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

Fact Sheet: Examples of Quality Improvement in ACS NSQIP® Participating Hospitals

In his editorial in the February 2015 issue of the Journal of the American Medical Association (JAMA), “Measuring Surgical Outcomes for Improvement Was Codman Wrong,” Dr. Donald M. Berwick clearly shows his support for hospitals tracking their surgical outcomes and then taking action to improve care.  He recognizes at the heart of quality improvement is the collection and review of robust clinical data. 

The American College of Surgeons National Quality Improvement Program (ACS NSQIP®) is the gold standard in clinical data registries across surgical specialties. Participating hospitals collect 30-day outcomes, receive risk-adjusted real-time reports, are able to benchmark against other participating hospitals, and ultimately use their data to identify quality improvement activities that matter to them. ACS NSQIP participating hospitals, as Dr. Berwick recognizes, “…know a great deal from their own experiences…” 

While participation alone in ACS NSQIP may lead to some improvement, real strides in decreasing risk for infections, readmissions, reoperations, morbidity and mortality come from quality improvement programs within single institutions, systems, state-wide collaboratives and national initiatives after data are reviewed.  Again, as Dr. Berwick notes, “In the pursuit of improvement, capturing local individual stories and within-organization trends is as important for learning as is calculating P values for relative differences between groups” – something the ACS NSQIP community knows and appreciates.

The ACS NSQIP Annual National Conference will be celebrating its tenth anniversary in Chicago, IL in July 2015.  Drawing surgeons, nurses, quality improvement experts, hospital administrators and researchers, this nearly week-long event grows each year with networking opportunities and sessions purposefully offered to allow hospitals to proudly showcase what they are doing with the data they are fed back through ACS NSQIP.  The 2014 conference in New York City boasted over 1,200 attendees, nearly 20 events on collaborative learning and about 125 presentations of hospitals sharing their quality improvement stories.  Over the past several years, there have been nearly 900 presentations on quality improvement topics at the ACS NSQIP conference. 

Hospitals come in all sizes as do the QI success stories representing improvement in surgical patient care, within single community based institutions, those with global recognition, and collaborative groups.  The conference, as well as volumes of ACS NSQIP Best Practices compendiums, captures this local movement of QI within ACS NSQIP sites across the US, Canada, and internationally. For example:

  • One nonprofit community hospital in the south recognized its urinary tract infection (UTI) rate was three times higher than at comparable hospitals. Through a carefully crafted QI project and monitoring of its NSQIP data for a good part of the year, it dropped its UTI rates to below average levels and length of stay for patients with UTIs from twice as long to same as patients without UTI.
  • A state collaborative with over 20 hospitals reported to have saved 533 lives and $75 million over three years, from 2009 to 2012.
  • A large hospital in the west aimed to significantly reduce its surgical site infection (SSI) rates.  The hospital described that by looking at its data and enacting principles learned at the ACS NSQIP conference, it produced significant and sustained improvement in its SSI rates.
  • A medical center in the east observed through its ACS NSQIP feedback reports an unfavorable upward trend in its venous thromboembolism (VTE) rates. The hospital established a multidisciplinary team, implemented standardized risk assessment, and initiated prophylaxis. The data soon showed VTE rates falling significantly year-over-year since implementation.