BACKGROUND/RATIONALE:
Background/Rationale: The focus of this project is to improve quality and safety in outpatient surgery through the development and implementation of an adverse event (AE) surveillance system. This system is based on using trigger tools (TTs) that screen outpatient surgical data from the VA Corporate Data Warehouse (CDW). Triggers flag outpatient surgeries with a high likelihood of patient safety problems enabling more efficient AE surveillance. I will carry out a comprehensive study of VA outpatient surgical quality, guided by a modified version of the Donabedian framework of structure, process, and outcomes to measure quality.

OBJECTIVE(S):
Objectives: 1) Develop a comprehensive database of VA outpatient surgeries from FY12-14, 2) Develop and validate an AE surveillance system for outpatient surgery, and (as of year 4 of the study) 3) Identify potential opportunities to improve quality and safety.

METHODS:
Methods: The CDA research will draw upon quantitative and qualitative methods. To achieve Aim 1, I will use input from surgical stakeholders (e.g., surgeons, anesthesiologists, nurses) to identify relevant variables to include in an AE surveillance system. I will then mine VA electronic data to identify and characterize outpatient surgeries from FY12-14 based on stakeholder input. I will aggregate information about procedures, providers, care settings, and same day pre- and post-procedure care from a variety of data sources including the VA Surgical Quality Improvement Program (VASQIP), administrative data files, and the CDW. In Aim 2, I will evaluate the predictive validity of TTs to detect AEs by reviewing a sample of trigger-flagged outpatient surgeries from patients' charts. The results of this effort will inform the development of a multivariate logistic regression model to identify outpatient surgeries with a high likelihood of having an AE. Lastly, in Aim 3, I will use analytical models to test whether antibiotics or opioids are associated with postoperative AEs in outpatient surgery; these results may lead to quality improvement opportunities.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Impact: Surgical quality in the outpatient setting has been largely neglected by researchers until recently and gaps in knowledge currently exist. This CDA developed and validated an AE surveillance model that predicted AEs with a high level of accuracy and showed that the outpatient surgical AE rate is higher than estimates in the literature (9% versus 1-5% in previous studies). The information generated in this study will inform quality measurement and improvement efforts in outpatient surgery.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX001520-01A1
Link: https://reporter.nih.gov/project-details/8780231

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PUBLICATIONS:

Journal Articles

1. Mull HJ, Rosen AK, Pizer SD, Itani KM. Association Between Postoperative Admission and Location of Hernia Surgery: A Matched Case-Control Study in the Veterans Administration. JAMA surgery. 2016 Dec 1; 151(12):1187-1190. [view]
2. Dasinger EA, Branch-Elliman W, Pizer SD, Abdulkerim H, Rosen AK, Charns MP, Hawn MT, Itani KMF, Mull HJ. Association between postoperative opioid use and outpatient surgical adverse events. American journal of surgery. 2019 Apr 1; 217(4):605-612. [view]
3. Shanahan J, Vimalananda VG, Graham L, Schumann R, Mull HJ. Association Between Preoperative Diabetes Control and Postoperative Adverse Events Among Veterans Health Administration Patients With Diabetes Who Underwent Elective Ambulatory Hernia Surgery. JAMA Network Open. 2023 Mar 1; 6(3):e236318. [view]
4. Mull HJ, Rivard PE, Legler A, Pizer SD, Hawn MT, Itani KMF, Rosen AK. Comparing definitions of outpatient surgery: Implications for quality measurement. American journal of surgery. 2017 Aug 1; 214(2):186-192. [view]
5. Mull HJ, Itani KMF, Pizer SD, Charns MP, Rivard PE, McIntosh N, Hawn MT, Rosen AK. Development of an Adverse Event Surveillance Model for Outpatient Surgery in the Veterans Health Administration. Health services research. 2018 Dec 1; 53(6):4507-4528. [view]
6. Mull HJ, Rosen AK, Charns MP, O WJ, Hawn MT, Itani KMF, Pizer SD. Emergency Department Use After Outpatient Surgery Among Dually Enrolled VA and Medicare Patients. Quality management in health care. 2019 Oct 1; 28(4):191-199. [view]
7. Branch-Elliman W, Pizer SD, Dasinger EA, Gold HS, Abdulkerim H, Rosen AK, Charns MP, Hawn MT, Itani KMF, Mull HJ. Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study. Antimicrobial resistance and infection control. 2019 Mar 6; 8:49. [view]
8. Mull HJ, Gellad ZF, Gupta RT, Valle JA, Makarov DV, Silverman T, Branch-Elliman W. Factors Associated With Emergency Department Visits and Hospital Admissions After Invasive Outpatient Procedures in the Veterans Health Administration. JAMA surgery. 2018 Aug 1; 153(8):774-776. [view]
9. Mull HJ, Rosen AK, O'Brien WJ, McIntosh N, Legler A, Hawn MT, Itani KMF, Pizer SD. Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration. Health services research. 2018 Oct 1; 53(5):3855-3880. [view]
10. Mull HJ, Rosen AK, Charns MP, Itani KMF, Rivard PE. Identifying Risks and Opportunities in Outpatient Surgical Patient Safety: A Qualitative Analysis of Veterans Health Administration Staff Perceptions. Journal of Patient Safety. 2021 Apr 1; 17(3):e177-e185. [view]
11. Linsenmeyer K, Branch-Elliman W, Kalver E, Mull HJ. Surgical site infections in outpatient surgeries: Less invasive procedures contribute substantially to the overall burden. Infection control and hospital epidemiology. 2019 Oct 1; 40(10):1191-1193. [view]
12. Mull HJ, Itani KMF, Charns MP, Pizer SD, Rivard PE, Hawn MT, Rosen AK. The Nature and Severity of Adverse Events in Select Outpatient Surgical Procedures in the Veterans Health Administration. Quality management in health care. 2018 Jul 1; 27(3):136-144. [view]

Journal Other

1. Rosen AK, Mull HJ. Identifying adverse events after outpatient surgery: improving measurement of patient safety. [Editorial]. BMJ quality & safety. 2016 Jan 1; 25(1):3-5. [view]

Conference Presentations

1. Mull HJ. Capturing the Value of Safety and Quality Improvement. Presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN. [view]
2. Mull HJ, Rivard PE, Pizer SD, Itani K, Rosen AK. Comparing Definitions of Outpatient Surgery: Implications for Quality Measurement. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN. [view]
3. Mull HJ, Rosen AK, Rivard PE, Itani K. Defining Outpatient Surgery Using a Consensus Approach in the Veteran’s Health Administration (VA). Presented at: VA Association of Surgeons Annual Meeting; 2015 May 3; Miami, FL. [view]
4. Mull HJ, Rivard PE, Legler A, Pizer SD, Hawn M, Itani K, Rosen AK. Defining Outpatient Surgery Using a Consensus Approach in the Veteran’s Health Administration (VA). Poster session presented at: VA HSR&D Career Development Annual Meeting; 2015 Jul 8; Philadelphia, PA. [view]

DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: none
MeSH Terms: none