Skip to main content

Advertisement

SpringerLink
Log in

Leveraging Quality Improvement and Patient Safety Initiatives to Enhance Value and Patient-Centered Care in Otolaryngology

  • SPECIAL TOPICS: Value Based Care in Otolaryngology (L Ishii and T Tollefson, Section Editors)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patient safety and quality improvement (PS/QI) initiatives have rapidly proliferated through all fields of healthcare including otolaryngology. Harnessing these initiatives provides an opportunity to systematically evaluate and disseminate best practices and to evaluate their effect in improving value for patients.

Recent Findings

New data registries and disease-specific quality improvement collaboratives provide opportunities for otolaryngologists to use data to enhance quality. We describe PS/QI measures that enhance value by improving quality and controlling costs. These include data registries that allow “big data” approaches, the benefits of multidisciplinary teams and care coordination, subspecialty-specific initiatives, use of M&M conference as a launchpad for PS/QI activity, and barriers to implementation of PS/QI strategies.

Summary

As changes in healthcare continue to accelerate, otolaryngologists who embrace opportunities to optimize value in their respective subspecialties will see improved outcomes for their patients and will reap the benefits of thriving, fulfilling clinical practices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fisher ES, Bynum JP, Skinner JS. Slowing the growth of health care costs—lessons from regional variation. N Engl J Med. 2009;360(9):849–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.

    Article  PubMed  CAS  Google Scholar 

  3. Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250(3):363–76.

    PubMed  Google Scholar 

  4. Das P, Zhu H, Shah RK, Roberson DW, Berry J, Skinner ML. Tracheotomy-related catastrophic events: results of a national survey. Laryngoscope. 2012;122(1):30–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wilkinson K, Martin I, Freeth H, Kelly K, Mason M. NCEPOD: on the right trach. URL http://www.ncepod.org.uk/2014tc.htm [accessed on 10 January 2016] 2014.

  6. Cetto R, Arora A, Hettige R, Nel M, Benjamin L, Gomez C, et al. Improving tracheostomy care: a prospective study of the multidisciplinary approach. Clin Otolaryngol. 2011;36(5):482–8.

    Article  PubMed  CAS  Google Scholar 

  7. Brown D, Cameron T, Donoghue F, McKinstry A, Sweeney J, Burt S, et al. Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team. Crit Care Resusc. 2009;11(1):14.

    PubMed  Google Scholar 

  8. Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L. Systematic review of multidisciplinary interventions in heart failure. Heart. 2005 Jul;91(7):899–906.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Kim MM, Barnato AE, Angus DC, Fleisher LF, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369–76.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zenga J, Nussenbaum B, Cornelius LA, Linette GP, Desai SC. Management controversies in head and neck melanoma: a systematic review. JAMA Facial Plast Surg. 2017;19(1):53–62.

    Article  PubMed  Google Scholar 

  11. Friedland P, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M. Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer. 2011;104(8):1246–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Capone RB, Sykes JM. The cleft and craniofacial team: the whole is greater than the sum of its parts. Facial Plast Surg. 2007;23(02):083–6.

    Article  CAS  Google Scholar 

  13. Snyderman CH, Wang EW, Fernandez-Miranda JC, Gardner PA. The making of a skull base team and the value of multidisciplinary approach in the management of sinonasal and ventral skull base malignancies. Otolaryngol Clin N Am. 2017 Apr;50(2):457–65.

    Article  Google Scholar 

  14. de Mestral C, Iqbal S, Fong N, LeBlanc J, Fata P, Razek T, et al. Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. Can J Surg. 2011 Jun;54(3):167–72.

    Article  PubMed  PubMed Central  Google Scholar 

  15. •• McGrath BA, Lynch J, Bonvento B, Wallace S, Poole V, Farrell A, et al. Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals. BMJ Open Quality 2017;6(1). The authors implemented multidisciplinary institutional changes guided by the Global Tracheostomy Collaborative in four UK hospitals. This resulted in rapid progress in patient safety and surrogate metrics for the quality of care.

