Reflections from a patient: CQI collaboration improves quality and patient experience
I have long admired the Collaborative Quality Initiatives, but never imagined that I would personally benefit from their work. Recently, I had a major surgical procedure. I had the same procedure twice before outside of Michigan. Despite being decades older, this was a substantially better experience than in the past. I had less pain and discomfort, I stayed in the hospital for a shorter period, I used fewer opiates and my husband reported that I looked much less pale and sickly following surgery. I attribute much of this to the evidence-based care at the hospital, supported in part by the Blue Cross Blue Shield of Michigan-sponsored CQIs.
In the Blue Cross-sponsored CQIs, hospitals and physicians across the state collect, share and analyze data, then design and implement changes to improve patient care. This had real impact for me.
One of my major concerns was that I would wake up from surgery with a tube running through my nose into my stomach. Following my prior surgeries, this tube caused me tremendous discomfort. So, I was thrilled to learn that it would not be used. The surgical resident told me that the tube was used to avoid a relatively infrequent complication, and the surgeons had concluded that the potential benefits did not outweigh the costs. Without the tube, I was much more comfortable and could begin eating much sooner after surgery. I lost less weight; my energy level was higher, and I spent less time in the hospital than I had previously.
I was also concerned about post-operative pain. In earlier surgeries, I experienced tremendous pain and had to take large doses of opiates both in the hospital and following discharge. Many of the CQIs now are addressing reduction of opioids post-surgery, and I benefitted from this work.
Although I had a large incision, I experienced very little pain. Because they kept me on an epidural for three days following surgery, I received only small doses of opiates. Otherwise, my pain was relieved with extra strength acetaminophen! The combination of education about avoiding opiates, good anesthetic pain relief through the epidural, and getting me up and moving almost immediately all contributed to my low pain levels.
Another concern was my post-surgery recovery. In earlier surgeries, it took a long time to regain my prior energy level. This time, the team worked with me on getting “in shape” before surgery. I received a pedometer and was contacted daily to report my steps. I also received a spirometer for breathing exercises prior to surgery to reduce the likelihood of pneumonia. My energy level after this surgery was better than in the past. The “pre-habilitation” program was very effective in helping me prepare for surgery.
While I never had a surgical site infection in the past, in this surgery I went through an evidence-based protocol – developed by the Michigan Surgical Quality Collaborative – to avoid such infections. Surgical site infections result in longer hospital stays and may affect the patient’s health and well-being. I am pleased to report that I had no complications following the surgery.
Compared to my past experiences with the same surgery, I received more pre-surgery information, which helped me to prepare and to understand what to expect and better self-manage my pain. Surgeons used new pain protocols that helped me manage my pain with much less opioid medication. And because surgeons now know that the post-surgery tube is not necessary, I was more comfortable in the hospital and was able to return to eating food sooner which accelerated my healing.
All of this resulted in a quicker hospital discharge, better healing and a better patient experience. I feel fortunate to both live in Michigan and to be the beneficiary of this important work.
Emily Santer is a health care manager at Blue Cross Blue Shield of Michigan