See also: Strong for Surgery in the News
National Impact: American College of Surgeons Takes Charge of Strong for Surgery
April 26, 2016
We recently announced that Strong for Surgery has been adopted by the American College of Surgeons, and oversight of the program will soon be shifting to this influential national organization. As this transition moves forward, we'll share updates through this blog, our newsletter, Twitter, and Facebook. Expect more great things to come!
A Fond Farewell to Wendy Klamp
April 11, 2016
Since Strong for Surgery launched almost four years ago, many of you have gotten to know our dedicated implementation coordinator, Wendy Klamp. In the first year, she helped build a public health campaign from scratch, recruit and train five pilot sites, and prove that surgeons and staff would join our efforts voluntarily and enthusiastically. She's spent countless hours helping hospitals and clinic staff map workflows, overcome obstacles, and successfully implement the program.
This month we bid a fond farewell to Wendy as she moves to Denver to be closer to family. She'll also be taking a job at the University of Colorado to develop a pre-surgery risk optimization program along the lines of Strong for Surgery. Wendy explains, "Working for CERTAIN has been a tremendous opportunity for me, in particular the opportunity to improve surgical outcomes for patients at a state and national level. I look forward to 300 days of sunshine and will continue being a Seahawks fan."
The Nutrition Checklist & Surgical Outcomes
September 1, 2015
This summer we began a study designed to examine the impact of the Strong for Surgery Nutrition Checklist on surgical outcomes. To do this, we're looking at two Washington State hospital datasets: the Surgical Care and Outcomes Assessment Program (SCOAP) will provide information about procedures, and the Comprehensive Hospital Abstract Reporting System (CHARS) will give further insight into inpatient hospital admissions and discharge information. By linking these two sources, we can get a better picture of how use of the Nutrition Checklist has influenced how well patients do after surgery.
We believe the Strong for Surgery Nutrition Checklist has helped improve care and outcomes in hospitals that have implemented it around the Northwest since the program started in 2012. Our hope is that this study will provide strong data to support further use and adoption of the checklist in the Northwest and beyond! We'll continue to share updates about this work through this blog, Twitter, and Facebook. Follow us for more great things to come!
Implementation Inspiration: Wendy Klamp
June 1, 2015
Strong for Surgery's success is the result of many engaged and dedicated people, but if we had to celebrate just one individual, Implementation Coordinator Wendy Klamp takes the cake. Wendy has been with Strong for Surgery since the very beginning and has spent the last three years working tirelessly in hospitals and clinics around the Northwest helping staff implement the program into clinical workflow. In this blog post, Wendy reflects on her experience and shares her insight into what it takes to successfully implement a quality improvement program in diverse healthcare settings.
Three years have gone by so fast! It has been such a privilege to do this work. When we started, I had so much trepidation, because it seemed like such an impossibly steep hill to climb. In the first year we had to create a public health campaign around pre-operative risk optimization, recruit and train five pilot sites, and prove that surgeons and staff would join our efforts voluntarily. That was a tall order! If I had known that three years later we would have engaged more than forty health systems, hospitals, and surgeon’s offices, I probably would have fainted!
I have learned that surgeons in Washington State and Oregon are passionately committed to improving patient care and incredibly generous with their time and support. Hospital leadership and clinic staff have been willing to go out on a limb to support us. Healthcare systems have built Strong for Surgery into their strategic plans. We have joined other great local and state organizations (WSHA, Qualis, and WSAND to name a few) to partner for our common interests. Who knew that so many people would get up for a 6:30 AM conference call every month?
I’ve also learned that every Strong for Surgery site is different and unique. This is not a one size fits all proposition. Some sites took a day to implement and others months or years. What matters is that in the end they all have built successful programs that meet their patients' needs. It can be hard to be patient with the pace. (If you know me, you understand why this is a challenge for me!) Now I realize that lasting change can take time, but it is worth it in the end. We’ve encountered every possible barrier and found a way to overcome it.
There are so many people who have helped and should be thanked publically. If I listed them all, it would take pages and pages. Many wonderful relationships have grown out of this that I will always treasure. Traveling from Bellingham to Portland and Port Townsend to Spokane has been so much fun! It’s not all work—I can tell you where to get the best cupcake in the state and which hospital gift shops have the best Christmas decorations! I’ve done planes, trains, and automobiles and even ferries to get to sites, but there was always a warm welcome waiting for me. I’ve had meetings in board rooms, auditoriums, coffee shops, subterranean basements, and the occasional parking lot.
We’ve checklisted over 6,000 patients at last count. I am really proud of that. Some of those folks are my friends, neighbors, and family members. When we started, the complication rate for colorectal surgery was around 10%. Now it’s a lot lower. I like to think about that and hope that in some small way I’ve made a contribution.