  16. Pandian V, Miller CR, Mirski MA, Schiavi AJ, Morad AH, Vaswani RS, et al. Multidisciplinary team approach in the management of tracheostomy patients. Otolaryngol Head Neck Surg. 2012;147(4):684–91.

    Article  PubMed  Google Scholar 

  17. Ward E, Pandian V, Brenner MJ. The primacy of patient-centered outcomes in tracheostomy care. Patient. 2017;1–3.

  18. Pritchett CV, Rietz MF, Ray A, Brenner MJ, Brown D. Inpatient nursing and parental comfort in managing pediatric tracheostomy care and emergencies. JAMA Otolaryngol Head Neck Surg. 2016;142(2):132–7.

    Article  PubMed  Google Scholar 

  19. Mirski MA, Pandian V, Bhatti N, Haut E, Feller-Kopman D, Morad A, et al. Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med. 2012 Jun;40(6):1827–34.

    Article  PubMed  Google Scholar 

  20. Mark LJ, Herzer KR, Cover R, Pandian V, Bhatti NI, Berkow LC, et al. Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies. Anesth Analg. 2015 Jul;121(1):127–39.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nobleza COS, Pandian V, Jasti R, Wu DH, Mirski MA, Geocadin RG. Outcomes of tracheostomy with concomitant and delayed percutaneous endoscopic gastrostomy in the neuroscience critical care unit. J Intensive Care Med 2017:0885066617718492, 088506661771849.

  22. • Graboyes EM, Gross J, Kallogjeri D, Piccirillo JF, Al-Gilani M, Stadler ME, et al. Association of compliance with process-related quality metrics and improved survival in oral cavity squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2016;142(5):430–7. This study identified compliance with a set of quality metrics for oral cavity cancer were associated with improved overall survival. This provides an excellent example of a study seeking to validate quality metrics in head and neck cancer.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cramer JD, Speedy SE, Ferris RL, Rademaker AW, Patel UA, Samant S. National evaluation of multidisciplinary quality metrics for head and neck cancer. Cancer. 2017;123(22):4372–81.

    Article  PubMed  Google Scholar 

  24. Graboyes EM, Garrett-Mayer E, Ellis MA, Sharma AK, Wahlquist AE, Lentsch EJ, et al. Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer. Cancer. 2017;123(24):4841–50.

    Article  PubMed  Google Scholar 

  25. Britt CJ, Chang H, Quon H, Kang H, Kiess AP, Eisele DW, et al. Quality indicators of laryngeal cancer care in commercially insured patients. Laryngoscope. 2017;127(12):2805–12.

    Article  PubMed  Google Scholar 

  26. Schoppy DW, Rhoads KF, Ma Y, Chen MM, Nussenbaum B, Orosco RK, et al. Measuring institutional quality in head and neck surgery using hospital-level data: negative margin rates and neck dissection yield. JAMA Otolaryngol Head Neck Surg. 2017;143(11):1111–6.

    Article  PubMed  Google Scholar 

  27. Cognetti DM, Nussenbaum B, Brenner MJ, Chi DH, McCormick ME, Venkatraman G, et al. Current state of overlapping, concurrent, and multiple-room surgery in otolaryngology: a national survey. Otolaryngol Head Neck Surg. 2017;157(6):998–1004.

    Article  PubMed  Google Scholar 

  28. Graboyes EM, Kallogjeri D, Saeed MJ, Olsen MA, Nussenbaum B. Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery. Laryngoscope. 2017;127(4):868–74.

    Article  PubMed  Google Scholar 

  29. Cramer JD, Patel UA, Samant S, Smith SS. Postoperative complications in elderly patients undergoing head and neck surgery: opportunities for quality improvement. Otolaryngol Head Neck Surg. 2016;154(3):518–26.

