At the time of launch two years ago, Strong for Surgery had identified five sites in Washington State to pilot the program. However the enthusiasm of one surgeon in Portland, OR, made including a sixth location a natural decision.
Dr. Joseph Frankhouse is a colorectal surgeon with Legacy Health, and serves as Medical Director of the Colorectal Cancer Center at Legacy Good Samaritan Medical Center. He started using the nutrition checklist in January 2013 and quickly championed the Strong for Surgery program with his Center’s program planning group. By that April, all four checklists had been adapted into the EMR system of Legacy Health, and both Dr. Frankhouse and his clinical partner, Dr. Alizah Rotramel, were using these tools.
Due to the success at Good Samaritan, Legacy Health recently expanded Strong for Surgery into two other hospitals in their system: Legacy Salmon Creek in Vancouver, WA, and Legacy Meridian Park in Tualatin, OR. We caught up with Dr. Frankhouse to hear his thoughts on the Strong for Surgery program and how it has impacted his practice.
S4S - Implementation of Strong for Surgery was very successful at Legacy Good Samaritan – what do you think made it work so well?
Dr. Frankhouse - Some hospitals have surgeons who practice at multiple facilities and maybe only go to a particular facility on an occasional basis. It’s always hard to get engagement from your surgeons in that situation. But most of the surgeons that operate at our facilities are employed by Legacy. So it is a little easier for me to get their interest and gain buy-in from the surgeons that work here. With the backbone of SCOAP, we already have a built-in infrastructure for data collection. That was also very helpful to us when implementing Strong for Surgery. SCOAP abstractors were part of our colorectal work group and helped us understand where we were going with the number of cases by looking at our data. Our infection rates, and other SCOAP parameters, were in place and functional before the concept of Strong for Surgery came along.
Once Strong for Surgery came into the picture, it seemed like an easy feature to add on that made a lot of sense – to help us, again, get everyone enthusiastic about taking care of patients. It added another element that would probably improve our outcomes, hopefully reduce our length stays, improve our infection rates, and a variety of things like that.
S4S – What initially stood out to you about the Strong for Surgery program?
Dr. Frankhouse - Probably Tom Varghese’s enthusiasm and the focus on nutrition. What became apparent to me was that there was a wealth of information about the benefits of arginine-based preoperative nutrition, but nobody really did much with that information. And so I think Tom's interest in this spurred us to look at all the data, really focus on it, and realize the important pieces that we were missing with our program. Here we were worried about infections, but we weren’t worried about the effect of preoperative nutrition on our infection rates and our outcomes.
This was an easy way for the hospital to say, "Why don't we spend $30 a patient, and just get them this nutrition [arginine-based supplementation] and in addition, spend more time talking to them about nutrition." Let's just imagine that we are going to stop one or two infections a year – it pays for itself so easily. Once you put it in that perspective, for the administration it’s an easy sell.
S4S - Have you been able to measure the effect Strong for Surgery has had on your surgical outcomes?
Dr. Frankhouse - We've published on our results in JAMA Surgery recently. It included all of our data up until the advent of Strong for Surgery. So my next plan, as I collect further data moving forward in a couple of years is to hopefully be able to demonstrate what Strong for Surgery has done for our program.