Strong for Surgery Celebrates 3 Years of Improving Patient Outcomes
May 14, 2015
by Bekky Herr
Strong for Surgery launched in Washington State three years ago on May 14, 2012, at the SCOAP Annual Meeting. At that time, Medical Director, Dr. Tom Varghese Jr. had an ambitious goal: to help every surgical patient become healthier and better prepared for their surgery. His enthusiasm caught the attention of clinicians and healthcare organizations all over the Northwest, and the Strong for Surgery program has grown from our first six pilot sites to now 50 hospitals and clinics representing more than 200 surgeons. By our estimates, over 5,500 patients have been screened using the Strong for Surgery checklists to help optimize their health for surgery!
We attribute our success to our dedicated stakeholders—from surgeon champions and enthusiastic clinicians, to community leaders—and we are incredibly grateful for the support we’ve received. As we celebrate this exciting milestone, we look forward to more exciting developments to be announced in the near future. Stay up-to-date with Strong for Surgery by following us on Twitter, liking us on Facebook, subscribing to our newsletter, and reading our blog.
Going Mobile to Improve Outcomes
February 18, 2015
Since launching in May of 2012, Strong for Surgery’s implementation process has involved hands-on support from our implementation team and considerable effort by clinic staff to adapt workflow. Successful hospitals and clinics customized the program and developed best practices to suit their unique needs. These sites are continually evaluating and adapting their approach, and we’re honored by their commitment.
As the program evolves and expands, we look to technology-based solutions for simplifying the implementation process and integrating patient input. CERTAIN Hub was launched in 2014 as a web-based portal for improving patient data collection and for delivering programs aimed at improving health and healthcare. In 2015, we will begin delivering Strong for Surgery programming through this mobile platform to achieve our goals of electronically assessing patient risk factors, delivering interactive risk reports to patients and clinicians, providing educational programming, and prompting risk-reduction behaviors prior to surgery. Pilot testing of Strong for Surgery delivered through CERTAIN Hub will begin at a small number of sites already successfully participating in the traditional S4S program.
Nutritional optimization is a great example of the potential for engaging patients in their care through this new mobile approach. Traditionally, Strong for Surgery sites screen patients for malnutrition using the nutrition checklist during their pre-op visit. Patients who are found to have poor nutritional status can be referred to a Registered Dietitian for an individualized care plan. Often this involves recommendation of a nutritional supplement patients consume in the days leading up to their surgery.
Strong for Surgery delivered through CERTAIN Hub will support and streamline this process in several ways. Patient pre-screening will begin before the patient steps foot in the exam room. The mobile platform will allow patients to complete an electronic survey, either at home or in the clinic waiting room, collecting baseline information on factors such as appetite or recent weight loss, and other important areas for assessing health status. Based on survey responses, a report will be sent to the patient and clinician summarizing the patient’s health status and modifiable risk factors. At the same time, patients will automatically receive educational resources they can use to improve their health prior to surgery.
CERTAIN Hub’s automated patient follow-up feature will help improve compliance in the care plan. If a patient is prescribed a nutrition supplement, they will be contacted in the days following their pre-op visit by text message or email. This simple series of prompts and questions will help ensure the patient has received the supplement and provide helpful reminders, like when to begin taking it.
To fully understand the impact and quality of their care, surgeons need to know the outcomes of their procedures beyond what happens the day of surgery. CERTAIN Hub will follow up with patients 30 days after a procedure to gather information about their compliance and recovery. This patient-reported outcomes data, compiled with information from the previous surveys, will be returned to the clinician in a comprehensive report. Eventually, clinicians will be able to compare their own patient data to aggregated de-identified data from all clinics participating in the program, allowing them to benchmark their outcomes, and giving them unprecedented insight into the impact of their care.
As this new Strong for Surgery initiative progresses, we look forward to continually sharing results with our stakeholders. Stay informed by reading our blog, subscribing to our newsletter, and following us on Twitter.
2015: Looking Forward to More Remarkable Milestones
December 30, 2014
When Strong for Surgery launched in Washington State almost three years ago, Medical Director, Dr. Tom Varghese Jr., had an ambitious goal: to help every surgical patient become healthier and better prepared for their surgery. His enthusiasm caught the attention of clinicians and healthcare organizations all over the northwest, and the Strong for Surgery program has grown exponentially from our first six pilot sites. As we look forward to the New Year, we reflect back on 2014—a year of growth, impact, and exciting new work:
We attribute our success to our dedicated stakeholders—from surgeon champions and enthusiastic clinicians, to community leaders—we are incredibly grateful for the support we’ve received. Currently, the Strong for Surgery program is active in 49 hospitals and clinics representing at least 200 surgeons. Most importantly, more than 4,000 patients have been screened and optimized using the Strong for Surgery checklists!
Strong for Surgery works to change practice by raising awareness of key factors in pre-surgical care that can improve post-operative outcomes. We are grateful that 2014 brought local and national media attention to the program.
Medical Director, Dr. Tom Varghese Jr., was honored to have the opportunity to present the Strong for Surgery program at more than 40 conferences, meetings, and webinars across the country in 2014. These events provide opportunities to connect directly with clinicians and stakeholders concerned with pre-surgical patient health optimization. Check out a few of our highlights from this year.