    Article  PubMed  Google Scholar 

  30. Chin R, Rao YJ, Hwang MY, Spencer CR, Pierro M, DeWees T, et al. Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer. 2017;123(23):4594–607.

    Article  PubMed  Google Scholar 

  31. Rudmik L, Xu Y, Alt JA, Deconde A, Smith TL, Schlosser RJ, et al. Evaluating surgeon-specific performance for endoscopic sinus surgery. JAMA Otolaryngol Head Neck Surg. 2017;143(9):891–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Scangas GA, Lehmann AE, Remenschneider AK, Su BM, Shrime MG, Metson R. The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps—a cost utility analysis. Laryngoscope. 2018;128(1):43–51.

    Article  PubMed  Google Scholar 

  33. Snyderman CH, Gardner PA, Lanisnik B, Ravnik J. Surgical telementoring: a new model for surgical training. Laryngoscope. 2016;126(6):1334–8.

    Article  PubMed  Google Scholar 

  34. Wang DE, Lam DJ, Bellmunt AM, Rosenfeld RM, Ikeda AK, Shin JJ. Intranasal steroid use for otitis media with effusion: ongoing opportunities for quality improvement. Otolaryngol Head Neck Surg. 2017;157(2):289–96.

    Article  PubMed  Google Scholar 

  35. Boss EF, Links AR, Saxton R, Cheng TL, Beach MC. Parent experience of care and decision making for children who snore. JAMA Otolaryngology–Head & Neck Surgery. 2017;143(3):218–25.

    Article  Google Scholar 

  36. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, et al. Tracheostomy placement in children younger than 2 years: 30-day outcomes using the National Surgical Quality Improvement Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016;142(3):241–6.

    Article  PubMed  Google Scholar 

  37. • Shah RK, Stey AM, Jatana KR, Rangel SJ, Boss EF. Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1019–26. This study provides a thorough evaluation of etiology of major postoperative morbidity in pediatric otolaryngology. It identified tracheostomy, airway reconstruction, mastoidectomy and abscess drainage as targets for quality improvement.

    Article  PubMed  Google Scholar 

  38. Lavin JM, Schroeder JW, Thompson DM. The “surgeon on service” model for timely, economically viable inpatient care of tracheostomy patients in academic pediatric otolaryngology. JAMA Otolaryngology–Head & Neck Surgery. 2017;143(10):1003–7.

    Article  Google Scholar 

  39. Dey JK, Ishii LE, Joseph AW, Goines J, Byrne PJ, Boahene KD, et al. The cost of facial deformity: a health utility and valuation study. JAMA Facial Plast Surg. 2016;18(4):241–9.

    Article  PubMed  Google Scholar 

  40. Brenner MJ. What cost-utility analysis can teach us about facial deformity: gambles, trade-offs, and willingness to pay. JAMA Facial Plastic Surgery. 2016;18(4):249–50.

    Article  PubMed  Google Scholar 

  41. Teti VP, Akdagli S, Most SP. Cost-effectiveness of corticosteroid nasal spray vs surgical therapy in patients with severe to extreme anatomical nasal obstruction. JAMA Facial Plastic Surgery. 2016;18(3):165–70.

    Article  PubMed  Google Scholar 

  42. Lanigan A, Lospinoso J, Bowe SN, Laury AM. The nasal fracture algorithm: a case for protocol-driven management to optimize care and resident work hours. Otolaryngol Head Neck Surg. 2017;156(6):1041–3.

    Article  PubMed  Google Scholar 

  43. Carroll TL, Werner A, Nahikian K, Dezube A, Roth DF. Rethinking the laryngopharyngeal reflux treatment algorithm: evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease. Laryngoscope. 2017;127(S6):S1–S13.

    Article  PubMed  CAS  Google Scholar 

  44. Hillel AT, Ochsner MC, Johns MM, Klein AM. A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room. Laryngoscope. 2016;126(6):1385–9.

