Military hospital's surgical care ranks among best in nation Published Aug. 3, 2015 By Elaine Sanchez BAMC Public Affairs JOINT BASE SAN ANTONIO-FORT SAM HOUSTON -- San Antonio Military Medical Center ranks among the top hospitals in the nation for surgical care, according to a recent report from the American College of Surgeons. SAMMC, an integrated Army and Air Force medical facility, earned an exemplary or average rating in 180 different surgical quality variables, placing the facility in the upper half of hundreds of esteemed hospitals throughout the nation. The report is issued by ACS' National Surgical Quality Improvement Program, or NSQIP, a voluntary program that gauges the quality of surgical programs across the nation. The aim is to help surgeons better understand their quality of care compared to similar hospitals with similar patients, according to the program's website. "The largest and best hospitals in the U.S. are part of this program, and our percentages place us in the top half of those hospitals," said Air Force Col. (Dr.) Joseph Brennan, chief of SAMMC's Department of Surgery. "We are very proud of that," said Brennan, who is assigned to the 959th Medical Group. Personnel from the 959th Medical Group working at SAMMC are part of the 59th Medical Wing headquartered at nearby Joint Base San Antonio-Lackland. They work together with their Army counterparts to provide health care to more than 240,000 beneficiaries in the San Antonio region. Data collection is key to the surgical program's success, Brennan noted. At SAMMC, a surgeon oversees the program and two nurses are dedicated to inputting preoperative through 30-day postoperative data into a secure, web-based platform. ACS analyzes rates of mortality and morbidity, such as pneumonia, surgical site infections, urinary tract infections, sepsis and readmissions. "Blinded" information is then shared with all participating hospitals, offering a snapshot of how hospitals rank according to surgical outcomes. This data offers priceless insight, noted Army Maj. (Dr.) George Kallingal, surgeon champion for NSQIP at SAMMC. "NSQIP foremost offers us an internal metric to ensure our surgical quality outcomes continue to progress at SAMMC and sets in motion the process of continual analysis and improvement," he said. SAMMC's surgical outcome data has been increasingly positive over the past three years, Brennan noted, an uptick he attributes directly to SAMMC's care providers and infection control, quality and process improvement teams. "As a result of the data, we've made multiple improvements to our surgical processes," he said, citing efforts to improve operating room preparations and catheter use. "And our exceptional staff did a great job pushing initiatives focused on better patient care." While NSQIP provided the framework for analysis, "the dedication of SAMMC personnel and their commitment to quality improvement is what fostered meaningful change," Kallingal said. "It will continue to be an important tool to provide the framework for improving surgical quality outcomes in the future." The program is an easy sell at SAMMC, added Mariea Shelton, process improvement coordinator. The aim, she said, is to always strive for "great outcomes in surgical procedures." With an eye on further improvements, Brennan hopes to add a third NSQIP surgical clinical reviewer soon to enable more data to be inputted and more feedback to be gained. "The more numbers we can track, the better off we'll be when it comes to gauging our strengths and weaknesses," he said. While the program is voluntary, the Department of Defense requires all military hospitals to participate in NSQIP. SAMMC has been a voluntary member of the program since 2009. "Participation in NSQIP means there is a total commitment to deliver the highest quality surgical patient care," said Marilyn McFarland, a NSQIP surgical clinical reviewer. "Quality patient care is priority here and it shows," added Laura Van Dyk, surgical clinical reviewer. Brennan praised the hospital's exceptional care, citing recent successes on The Joint Commission reaccreditation survey, Level I trauma center reverification, and a Commission on Cancer silver designation for SAMMC's cancer program. "Our focus has always been on providing the best patient care, on what's best for the patient," the colonel said. "That emphasis has never wavered. This is just a great organization, from the leadership on down."