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Jefferson Surgical Solutions

Hospital-acquired infections, such as pneumonia, can affect a patient’s length of stay, cost of care and risk of mortality following surgery. In 2016, a Department of Surgery team at Thomas Jefferson University Hospital in Center City launched a program aimed at reducing the incidence of postoperative pneumonia and respiratory failure. By applying a care bundle called ICOUGHSM, a significant decrease in postoperative pneumonia and respiratory failure has been observed through the Agency for Healthcare Research and Quality patient safety indicator reporting system.

More recently, a multidisciplinary team – including nurses and physicians, as well as speech and swallow experts – has expanded the program to include a swallow evaluation. The goal: decrease the number of postoperative aspiration events. With the support of Surgical Clinical Nurse Reviewers Christine Schleider, RN, MSN, and Kathleen Shindle, RN, BSN, the postoperative pneumonia and respiratory failure prevention program is now being shared and implemented in many of our Enterprise hospitals.

“Now that we are part of this large enterprise, we can share workflows, practices, and policies related to surgical safety,” says Scott W. Cowan, MD. “Multiple surgical leaders have worked together to develop pathways and order sets which serve to standardize care for patients undergoing common surgical procedures in our hospitals.”

Dr. Cowan works closely with quality and safety leaders across Jefferson Health, including Kristin M. Noonan, MD, in Abington; Ramsey M. Dallal, MD, and Radi Zaki, MD, at Einstein; Mohammed I. Kahn, MD, in Northeast Philadelphia; and David P. May, MD, MBA, and Roy L. Sandau, DO, in New Jersey.

“It’s been a privilege to get to know surgical quality and safety leaders across the enterprise,” Dr. Cowan says. “Now we’re working together to leverage what we’ve found to be successful at the different hospitals to provide consistently safe, high-quality care.”

Members of the information technology team have created dashboards for surgical services, which surgeons can use to understand their quality, safety, and other performance metrics and compare themselves to their peers. This information also helps surgeons identify opportunities to learn from their colleagues to improve care – whether by modifying a technique or using different equipment.

Dr. Cowan explains that while some safety and quality programs have started in Center City, many exceptional programs have been launched by surgical colleagues at other hospitals. For example, the surgical teams at Jefferson Health – New Jersey and Jefferson Health – Abington championed the use of surgical debriefs. Surgical leaders from across the enterprise came together to discuss an effective – and practical – way to implement debriefs across the enterprise. At the time of the debrief, everyone in the operating room pauses to run through a checklist in the electronic medical record system. The list reviews important aspects of the surgery, including procedure type, blood loss during surgery, potential complications, and opportunities for continual improvement. In addition to improving safety and quality of care, the surgical debrief is intended to increase the accuracy of documentation in the medical record. As of September 2022, all Jefferson Health hospitals are using this practice.

Dr. Cowan states, “It is a very exciting time to partner and learn from our colleagues. All of our surgeons have successes to share that can be used to improve the care of all patients who undergo an operation in our Jefferson enterprise hospitals. It is a privilege to work with this amazing group of surgeon leaders.”

For more information about Quality & Safety initiatives at Jefferson, please visit Jeffersonhealth.org/about-us/quality-safety.

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