QI/PI: POSNA Safe Surgery Program (PSSP)— First-Year Results Implementing Quality Metrics

Background: Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics. These external organizations rarely consult pediatric orthopaedists themselves; therefore, POSNA members strongly supported the creation of a new performance evaluation. As a result, POSNA developed a member-driven process for driving quality improvements in pediatric orthopaedics: the POSNA Safe Surgery Program (PSSP). The PSSP aims to develop key quality metrics that members believe improve outcomes in pediatric orthopaedics. This paper aims to summarize the first year of implementing the PSSP quality metrics. Methods: The POSNA Quality, Safety, and Value Initiative (QSVI) Council developed 20 PSSP quality metrics for five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE). The quality metrics were integrated into five online surveys (one per domain) and distributed to POSNA member orthopaedic centers across North America. Results: Thirty-three POSNA member orthopaedic centers responded to at least one domain-specific survey. Spine had the highest response rate (88%), while hand/UE and hip/LE had the lowest (70% and 73%, respectively). Centers meeting each quality metric ranged from 65% to 92% in sports medicine, 62% to 100% in trauma, 79% to 100% in spine, 83% to 96% in hip/LE, and 83% to 100% in hand/UE. Large and very large centers, as well as specialized children's hospitals, provided more detailed protocols and procedures, likely due to greater resources and specialization. There was nearly 100% agreement between centers on protocols with well-known, easy-to-follow checklists for fulfilling a quality metric. Conclusions: The primary goal of the PSSP is to create internally developed, surgeon-driven quality metrics that determine high-quality care. By using these quality metrics and reports, we hope surgeons can gain institutional resources to drive improvements in their centers. In its first year, the PSSP demonstrated that these quality metrics can be successfully distributed and reviewed by POSNA members. Our future work will focus on expanding the PSSP to more pediatric orthopaedic centers, iteratively evaluating and modifying the metrics, and adding metrics for additional domains.