American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS, Maryland Health Care Leaders Highlight Quality Improvement

U.S. Senator Ben Cardin Delivers Keynote; Speaks to Cost-Saving Benefits for Washington


CHICAGO (Sept.1, 2011): The American College of Surgeons (ACS) continued its surgical health care quality national tour on Aug. 30 with its second community forum sponsored by Johns Hopkins Department of Surgery and Johns Hopkins Armstrong Institute for Patient Safety and Quality at the Johns Hopkins Medical Campus in Baltimore, MD. U.S. Senator Ben Cardin (D-MD) served as keynote speaker at the event, which was attended by 80 Maryland health care leaders. The community forum is part of the ACS Inspiring Quality initiative to raise awareness of proven models of quality improvement, coordinated care and disease management that can help improve the quality and value of health care.

Hosted by Julie Freischlag, MD, FACS, The William Stewart Halsted Professor and Chair at Johns Hopkins University School of Medicine’s Department of Surgery and a member of the ACS Board of Regents, the forum featured panelists who are surgical and nursing leaders from The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Sinai Hospital of Baltimore and the University of Maryland School of Medicine. These individuals came together to participate in a discussion on quality improvement programs that reduce complications, improve outcomes and cut health care costs. 

“When we’re looking for higher quality at lower costs, we’ve really found common ground with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) that shows we can prevent complications, improve care and reduce costs,” said Dr. Freischlag. “The average savings per hospital can be millions of dollars as we work to prevent complications. Potential yearly savings if 4,500 hospitals across the nation adopt NSQIP could be $13-26 billion, with an estimated total savings over a decade approaching $260 billion,” she said, citing statistics from a 2009 study in the Annals of Surgery that found participating hospitals prevent 250-500 complications and save 12-36 lives per hospital, per year1.

Ronald R. Peterson, President, The Johns Hopkins Hospital and Health System, introduced Senator Cardin, praising the lawmaker for being a long-time patient advocate and touching on how hospitals and health systems nationwide are eager to identify and use the tools that can help improve patient safety to reduce adverse outcomes and save lives.

“We are the most expensive nation in health care. It’s not sustainable. Our goal in Washington is to figure out how we can do things more cost-effectively in health care and that’s exactly what you were talking about,” said Senator Cardin referencing Dr. Freischlag’s opening remarks about ACS NSQIP. “The $250 billion in cost savings caught my attention – that and lives saved. That’s a lot of money. That could go a long way in dealing with costs in health care, and that’s just in surgery.”

Currently about 400 hospitals participate in ACS NSQIP, which is based on collecting clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. Called “Best in the Nation” by the Institute of Medicine, ACS NSQIP is serving as a national model for outcomes-based quality improvement. In early August, the Centers for Medicare and Medicaid Services (CMS) announced in its fiscal year 2012 Inpatient Prospective Payment System (IPPS) final rule that it is considering implementing two ACS NSQIP outcomes measures as early as 2015. Also, beginning in 2014, hospitals will need to report on participation in a general surgery registry as part of the new CMS value-based purchasing program.

To encourage hospitals to collaborate and share best practices in quality improvement, ACS will host a series of community forums across the nation with health care leaders representing academic medical centers and medical schools, hospitals and not-for-profit health care associations. Following Tuesday’s forum, other ACS Inspiring Quality locations will potentially include California, Massachusetts, Minnesota, Pennsylvania, Texas, Virginia and the state of Washington.

Comments made by panelists during the community forum, included:

  • Fizan Abdullah, MD, PhD, FACS, Associate Professor of Pediatric Surgery, Johns Hopkins University School of Medicine
    “I see the American College of Surgeons NSQIP Pediatric program as a direct tool for all surgeons in children’s centers to help ensure that we deliver the best results after surgery for parents and children every time. In the one year this program has been instituted at Johns Hopkins and rolled out nationally to over 30 hospitals, it has already served as an opportunity for surgeons of different specialties to all sit down together and focus on how we can improve operating room performance, outcomes, and minimize complications.” 
  • Deborah J. Baker, DNP, CRNP, Director of Nursing, The Johns Hopkins Hospital’s Department of Surgery
    “The data we get from NSQIP and some of our other process databases are really helpful in convincing teams to work together and stay together. I see the data as what keeps us together, keeps us going and provides relevance in what we’re doing. Promoting teamwork is the single most effective way to improve the communication that is needed to ensure safety and quality every minute of the day for every patient. Some of the ways we’re able to accomplish this is through CUSP (Comprehensive Unit-Based Safety Program) and through NSQIP outcomes data. These programs have been really phenomenal in fostering teamwork through multi-disciplinary teams. We’ve seen a decrease from 29 percent to as low as 15 percent in surgical site infections which is a real demonstration in safety outcomes.”
  • Sean M. Berenholtz, MD, MHS, FCCM, Associate Professor of Anesthesiology/Critical Care Medicine and Surgery, Johns Hopkins University School of Medicine
    “One area in the field of patient safety that has gained increased attention over the past 10 years or so is that of health care associated infections. These infections are among the most common of complications in hospital care and take more lives each year than HIV and breast cancer combined. Eliminating health care complications has become a national priority and the use of NSQIP, and the vision of ACS to establish that program, helps us in these efforts tremendously.”
  • Thomas Genuit, MD, MBA, FACS, Chief, Division of Trauma, Sinai Hospital of Baltimore
    “One of the areas where structured quality improvement and a systems approach to care has made substantial impact in outcomes is trauma surgery. The process of standard setting for resources and training, ongoing quality reporting and benchmarking, and formalized trauma center certification that’s witnessed here in Maryland, represent the pillars of a systemic accountability for patient care outcomes and cost reduction.”
  • Elliott R. Haut, MD, FACS, Associate Professor of Surgery, Johns Hopkins University School of Medicine
    “According to the Surgeon General there are over 100,000 deaths related to venous thromboembolism (VTE) within the United States each year. The Agency for Healthcare Research and Quality (AHRQ) reports this is the number one preventable cause of in-hospital deaths for patients that we take care of. We know that surgical patients are at an extremely high risk for blood clots such as this. Not every single one of these blood clots can be prevented, but prevention techniques can cut the rates substantially and make a huge difference in outcomes for patients.”
  • Martin A. Makary, MD, MPH, FACS, Associate Professor of Surgery, Johns Hopkins University School of Medicine
    “Believe it or not, but the only way to measure outcomes that surgeons celebrate and don’t criticize, because it was developed by surgeons in the Department of Veterans Affairs, is ACS NSQIP. Hospitals are now saying we want to make our outcomes transparent because we know we do very well and it increases the trust in the community. Technology is moving so fast that everything is going to be transparent soon enough and we’re in an amazing position to be taking a lead in transparency and better outcomes with the American College of Surgeons.” 
  • Patricia L. Turner, MD, FACS, Associate Professor of Surgery, University of Maryland School of Medicine
    “For the physicians in the room, we all think we take care of the sickest patients, but the reality is that when you are comparing complications and outcomes you are not always comparing apples to apples. ACS NSQIP is probably the best data that you are going to find because it’s risk-adjusted. There is no question that if you have better data, more accurate data, you are able to make better assessments. The difference between what we’ve used in the past – administrative data based on billing records – and what we have with NSQIP – clinical data based on patient charts – is really night and day.”

To view the archived forum video, visit


1. Hall, BL et al. "Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program." Ann Surg. 2009 Sep; 250(3):363-76.

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit


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