VistA Monograph Wiki/Surgery:Risk Assessment

Overview

The Risk Assessment module of the Surgery software provides medical facilities a mechanism to track information relating to both surgical risk and operative mortality. This information, once downloaded to the VA national database, supports a program of total quality improvement in Surgery in VHA.

The National Surgical Quality Improvement Program (NSQIP) was established to develop distributions of observed-to-expected (O/E) mortality and morbidity ratios (risk-adjusted outcomes) across facilities for all operations, for eight major sub-specialties, and for cardiac surgery. At each of VA's medical facilities

performing surgery, a Surgical Clinical Nurse Reviewer, under the direction of the Chief of Surgery, collects risk and outcome data. All patients undergoing major surgery requiring general, spinal, or epidural anesthesia are assessed. Completed non-cardiac assessments are electronically transmitted to the Hines, IL Center for Cooperative Studies in Health Services (CCSHS), while cardiac assessments are transmitted to the Denver Cardiac Coordinating Center for data analysis. At these centers, models are continually developed and enhanced for the major surgical subspecialties and procedure-specific cardiac surgeries. Managerial reports are prepared at the coordinating centers to provide Chiefs of Surgery with their own risk-adjusted data compared to the VA national averages.

Features

The Risk Assessment module:

• Provides for entry of non-cardiac assessment information including pre-operative information, laboratory test results, operation information, and intraoperative and post-operative occurrences.
• Provides for entry of cardiac assessment information, including clinical information, cardiac catheterization and angiographic data, operative risk summary data, cardiac procedures requiring cardio-pulmonary bypass, and intraoperative and post-operative occurrences.
• Creates a Surgery Risk Assessment report on each patient assessed.
• Transmits completed Surgery Risk Assessments to Hines CCSHS and Denver Cardiac Coordinating Center.
• Lists Surgery Risk Assessments by categories, including complete, incomplete, and transmitted assessments, as well as lists of major surgical cases and all surgical cases.
• Generates a monthly Surgical Case Workload Report.

• Prints follow-up letters to patients 30 days after a procedure.