Group?
For purposes of Group PQI project participation, the ABTS has defined “group” as:

“Two or more thoracic surgeons, sharing a common central organizational structure, who work together to provide patient care, regardless of individual contractual affiliations or relationships. These cardiothoracic surgeons may provide services at single or multiple facilities or locations in a variety of clinical settings, including hospitals and offices.”

Examples of Group PQIs
  1. Early Foley removal prior to thoracic epidural removal

  2. Increased incidence of urinary tract infection identified in NSQIP data addressed through a dedicated nursing education program

  3. Reduction in epidural utilization for thoracotomies through implementation of new pain control strategies: impact on length of stay

  4. Multidisciplinary effort to fast tracking esophagectomy patients and reduction in length of stay

  5. Analysis of the use of in-house versus outpatient barium swallow study after esophagectomy: increased hospital stay and minimal utility associated with in-house performance

  6. Between January 2008 and December 2012, a multicenter quality collaborative of cardiac surgeons in Michigan initiated a focus on blood conservation as a quality metric, with educational presentations and quarterly reporting of institutional-level perioperative transfusion rates and outcomes. This prospective cohort study was undertaken to determine the effect of that initiative on transfusion rates after isolated coronary artery bypass grafting (CABG). Transfusion rates continuously decreased for all blood products. RBC use decreased from 56.4% in 2008 (baseline) to 38.3% in 2012, FFP use decreased from 14.8% to 9.1%, and platelet use decreased from 20.5% to 13.4% (ptrend < 0.001 for all). (Michigan Society of Thoracic and Cardiovascular Surgeons)

  7. Off-pump coronary artery bypass (OPCAB) may be associated with improved outcomes when compared with on-pump coronary artery bypass. This study evaluates the use of a system for access and stabilization (SAS) with a coronary stabilizer as well as a clinical effectiveness quality initiative (CEQI) process regarding outcomes. This included the development of an expanded heart care team as well as standardization and refinement of perioperative care. Our aim was to evaluate morbidity and mortality of on-pump coronary artery bypass grafting (CABG) compared with OPCAB surgery using SAS in addition to a CEQI initiative. One-thousand two-hundred sixty-seven procedures were performed; 405 on-pump CABGs, 90 OPCABs pre-SAS, and 772 OPCABs with SAS, of which 552 were in the SAS + CEQI group. Statistically mortality was significantly lower in the SAS + CEQI vs the on-pump group (0.7% vs 3.0%, p < 0.01). The percentage of patients with prolonged ventilation was significantly lower statistically in the SAS + CEQI vs the on-pump group (4.2% vs 9.7%, p < 0.01). Statistically the length of stay was significantly lower in both SAS groups compared with the on-pump group (p < 0.01). (The Lankenau Hospital)