Below are the current Performance Indexes and Supporting Documents. Year 1 site documents are for newly recruited MSSIC sites and are participation only. All other sites look for your Cohort and choose the appropriate documents. It is important that the Performance Index and the Performance Index Supporting Document are referenced together.
Welcome to the MSSIC Early Ambulation toolkit. The early ambulation of patients after surgery has been demonstrated as a best practice in published literature and research. MSSIC data shows that early ambulation has a significant impact on reducing the occurrence of urinary retention and readmission. Additionally, we know that early ambulation after surgery promotes blood flow and oxygenation, reduces the risk of VTE, promotes wound healing, improves the function of gastrointestinal and pulmonary functions, increases tone and strength, improves appetite, and even improves mental well-being. Additional research has also indicated that patients that practice early and frequent ambulation tend to be discharged sooner.
Recent literature review of ERAS protocols, specific for spine surgery, all strongly support early ambulation as defined within hours of surgery stop time. The ERAS for spine surgery pathways all include early ambulation no later than 8 hours after surgery, and most within 4 to 6 hours after surgery. Each MSSIC site is encouraged to assess the current state at their institution, perform root cause analysis, and take into consideration their unique patient population and unique site culture when developing an action plan. Our hope is that the following tools and resources will assist you in that process.
The following resources are past presentations from MSSIC meetings with the content focus on Early Ambulation.
The following resources are publication articles describing how to practically implement an Early Ambulation program.
Attached are tools and resources that have been graciously shared by other MSSIC sites. You may use them to assist in the development of your own site tools.
Welcome to the MSSIC ERAS toolkit. Enhanced Recovery After Surgery (ERAS) protocols reduce postoperative complications, hospital length of stay and overall healthcare costs. ERAS positively influences patient subjective well-being and put the patient at the center of perioperative management and recovery. In 2019, MSSIC’s interest in pursuing ERAS as a collaborative-wide initiative piqued and making ERAS a standard of care for every MSSIC site would be necessary to facilitate the maximum clinical and financial gains.
The MSSIC Coordinating Center has created this ERAS toolkit which contains numerous resources, patient education, publications, example protocols and risk assessment tools to support our participating sites. We have also created a “MSSIC ERAS Patient Video” for sites to incorporate into their pre-surgical patient education.
During Phase I, sites demonstrate multidisciplinary team engagement towards the development of ERAS. They also document their entire ERAS protocol on the MSSIC ERAS template as well as the standardized process for implementing them. Additionally, all supporting documents such as patient education, order sets, and risk assessment tools are submitted for review and approval. Phase 2 of MSSIC ERAS includes the tracking of implementation compliance so that processes can be evaluated and adjusted where needed. Also, the enhancement of risk assessment and optimization occurs by requiring these key risk assessments with optimization be in place: smoking cessation, glycemic control, opioid risk assessment, and optimization of anemia and/or nutritional assessment.
While the MSSIC ERAS Protocol guideline outlines both required and suggested elements, sites are encouraged to assess the current state at their institution and take into consideration their unique patient population and unique site culture when developing an ERAS protocol. Our hope is that the following tools and resources will assist you in that process.
MSSIC sites have positively impacted the standard of care for spine surgery patients and made remarkable strides with ERAS. As a result, members of the MSSIC Coordinating Center were interviewed by the ERAS-USA organization. It is currently live on the ERAS-USA website, and we are excited to share it with you (ERAS- interview with MSSIC). The hard work and commitment to quality improvement at our MSSIC sites makes this level of success possible. Individually, we can take steps to improve the standard of care for our local spine surgery patients. However, together, we are transforming how spine surgery patients are cared for across the state of Michigan and now, nationally.
The following resources are past presentations from MSSIC meetings with the content focus of ERAS as well as the MSSIC ERAS Pathway guideline.
The following resources are publication articles describing various ERAS pathways at different institutions, common ERAS elements, and the effect ERAS has on patient outcomes.
The following resources are examples of screening tools that can identify risks and interventions to better optimize patients before spine surgery. Included are MSSIC Risk Assessments, Smoking Cessation Best Practice Guidelines, the American College of Surgeon’s “Strong for Surgery” program, and the American Society of Enhanced Recovery (ASER) implementation guide. There are also articles describing the screening tools and interventions implemented by Cleveland Clinic and tools to screen for Frailty.