    Article  PubMed  Google Scholar 

  45. Copson B, Wijewickrema S, Zhou Y, Piromchai P, Briggs R, Bailey J, et al. Supporting skill acquisition in cochlear implant surgery through virtual reality simulation. Cochlear Implants International. 2017;18(2):89–96.

    Article  PubMed  Google Scholar 

  46. Morrison RJ, Bowe SN, Brenner MJ. Teaching quality improvement and patient safety in residency education: strategies for meaningful resident quality and safety initiatives. JAMA Otolaryngology–Head & Neck Surgery. 2017;143(11):1069–70.

    Article  Google Scholar 

  47. Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current status of simulation in otolaryngology: a systematic review. J Surg Educ. 2017 Mar - Apr;74(2):203–15.

    Article  PubMed  Google Scholar 

  48. Bowe SN. Quality improvement in otolaryngology residency: survey of program directors. Otolaryngol Head Neck Surg. 2016;154(2):349–54.

    Article  PubMed  Google Scholar 

  49. Vosler PS, Kass JI, Wang EW, Snyderman CH. Successful implementation of a clinical care pathway for management of epistaxis at a tertiary care center. Otolaryngol Head Neck Surg. 2016;155(5):879–85.

    Article  PubMed  Google Scholar 

  50. Balakrishnan K, Arjmand EM, Nussenbaum B, Snyderman AC. National Multispecialty Survey Results: comparing morbidity and mortality conference practices within and outside otolaryngology. Otolaryngol Head Neck Surg 2017.

  51. Phillips DR, Ellsperman SE, Matt BH, Zarzaur BL. Comparison of automated posttonsillectomy bleed capture with self-report. JAMA Otolaryngology–Head & Neck Surgery. 2017;143(8):764–8.

    Article  Google Scholar 

  52. Leenstra JL, Beckman TJ, Reed DA, Mundell WC, Thomas KG, Krajicek BJ, et al. Validation of a method for assessing resident physicians’ quality improvement proposals. J Gen Intern Med. 2007;22(9):1330–4.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Vila PM, Lewis S, Cunningham G, Brereton J, Espinel AG, Roberson DW, et al. A novel patient safety event reporting tool in otolaryngology. Otolaryngol Head Neck Surg. 2017;157(1):117–22.

    Article  PubMed  Google Scholar 

  54. Dzau VJ, Kirch DG, Nasca TJ. To care is human—collectively confronting the clinician-burnout crisis. N Engl J Med. 2018;378(4):312–4.

    Article  PubMed  Google Scholar 

  55. Hurtado M, Swift E, Corrigan J. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine. In: Committee on the national quality report on health care delivery; 2001.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA

    Michael Brenner

  2. Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    John Cramer

  3. Ross School of Business, University of Michigan, Ann Arbor, MI, USA

    Samantha Cohen

  4. Department of Otorhinolaryngology, Mayo Clinic Children’s Center, 200 First Street SW, Gonda 12-366, Rochester, MN, 55905, USA

    Karthik Balakrishnan

Authors
  1. Michael Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Cramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samantha Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karthik Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karthik Balakrishnan.

Ethics declarations

Conflict of Interest

Dr. Karthik Balakrishnan, Dr. John Cramer, and Dr. Samantha Cohen declare that they have no competing interests.

Dr. Michael Brenner reports (unpaid) service as associate editor for Health Policy and Patient Safety/Quality Improvement for the journal Otolaryngology—Head and Neck Surgery, (unpaid) service on Board of Directors and as treasurer for Global Tracheostomy Collaborative, and obtained research funding from the National Institutes of Health. He has no financial disclosures.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on SPECIAL TOPICS: Value Based Care in Otolaryngology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brenner, M., Cramer, J., Cohen, S. et al. Leveraging Quality Improvement and Patient Safety Initiatives to Enhance Value and Patient-Centered Care in Otolaryngology. Curr Otorhinolaryngol Rep 6, 231–238 (2018). https://doi.org/10.1007/s40136-018-0209-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-018-0209-1

Keywords

Search

Navigation