Article Text
PDF
Abstract
Background Racial and ethnic disparities exist.
We can stratify processes of care and outcomes by race & ethnicity and language to identify disparities.
Objectives Identify and eliminate disparities in patients having tonsillectomy surgery.
Methods We analyzed three measures, stratified by race & ethnicity and language.
Rate of prophylaxis for post-operative nausea and vomiting – PONV
Rate of PONV
Rate of return to the operating room with 30 days
We used IHI’s improvement methodology – PDSA cycles, SPC charts to close disparity gaps.
Results
Black patients had a lower rate of prophylaxis at our main hospital (77%) compared to Non-Hispanic White patients (90%). At our ambulatory surgery center no disparity existed, the rate of prophylaxis 98-99% across all patients. (figure 1A)
PONV rates were much higher in Black patients (7.3%) at our main hospital compared to Non-Hispanic White patients (3.1%). No disparity existed at our ambulatory surgery center where the rates were 1-2% for all patients. (figure 2A)
The 30-day return to OR rate across our system was 1.4% (figure 3A), the funnel plots revealed disparities for Vietnamese (3.5%), Somali (2.4%) and Spanish speaking (1.8%) patients (figure 3B). English speaking patients had a rate of 1.3%. When stratified by race and ethnicity. We found disparities in outcomes for Asian patients (2.7%), Black patient (2.4%) and Hispanic patients (1.6%). Non-Hispanic white had a rate of 0.95% (figure 3C).
ResultsA rapid series of PDSA cycles followed – annotated in (figure 3A)
98-100% of all patients now receive PONV prophylaxis (figure 1B).
3x reduction PONV rates for Black patients (3.6% to 1%), 6x reduction for Hispanic patients (2.4% to 0.3%). (figure 2B)
Reduction in re-operation rate for Asian patients (2.7% to 0%). Rates for black patients and Hispanic patients are unchanged. (figure 3B and 3C)
Conclusions and Implications We can identify and eliminate disparities in treatment process and outcomes.