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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY February 2013 | Archived Issues

Sinus Center Leads with Quality-Assurance Program

Improving quality of care and being able to measure that improvement have become the main ingredients and universal themes in healthcare organizations. Quality and the awareness of its importance are the unifying concepts seen in numerous hospital-wide programs across the nation. Evidence-based medicine allows us to give growing attention to patient safety and quality of care. Recognizing and accepting this, the physicians at the Cedars-Sinai Sinus Center have become leaders in their quality-assurance program.

The physicians of the Cedars-Sinai Sinus Center, under the direction of Medical Director Martin Hopp, MD, became pioneers in sinus surgery when they started implementing the "balloon sinuplasty" procedure for their patients (illustrated above). They were among the first physicians in the nation to do image-guided sinus surgery, and now have led the way for balloon sinuplasty. This tissue-saving procedure uses balloon catheters, inspired by those used for cardiac catheterization, to stretch open the nasal sinus ostium without any cutting. Convinced that their patients found this to have better results while being minimally invasive and tissue sparing, the center's physicians agreed that a quality-assurance program would be essential to measure success and patient outcomes.

Sinus Center physicians undertook a sinus surgery quality-assurance program using a proven quality-of-life instrument, the Sino Nasal Outcome Test (SNOT-22). The SNOT-22 is an evidence-based, validated instrument used to assess the severity of a patient's sinusitis symptoms. In our QA program, this form is given to patients before their sinus surgery, and is administered again at three, six and 12 months post-op. The 22-symptom checklist includes symptoms such as sneezing, ear pain and loss of smell or taste. The patient is asked to rank these 22 symptoms on a scale from 0 to 5. The data are collected, abstracted and analyzed by a biostatistician.

Multiple statistical tests are done on the outcome data to measure whether patients who undergo sinus surgery at Cedars-Sinai are improving. Our quality-assurance program has evaluated more than 400 consecutive patients. The data consistently demonstrate that the vast majority of our patients are statistically significantly better at three, six and 12 months after surgery. These results have established two important things for quality assurance:

  • We can test, demonstrate and measure the quality of surgical care received by patients of the Sinus Center by evidence-based medicine statistical analysis.
  • Our surgical outcomes testing shows that more than 89 percent of our patients are doing much better as long as one year after surgery. This is the leading long-term outcome among all institutions in the U.S.

Since these results were shown at national meetings, Yale-New Haven Hospital and the Mayo Clinic have adopted the same QA protocol. The Sinus Center is now working to expand this patient-centered QA instrument to include "appropriateness of surgery," focusing on the reasons for surgery, to further ensure our patients receive the best care possible.

Submitted by the Sinus Center in the Department of Surgery