Robert A. Wynbrandt
Robert A. Wynbrandt, Executive Director & General Counsel
Donna McDonald, Director of Quality
STS News, Summer 2017 -- If we were hard-pressed to identify the one thing that distinguishes The Society of Thoracic Surgeons from all of the other national medical specialty societies, most of us would probably identify the STS National Database, particularly in light of its international recognition and all of the other STS initiatives and activities that are dependent on it. In this next guest column by another member of the management team, STS Director of Quality Donna McDonald (whose department is responsible for the care and feeding of the Database, among other things) takes us on a grand tour of the STS Quality world. Donna was initially employed as a registered nurse, and spent a significant portion of her career in the Cardiac Surgery ICU at the former Michael Reese Hospital in Chicago before moving on to the world of clinical research and informatics. She joined the STS staff in 2009, and was promoted to the position of Director of Quality last year.
Any tour of the STS Quality world necessarily starts with the National Database, which was developed by and for cardiothoracic surgeons to assess quality and improve outcomes for their patients. The Database currently has three components—the Adult Cardiac Surgery Database (ACSD), the Congenital Heart Surgery Database (CHSD), and the General Thoracic Surgery Database (GTSD), and the Society is planning to expand its scope with the addition of the Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) next year. The ACSD is the largest component of the Database, including more than 6.2 million procedure records submitted by the vast majority of adult cardiac surgery programs in the United States, and also serving 21 international participants. The Society’s Workforce on National Databases is responsible for developing and enhancing all of the components of the STS National Database. This includes modernizing data collection and leveraging existing resources such as the electronic medical record to reduce the data collection burden for participants.
One recent major Database advancement includes dashboard reporting, which will be fully implemented within the next year to allow more timely feedback for quality improvement initiatives (see cover story). Other coming attractions include linkages to datasets such as cancer registries and the National Death Index, which will improve the specialty’s ability to track long-term outcomes. Patient-reported outcomes and quality-of-life assessments also are on the horizon.
In addition to serving as a quality improvement tool, the STS National Database provides a mechanism to assess new technologies and techniques, monitor device safety, and support research. The Database can even put money in your pocket by providing data for the Relative Value Scale Update Committee (RUC) process and through quality reporting to CMS for the Merit-Based Incentive Payment System.
Public Reporting
Participants in the STS National Database have the opportunity to share their risk-adjusted surgical outcomes with the public on a voluntary basis. Public reporting started with the ACSD in 2010 in collaboration with Consumer Reports, and that arrangement continues today. In addition, it is now available for all three Database components via the STS website (publicreporting.sts.org). The Society believes that publicly reporting surgical outcomes is an ethical responsibility of the specialty and continues to refine its associated tools in order to provide the public with scientifically valid, user-friendly information.
Quality Measurement
Our next stop on the tour is quality measurement territory. The STS Quality Measurement Task Force is responsible for developing risk models and quality measures. Risk modeling allows for fair comparisons of outcomes involving the most commonly performed procedures in cardiothoracic surgery. Quality measures are tools used to promote process, structure, or outcome goals for providers using language that is understandable to patients, and STS has more quality measures endorsed by the National Quality Forum than any other medical specialty society. These measures are used to benchmark quality for cardiothoracic surgery programs, payers, and patients.
Quality is a journey—not a destination.
Clinical Practice Documents
The Workforce on Evidence Based Surgery develops clinical practice documents, including clinical practice guidelines and expert consensus papers, which provide surgeons with practical, point-of-care assistance. Each guideline topic undergoes an exhaustive, collaborative review of clinical information and scientific evidence published in the medical literature, and is subject to development and adoption processes that follow Institute of Medicine standards. There’s even an app that will connect you to the Society’s clinical practice guidelines! You can download the app and find other valuable resources at www.sts.org/guidelines.
Patient Safety
Cardiothoracic surgeons have long been recognized as safety leaders in health care. The Workforce on Patient Safety provides resources and plans educational programs to enhance awareness of safety issues in cardiothoracic surgery. This includes the Patient Safety Symposium at the STS Annual Meeting. Past topics have included resilience, avoiding burnout, building strong teams, how to safely introduce new techniques and technology, how to deal with patients, families, and staff following unanticipated events, and optimizing communication during care transitions. You can access narrated PowerPoint slides of past symposia at learningcenter.sts.org.
The STS staff recognizes that quality is a journey—not a destination—and appreciates all of you who travel with us! We believe that the specialty of cardiothoracic surgery and its practitioners personify the words of Ralph Waldo Emerson: “Do not go where the path may lead. Go instead where there is no path and leave a trail.”