Establishing a Hernia Repair Program in Hospitals

Educational Objectives

The goal of this program is to facilitate establishment of successful hernia repair programs. After hearing and assimilating this program, the clinician will be better able to:

1. Elaborate on the components and value to an institution of a successful hernia repair program.

Summary

Components of hernia repair program: general principles — inclusive design incorporates all surgeons who repair hernias at institution (in contrast to design as center of excellence); effort to improve outcomes collaborative; American Hernia Society Quality Collaborative (AHSQC) provides cost-free format to measure quality; success contingent on voluntary participation of surgeons; education — includes development of guidelines to improve value, conferences, and journal clubs; marketing — cooperation of administration helpful; call center of hospital directs unreferred patients with hernias to members of program; research — quality metrics provide framework

Mission statement: goal of participants to improve treatment of patients with hernias through improvement in quality, reduction of costs, research, and education; first element in establishing program

Stakeholders: all surgeons who repair hernias (eg, general, plastic, colorectal, trauma surgeons); administrators (chief and administrator of department); purchasing agent of operating room; appoint director (shoulders greatest responsibility)

Establishing guidelines: convene meeting with stakeholders to discuss available data; include operative approaches, classification of wounds, and types of mesh; individuals commit to comply with guidelines

Maintenance: monthly conferences; quarterly journal clubs; monthly feedback to all participants (eg, on use of mesh, rates of readmission, accuracy of data, extent of participation in program); participants must input ≥80% of patients into AHSQC to maintain membership in program

Improvement in quality: assessment of data; identification of problems; implementation of changes; reassessment; feedback to participants to confirm changes in practice

Keys to participation: 1) belief in vision of program; 2) personal investment through encouragement of all individuals to participate in discussions; 3) follow-up by providing data to individuals; 4) early management of resistance; and 5) willingness of participants (including director) to accept feedback

Challenges: greatest obstacle resistance of individuals to allotting extra time (implies that hernia center not priority); remind participants that hernia center represents opportunity to deliver better care to patients; AHSQC form requires 2 extra minutes for each operation

Implementation of hernia repair program at Cleveland Clinic: monthly conferences and worldwide teleconferencing with case presentations and exchange of opinions (eg, participants in Florida, Abu Dhabi); guidelines sent to all participants; assessment — studied cost to demonstrate value of program; examined influence of program on institutional use of mesh; retrospectively reviewed use of mesh 19 mo before and 16 mo after start of program; >14,000 cases from 18 hospitals reviewed; found 52% of all hernia repairs performed by participating surgeons; use of biologic mesh reduced ≈50% for every class of wound; program saved >$500,000 in first 16 mo; use of biologic mesh eliminated completely in clean cases and reduced significantly in clean-contaminated and contaminated cases; concluded that institutional hernia program with participation of all stakeholders in hospital significantly influenced use of mesh and improved value by reducing cost

Readings

Fischer JP et al: A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg 2016 Feb;137(2):647-59; Krpata DM et al: Development of a disease-based hernia program and the impact on cost for a hospital system. Ann Surg 2016 Nov 30. [Epub ahead of print]; Stephan B et al: Value-based clinical quality improvement (cqi) for patients undergoing abdominal wall reconstruction. Surg Technol Int 2015 May;26:135-42.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Krpata was  recorded at Updates in Abdominal Wall Reconstruction, presented by the Cleveland Clinic Digestive Disease and Surgery Institute and held January 12-14, 2017, in Orlando, FL. For information about the next Updates in Abdominal Wall Reconstruction, please visit clevelandclinicmeded.com. The Audio Digest Foundation thanks the speakers and sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

GS640902

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.