As orthopaedists, we strive daily to decrease complications, provide the highest quality patient care, and improve the value of the services we offer. Although every practice and every hospital expends considerable effort on achieving these goals, many operate in isolation, unaware of what worked well in a similar practice or hospital across the state or across the nation.

The goal of the Pediatric Orthopaedic Society of North America (POSNA) Quality, Safety, and Value Initiative (QSVI) is to provide a unified program at the organizational level to coordinate and share the best ideas and practices for improving quality of care, increasing patient safety, and delivering value. The program was established in 2011, under the leadership of Peter M. Waters, MD, then the incoming POSNA president. He appointed John M. (Jack) Flynn, MD, to organize and launch the QSVI program, with the leadership’s full support and resources.

A fundamental belief in quality improvement is that a “rising tide lifts all boats,” but the clinical response has been more like a tsunami. The initial query to POSNA members was aimed at finding a few like-minded individuals passionate about QSVI issues. To the great surprise of POSNA leadership, nearly 100 members quickly and enthusiastically volunteered for the new initiative.

The structure and focus of the POSNA QSVI is appropriately bottom-up, and began with member surveys and member-derived goals. Today, QSVI programs have affected nearly all POSNA members by providing information and support to improve clinical care for thousands of patients.

Tools, research, education
The POSNA QSVI team has the following three goals:

• to develop clinical tools that members can use to improve quality and safety at their institutions
• to conduct multicenter research trials focused on determining complication rates, the efficacy of safety interventions, and other QSVI questions
• to educate members on best practices and new developments in the realms of quality, safety, and value

Quality improvement techniques that focus on practical, real-world, real-time solutions are encouraged, and these efforts are bearing fruit. In July 2013, the Journal of Pediatric Orthopaedics published “Building Consensus: Development of a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery.” These guidelines have the potential to save hundreds of children from infections, as well as to reduce healthcare costs by millions of dollars.

Additional projects are underway, including the following:

• publication of a “compartment syndrome alert process,” developed by a busy pediatric trauma center, which has resulted in nearly eliminating the need for urgent compartment releases
• information on an operating room utilization project that produced more than $1 million of “lost” hospital revenue just by improving the capacity of a single surgeon
• an analysis of the value of posterior spinal fusion for idiopathic scoliosis
• the development of processes that leverage the power of new technology, such as a comprehensive, computerized check-list that can integrate with a hospital’s electronic health record
• creation of sophisticated, validated surgical simulation programs to efficiently teach the next generation of surgeons

Getting the word out
QSVI information is disseminated in several ways, including focused, themed programming at the 2012 and 2013 POSNA annual meeting. At the 2014 POSNA annual meeting, Mininder S. Kocher, MD, MPH, will present a QSVI-focused precourse. Working groups communicate regularly through POSNA’s SharePoint site. Mobile apps, publications, courses on QSVI methodology, and coordination with the National Surgical Quality Improvement Program are ongoing.

The POSNA QSVI work is currently being supported through funding from a QSVI-directed research effort, ongoing POSNA participation, and support from the AAOS, other specialty groups, and an enthusiastic POSNA membership. All POSNA committees, specific clinical specialty areas, and selected quality improvement experts are represented. Sharing goals and topics with other specialty groups, such as the Scoliosis Research Society, is encouraged and has been highly productive.

The POSNA QSVI will enhance research and healthcare delivery in pediatric orthopaedics and aid members in their practice—with the singular focus of producing higher quality, safer care at a better value for our patients and families.

James J. McCarthy, MD, is a member of the POSNA Board of Directors.

References

1. Vitale MG, Riedel MD, Glotzbecker MP, et al: Building consensus: Development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 2013 Jul-Aug;33(5):471-8. doi: 10.1097/BPO.0b013e3182840de2
2. Schaffzin J, Bisig J, Prichard H, et al: Developing a Collaborative System to Improve Compartment Syndrome Recognition. To be published November 11, 2013.