Transforming Healthcare Through Award-Winning Quality Initiatives

NAPA’s PSO supports a culture of safety with data-driven improvement

By Julie Marhalik-Helms, BSN, RN, Vice President of Quality Improvement, NAPA  

In 2019, North American Partners in Anesthesia (NAPA) founded the NAPA Anesthesia Patient Safety Institute (NAPSI), our federally listed Patient Safety Organization (PSO). Today, our work through NAPSI is leading to nationally recognized quality innovation.  

NAPA’s goals with establishing a PSO was to improve clinical care and outcomes by providing tools and support to our frontline clinicians and to implement a culture of safety for our clinical teams covering hundreds of healthcare facilities nationwide where NAPA provides anesthesia services. Through our federally listed PSO, we analyze clinical data from up to two million cases per year to identify opportunities to mitigate patient risks and develop safety initiatives with meaningful results.  

Award-Winning Initiatives  

NAPSI’s ongoing pursuit of patient safety innovation, creation of scalable programs with robust analyses—coupled with a dedicated team of doctors, nurses, and analysts focused on a deeper understanding of cause and effect, practical safety I and II processes, and continuous improvement—results in meaningful evidence-based improvements in patient care. Enterprise-wide process improvement efforts have included various perioperative topics, such as opioid-free pain management, standardizing a preoperative pause to assess every patient for risk factors that increase the likelihood of anesthesia complications, and proactively assessing for and treating increased risks for nausea and vomiting (PONV)—each a major component of the patient experience. 

Insight gleaned from safe table case reviews inspired the PSO’s Anesthesia Risk Alerts (ARA) program, which was recognized by The Joint Commission (TJC) and National Quality Forum (NQF) with the 2022 John M. Eisenberg Patient Safety and Quality Award for National Level Innovation in Patient Safety and Quality—the nation’s highest honor for healthcare quality. NAPSI’s ARA program more recently earned the 2023 Patient Safety Award presented by the American Society for Health Care Risk Management (ASHRM).   

In announcing the Eisenberg Award, TJC/NQF noted that within two years of implementing the ARA program across NAPA’s partner healthcare facilities, compliance with the program’s protocols exceeded 95%. Furthermore, “by encouraging clinicians to work together in implementing (risk) mitigation strategies, ARA was found to promote a perioperative culture of safety and collaborative workplace environments in and beyond the OR.”   

How a PSO Benefits Patient Care  

The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), which allowed for the creation of PSOs, promotes effective strategies for reducing medical errors and increasing patient safety. This is ingrained in NAPSI’s mission. The safety culture afforded by PSOs allows healthcare providers to review, discuss, and evaluate outcomes data, and engage in educational clinical dialogue to advance quality care delivery and prevent patient harm in a protected environment without fear.

NAPSI developed proprietary tools in collaboration with our IT and analytics teams to allow our anesthesia providers to easily report through our patient safety evaluation system (PSES). Recognizing that adverse events may impact clinicians in myriad ways, which can include mental and emotional trauma experienced by the anesthesia provider, NAPSI is deeply committed to providing resources that support clinician wellness as evidenced by our Care for the Caregiver Program, led by Eric Bernstein, MD. Through this program under our PSO, clinicians are provided support by trained peers with a goal of reducing the stresses experienced by “second victims.” 

Collecting and Analyzing Data  

NAPA has been a longtime leader in anesthesia quality, collecting and analyzing clinical quality data for more than 20 years. NAPSI has leveraged innovative technology through the creation of two proprietary software programs: the NQIPS (NAPA Quality Improvement and Patient Safety) reporting system and the CSA app (Clinical Safety Application). Through the NQIPS system, providers can report and analyze adverse events after they occur to better understand how such events may be prevented in the future. Through the CSA app, providers can communicate and address safety concerns with other members of the anesthesia team before adverse events occur.

We are firm believers in closed-loop communication as evidenced by our provider dashboard and individual clinician KPIs (Key Performance Indicators). This wealth of information empowers individual clinicians with their own performance metrics and enables local anesthesia leadership to provide meaningful personal feedback, review case outcomes at local and regional Quality meetings, and issue data-driven Clinical Practice Advisories (CPAs), which have been shown to drive higher performance and satisfaction. NAPA has successfully used a variety of data to reduce clinical risk, improve quality of care, and support our hospital, ASC, and office-based partners through collaborative partnerships to improve patient safety.

Transforming Healthcare   

NAPSI provides the infrastructure to develop new patient-focused clinical initiatives such as ARA, and clinician-focused programs such the Care for the Caregiver program. Under our PSO, we can also allocate more resources for Quality Improvement and clinical education, create collaborative workplace cultures of safety that improve clinician recruitment and retention, and leverage data analytics to enhance economic value for our healthcare partners.

As a clinician-led, single-specialty anesthesia services company that is at the forefront of innovation, NAPA continues to make patient safety and quality our highest priority. Being one of the few national organizations to build and maintain a PSO that is modeling transformative healthcare is one of many ways that NAPA differentiates itself to talented anesthesia clinicians and healthcare providers and lives our vision of serving as a catalyst for positive change.