Quality Improvement

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

o Otolaryngology service line improved inpatient HCAHP scores from 70% to above 88% in the last fiscal year despite battling constraints to staffing shortage, depleted app support and bedspace capacity through the pandemic. o Despite the constraints of the pandemic and growth of free flap and overall major case volume which should drive up los and increase readmission and morbidity/mortality rates - through routine inpatient service line-directed operational improvement projects/initiatives the following key inpatient metrics saw significant results/improvements. o Length of stay < 7 days with LOS index <1.3 o Mortality rate of 0.4 o Readmission rate of <5% o Exemplary observed Morbidity rate of 2.6% (NSQIP)

QUALITY IMPROVEMENT PROJECTS

o Development and implementation of Enhanced Recovery After Surgery Pathway for HN surgery patients o Development and Implementation of a Comprehensive Inpatient Multimodal Pain Management

Protocol (below) o Development and Implementation of a Comprehensive Outpatient Pain Management Protocol (attachment) o Readmission Nomogram Project to help identify at risk patients for readmission o Length of stay Reduction Project o Outpatient JP drain management project o Enteric feeding optimization project for inpatients after major HN surgery o Validation of NiRADS grading system for HPV positive cancer

OUTPATIENT QUALITY IMPROVEMENT PROJECTS

o No Show Pilot at Pediatric Otolaryngology Lake Boone Trail Clinic- lowered our no show rate from 8.7% to 6.1% o SAFE Culture Improvement: increased SAFE reports and monthly reporting to staff the results and improvements created from their reports o Virtual Scribe Pilot- 5 Physicians working with virtual scribes to provide feedback to department leaders if we should implement more widely o Staff survey that informed clinical leadership on areas in need of improvement o Implemented provider wait time screen at Meadowmont to update patients

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