Otolaryngology–Head and Neck Surgery | 2019
Highlights from the Current Issue: December 2019
Abstract
H appy December! We made it through to 2019’s holiday season. Hopefully you will find time to spend with family and friends and enjoy everything that this joyous season brings. It is once again the time to present the journal’s focus section on patient safety and quality improvement (PS/QI). In this issue, we offer the second in a series of invited papers on PS/QI, which focuses on the value and conduct of root cause analyses (RCAs) and their implementation as a method to reduce medical errors. In addition, we present 3 papers that demonstrate specific PS/ QI projects that may provide some insight and guidance on various topics in otolaryngology. We hope you enjoy reading them! In our first manuscript, Balakrishnan and colleagues discuss the use of RCAs as a tool in the identification and mitigation of medical errors. The authors provide a primer in the process of utilizing RCAs in clinical practice, recognizing the absence of practical experience among many physicians. They focus attention on recognizing and identifying system errors, recording adverse events, and determining specific errors that warrant the need for RCA. They further describe the process of RCA, including the steps necessary to conduct a successful RCA and the translation of identified concerns into actionable steps. Finally, Balakrishnan and associates discuss strategies that otolaryngologists can use to implement points from the RCA into clinical practice and medical education. This primer provides a useful guide for physicians that will allow them to incorporate a systematic approach to the reduction of medical errors into their practices. In our second paper, Azmy and colleagues identify risk factors for perioperative blood transfusions (PBTs) in neck dissection and evaluate the association of PBT with other postoperative outcomes. Using the ACS-NSQIP database (American College of Surgeons–National Surgical Quality Improvement Program), they identified 3090 patients to include in their analysis. Of these individuals, 249 received PBT either intraoperatively or on the day of surgery. The authors then examined the use of PBT in association with other patient factors and with various postoperative complications. Based on their analysis, patient factors that were independently associated with a higher risk of PBT were ASA class 3 (American Society of Anesthesiologists), preoperative weight loss, and anemia. In addition, PBT was significantly associated with unplanned return to the operating room within 30 days but not with unplanned readmissions within 30 days. In their database cohort, 11% of patients underwent PBT with neck dissection. Azmy and associates assess their data and note that awareness of patient risk factors for PBT may allow appropriate preoperative surgical planning and may permit patient management that will reduce the need for additional unplanned surgery. In our third manuscript, Youssef and Vyas outline and evaluate the use of Medicare services, benefits, and reimbursements in the otolaryngology community. Using the publicly available Medicare database, the authors studied payment and utilization data from the 5-year period from January 1, 2012, through December 31, 2016, for all otolaryngologists who provided services to Medicare beneficiaries. The authors noted that a total of $701,195,375 was paid to 8572 individual otolaryngologists for 815 unique Healthcare Common Procedure Coding System codes for 13,942,536 procedure claims. They further stated that the average number of services coded per otolaryngologist was 1627, with an average payment per otolaryngologist of $81,800.67. In analyzing the procedures completed, the authors reported that the most significant contributors to Medicare were large-scale, low-cost procedures that were conducted in clinic, such as nasal endoscopy. On the basis of their analysis, Youssef and Vyas note that otolaryngologists should be aware of trends and utilization of procedures in their areas and should work with policy makers toward sustainable payment models. In our fourth paper, Chen and colleagues report on their adaptation of a mobile smartphone platform to facilitate the assessment of resident operative experiences in otolaryngology. The authors utilized a platform known as SIMPL (System for Improving and Measuring Procedural Learning) in a pilot program for faculty and residents to assess resident performance and autonomy during operative cases. In this pilot, 23 residents and 17 faculty were trained with a standardized curriculum to assess performance in cases that represented all 14 key indicators in otolaryngology. Over a 6-month period, 126 unique procedures were logged with