Strong for Surgery empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. The checklists are used to screen patients for potential risk factors that can lead to surgical complications, and to provide appropriate interventions to ensure better surgical outcomes. A patient’s risk of negative outcomes from an operation is often both predetermined and modifiable before entering the operating room. Preoperative checklists serve as a communication tool for patients and clinicians to consider common risk areas.
The Strong for Surgery tools are free to surgeons and hospitals. You may choose to use the entire program or only pieces. The current tools are attached below. Under the Provider Resources is a comprehensive implementation guide detailing how to successfully implement the tools.
You may also go to the site below for more information or contact:
Susan Chishimba,
Program Manager, Strong for Surgery
schishimba@facs.org
Attached are tools and resources that have been graciously shared by other MSSIC sites. You may use them to assist in the development of your own site tools.
Welcome to the MSSIC Opioid Resource toolkit. It contains resources to support the MSSIC Opioid Prescribing Guidelines performance measures and resources from Michigan OPEN and publication articles. The opioid epidemic continues to represent a significant public health crisis in the U.S. Prescription opioid use has been recognized as a key contributor to this epidemic and surgeons play an important role in this epidemic. Opioids prescribed after surgery are associated with a well-documented risk of chronic opioid dependence, especially in opioid-naïve patients. In recent years, MSSIC has collaborated with the BCBSM CQI, Michigan-OPEN , whose mission is to support providers in combating opioid misuse and to develop prescribing guidelines for various surgical specialties. Studies have demonstrated that for opioid naïve patients, post-discharge pill counts reveal that patients do not necessarily use all the opioids they are discharged with.
What does the literature and MSSIC data show? MSSIC data and literature (including a study out of Mayo Clinic) support the judicious use of opiates as beneficial. There is no evidence of decreased satisfaction or increased healthcare utilization with less prescribing. Patients with < 225 MME are less likely to be on opioids 90 days after surgery. There is a great deal of MSSIC site variability in opioid prescribing patterns – we have an opportunity to make positive changes in discharge prescribing for opioid naïve patients.
The Michigan Opioid Prescribing Engagement Network (Michigan OPEN) launched with support from the Michigan Department of Health and Human Services, Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships, and the Institute for Healthcare Policy and Innovation (IHPI) at the University of Michigan. Michigan OPEN was founded in an effort to develop a preventive approach to the opioid epidemic in the state of Michigan by tailoring postoperative and acute care opioid prescribing. MSSIC is proud to partner with M-OPEN in an effort to prevent chronic opioid use and opioid-related harms. The attached tools have been developed by M-OPEN and customized materials, with your organization’s logo, are available by request, free of charge. Materials will be sent as a PDF for you to print using your preferred method. Just go to their website at Michigan-open.org and click on “Education” at the top of the website. Complete the request form and a member of the Michigan OPEN team will be in contact with you to confirm your request.
Welcome to the MSSIC QI Education & Tools toolkit. It contains past MSSIC QI Education, current ERAS reporting forms and examples, QI Report template and the example QI Report from “Avenger Medical Center.” Also attached is the helpful document, “What Successful MSSIC Sites Do.” It describes practical tips gleaned from top performing MSSIC sites. Additionally, there are resources under “Other QI Resources” that describe different methods and tools helpful in the development and implementation of QI Initiatives. As always, please reach out to the MSSIC QI team with any questions or needs:
Kari Jarabek, BSN, RN, kjarabe1@hfhs.org, or (313) 574-9633
Allison Jauss, MSN, RN, ajauss1@hfhs.org, or (313) 399-3620
Welcome to the MSSIC SSI toolkit. It contains past MSSIC presentations focused on SSI prevention and MSSIC developed resources such as: Back to the basics, MSSIC Personal and Home Hygiene patient education tool, and the MSSIC SSI Prevention Guidelines. Also included are numerous publication articles with a focus on SSI prevention. Each MSSIC site is encouraged to assess the current state at their institution, perform root cause analysis, and take into consideration their unique patient population and unique site culture when developing an action plan. Our hope is that the following tools and resources will assist you in that process.
Welcome to the MSSIC UR toolkit. It contains past MSSIC presentations focused on UR prevention and MSSIC developed resources such as the: MSSIC UR Prevention Guidelines and the MSSIC Guideline for Policies on Preop PVR assessment and documentation. Publication articles are attached as well as some shared site resources. Each MSSIC site is encouraged to assess the current state at their institution, perform root cause analysis, and take into consideration their unique patient population and unique site culture when developing an action plan. Our hope is that the following tools and resources will assist you in that process.