It is well known that smoking is a major cause of surgical complications. Smoking is one of the biggest risk factors in spine surgery—especially in spine fusion, where smokers have a two- to three-times higher chance of fusion failure. The Strong for Surgery smoking checklist offers a convenient way to screen patients for smoking status, and directs them to appropriate cessation resources. Because of this, the Life Sciences Discovery Fund provided funding to support implementation of the S4S program in spine clinics. In 2014, the S4S smoking checklist was implemented in 14 hospitals and clinics around Washington State. To emphasize the importance of patients quitting smoking before their surgery, we engage with audiences about this health issue through social media—especially via Twitter (@Strong4Surgery) where we posted more than 60 smoking-cessation tweets through the year!
The CERTAIN Hub: Improving Data, Improving Care
The CERTAIN Hub is a web-based platform for improved patient data collection and for delivering programs aimed at improving healthcare. It was rolled out to a select number of spine clinics in May 2014; and in July incorporated the Strong for Surgery checklists into electronic surveys given to patients. Through the CERTAIN hub, patients who indicate they are current smokers are automatically directed to free S4S resources to help them quit. In October, Dr. Varghese spoke about the interactivity of the Strong for Surgery patient-facing interface, and reiterated the value of a multi-pronged approach to ending smoking amongst spine surgery patients. His presentation also featured preliminary data from Spine SCOAP that showed improvements in smoking rates over the course of the Strong for Surgery program.
Perioperative Glucose Control Best Practices
One-in-four surgical patients experiences hyperglycemia during their hospital stay, which is strongly associated with surgical site infections and other complications. That is why Strong for Surgery teamed up with the Washington State Hospital Association (WSHA) and Qualis Health to review current surgical glucose control practices and evidence-based research on successful implementation of perioperative glucose control. Draft guidelines developed by the collaborative were presented at the April 23rd Partnership for Patients Safe Table “Reducing Surgical Site Infections in the Perioperative Period.” Learn more and review a draft of these guidelines.
Opioid Minimization Pilot Project
Undertreated pain, opioid related adverse events, and prescription opioid abuse remain important public health problems. Strategies for helping patients to achieve pain relief and also minimize their use of opioids are needed now more than ever. In 2014 Strong for Surgery began an exploratory opioid minimization pilot project with the goal of educating patients about alternatives to opioids for pain management in a core group of pilot sites. An active group of healthcare stakeholders is working together to design, develop, and test a comprehensive opioid minimization strategy.
Looking ahead: Mobile Strong for Surgery
Until now, the Strong for Surgery implementation process has involved hands-on support from our implementation staff and considerable effort by clinic staff to adapt workflow. As the program evolves and expands, we recognize the need for a more scalable implementation model. To that end, in 2015 we will begin developing a mobile platform aimed at improving the S4S checklists and screening process, while reducing the burden of day-to-day program management by clinicians and their staff. Mobile Strong for Surgery will complement the traditional S4S program by electronically assessing patient risk factors, delivering interactive risk reports to patients and clinicians, providing educational programming, and prompting risk-reduction behaviors prior to surgery.
Wishing You a Safe and Healthy New Year!
We have much to look forward to in the New Year and we hope to continue sharing our success with you. Stay up-to-date with Strong for Surgery by following us on Twitter, liking us on Facebook, and reading our blog. On behalf of the Strong for Surgery team, we wish you a safe and healthy 2015!
Raising Awareness: Strong for Surgery Presentations in 2014
December 29, 2014
The Strong for Surgery team was honored to have the opportunity to present the program at more than 40 conferences, meetings, and webinars across the country in 2014. These events provided valuable opportunities to connect directly with clinicians and healthcare stakeholders concerned with pre-surgical patient health optimization. Here are just a few highlights:
- Nov. 15: North Pacific Surgical Association Annual Meeting
- Oct. 26-30: American College of Surgeons Clinical Congress
- Oct. 10: Washington State Council of Perioperative Nurses Mini-Congress
- Sep. 10: University of Utah School of Medicine Grand Rounds
- Aug. 5: HealthQuest TV segment
- Jun. 15: WA-OR American College of Surgeons Summer Conference
- Jun. 4: SCOAP Annual Statewide Meeting & Spine Forum
- May 20: American Society of Colon and Rectal Surgeons Annual Meeting
- May 13: Comprehensive Unit-Based Safety Program (CUSP) for Safe Surgery [SUSP]Webinar
- Apr. 23: WSHA Partnership for Patients Safe Table
- Mar. 26: WSMA Webinar: "Optimization of Patients Prior to Surgery"
- Mar. 22: WA State Society of Anesthesiologists
- Jan. 31: 20th Annual Department of Surgery Research Symposium and Schilling Lecture
- Jan. 20: ASPEN Clinical Nutrition Week
- Jan. 10: 104th Seattle Surgical Society Annual Meeting
Success in the City of Roses: Q & A with Dr. Joe Frankhouse
November 17, 2014
At the time of launch two years ago, Strong for Surgery had identified five sites in Washington State to pilot the program. However the enthusiasm of one surgeon in Portland, OR, made including a sixth location a natural decision.