Dear Friends and Colleagues,

In our pursuit of excellence to provide high-quality, value-driven healthcare, we must consistently revisit today’s care, measure our performance and outcomes, and test hypotheses to improve our current practices. Lurie Children’s organization-level quality improvement work conducted through individual units and the Center for Quality and Safety aids our overall pursuit to improve healthcare for children. Equally as valuable is our participation in national quality improvement programs, which provide the data needed to compare what we do to our peers. The peer-to-peer comparisons inform how we invest resources in internal quality improvement projects to improve our surgical outcomes and also serve to generate opportunities for further research. This month, I would like to showcase Mehul Raval, MD, MS, a physician-scientist who focuses on improving the results of children’s surgical care, to learn how he and the surgical team leveraged the data from one national program to implement quality improvement projects and research for the care of children with appendicitis.

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) is a clinical, outcomes-based program that collects data from more than 150 participating hospitals, allowing quality improvement teams at these hospitals to compare surgical outcomes with one another to gauge how they perform. For Mehul, one of several surgeons who were key to establishing NSQIP-Pediatric, participation in the national program helped our Division of Pediatric Surgery identify certain quality targets that ultimately led to the generation of a clear clinical practice guideline for the care of pediatric patients with appendicitis—something that Lurie Children’s did not have when Mehul joined the hospital in 2018—and to the publication of research studies that further enhanced patient care.

Caught early, acute appendicitis can be managed with laparoscopic surgery and has a straightforward recovery. However, when appendicitis has advanced to the point of perforation, it is more complex and includes extended hospitalization and potential complications such as wound infections and intra-abdominal abscess formation. From NSQIP-Pediatric benchmarks, Mehul and his team recognized Lurie Children’s had a longer-than-expected length of stay for managing appendicitis than our peers. From this, the Division of Pediatric Surgery, with support from the Center for Quality and Safety, initiated quality improvement projects that changed the way we care for appendicitis in children, including the development of a same-day discharge protocol for patients with early, acute appendicitis and the identification of clear criteria for discharging patients with complicated appendicitis from the hospital. These advances resulted in improved care delivery, decreased length of stay, and improved patient outcomes. The team’s work also raised research questions, such as which antibiotics were ideal for managing the postoperative care of complex appendicitis and the requisite duration of antibiotic treatment. These questions allowed Mehul to engage with our research community and generate new knowledge about post-surgical treatments and care that has improved antibiotic stewardship.

It’s exciting to share with you how our participation in the NSQIP-Pediatric gives us a more holistic perspective on our surgical outcomes that drives our internal quality improvement work and inspires further research. I encourage everyone to take a broad view of the quality improvement–research landscape and look for those collaboration opportunities that keep us at the forefront of delivering superior care to every child.

With kindness and respect,

Pat