Innovation in Patient Safety and Quality at the National Level
The American College of Surgeons National Surgical Quality Improvement Program: Achieving Better and Safer Surgery

https://doi.org/10.1016/S1553-7250(15)41026-8Get rights and content

Article-at-a-Glance

Background

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), in operation since late 2004, evaluates surgical quality and safety by feeding back valid, timely, risk-adjusted outcomes, which providers use to improve care.

Methods

A number of components have been developed and refined in the more than a decade since ACS NSQIP’s initiation. These items can be grouped into areas of data collection, case sampling, risk adjustment, feedback reporting, the expansion into procedure-targeted sampling, development of improvement collaboratives, and the development of improvement tools. Although ACS NSQIP was originally designed as a hospital-based program, it now also allows for surgeon-specific reporting that can be used by individual surgeons as a feedback tool to improve their performance.

Results

There are more than 600 ACS NSQIP hospitals in 49 of the 50 states of the United States and in 13 other countries. Virtually all surgical (sub)specialties are touched by ACS NSQIP, which contains several million patient records and more than 100 statistically risk-adjusted models. In studies that have used ACS NSQIP clinical data, demonstrable improvement has been reported in local hospitals, in regional collaboratives, and across the program overall. Concomitantly, substantial cost savings for individual hospitals, as well as at regional and national levels, have been reported.

Conclusion

ACS NSQIP has not only demonstrated how and why the use of accurate clinical data is crucial, but also how the program, through its risk-adjusted feedback, improvement tools, and hospital collaboratives, helps hospitals and providers to achieve safer surgery and better patient care.

Section snippets

Ways to Achieve Accurate Data Collection

Across the many ACS quality improvement programs,10 frontline providers are continually striving to find and use the most accurate data possible when evaluating, diagnosing, and treating their patients. Likewise, having accurate data is central to measuring and evaluating the quality of surgical care. Many factors contribute to the collection of accurate data in ACS NSQIP, including well-specified definitions for every data variable, training and annual testing of the data abstractors,

Feeding Back the Data

Regardless of which tailored module a hospital chooses, feeding back data is critical to achieving improvement—and this area is one in which many of the advances in the program have occurred. Similar to the VA program, ACS NSQIP initially fed back risk-adjusted reports semiannually to its hospitals. The program then increased the frequency of reports to quarterly. In 2011 we added real-time, risk-adjusted reports to the program, including real-time summary dashboards.

Individual-provider data

Developing a Collection of Surgical Improvement Tools

ACS NSQIP recognized early on that to achieve quality improvement (QI), having data is necessary but not sufficient. ACS NSQIP created several tools for hospitals to use to spur QI. A number of clinical guidelines were developed targeting the challenges that ACS NSQIP hospitals have faced (Sidebar 1, page 202). For example, some of the first guidelines addressed the most common occurrences in hospitals—SSI, urinary tract infection, pneumonia, and venous thromboembolism. Most of the hospitals

Summary

The improvements that have been accomplished by local hospitals and providers participating in ACS NSQIP have been possible because their efforts have been built on the foundation of high-quality data, which are essential to achieving and sustaining improvement. Importantly, data should be clinically meaningful and as accurate as possible without creating an infeasible burden. Without accurate data, not only is it difficult to know how good (or not good) the care is, it is difficult to gain

References (27)

  • American College of Surgeons. Welcome to ACS NSQIP. Accessed Mar 28, 2015....
  • R.W. Krell

    Profiling hospitals on bariatric surgery quality: Which outcomes are most reliable?

    J Am Coll Surg.

    (2014)
  • American College of Surgeons. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Accessed...
  • Cited by (103)

    • Gender dysphoria and gender-affirming surgery: The New York state experience

      2024, Journal of Plastic, Reconstructive and Aesthetic Surgery
    View all citing articles on Scopus
    View full text