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

Case Studies

Recent case studies show how hospitals have used the American College of Surgeon National Surgical Quality Improvement Program (ACS NSQIP®) to save money and achieve measurable improvements in quality of care.

Saint Francis Hospital and Medical Center - Hartford, Conn.

Urinary tract infection (UTI), which can develop from urethral catheterization, can lead to longer hospital stay and further complications such as bacteremia. CMS has named UTI a “never” occurrence and stated that, in the future, payments to hospitals where UTI occurs may be reduced or even eliminated. The surgical team at Saint Francis Hospital and Medical Center, a 600-bed regional hospital in Hartford, Conn., reviewed the hospital’s 74 UTI cases over four years, finding that its 41 inpatient cases resulted in five deaths and had an additional cost of more than $52,000, on average, while its 33 outpatient cases cost an additional $758, on average, and resulted in two readmissions and four visits to the emergency department. By using the information it learned from its ACS NSQIP data, Saint Francis was able to reduce its rate of post-surgical UTIs by 62 percent over three years (from 2.6 percent in 2008 to 1.5 percent in 2011).

Cuyuna Regional Medical Center – Crosby, Minn.

Cuyuna Regional Medical Center, a 140-bed rural hospital in Crosby, Minn., was experiencing a higher incidence of stroke compared with the national average (0.5 percent vs. 0.2 percent). Through ACS NSQIP, the hospital determined there were a greater number of occurrences related to orthopedic cases compared with the national average. Also, nearly all were inpatient cases. The improvement strategy included changing the anesthesia plan and standardizing anticoagulation orders and protocols. Within one year, stroke incidence fell to below the national average (0.1 percent vs. 0.2 percent).

Danbury Hospital – Danbury, Conn.

At Danbury Hospital, a 370-bed academic hospital in Danbury, Conn., the Surgical Clinical Reviewer (SCR) who was responsible for collecting ACS NSQIP data noticed certain surgical issues were not meeting internal and external regulatory standards. Working with the chair of the surgery department, the SCR alerted hospital staff to inconsistencies in  American Society of Anesthesiologists (ASA) preoperative assessment score  and wound classification, and certain other measures. These issues had not previously been identified. The SCR, surgeons, hospital administration and nurses developed a system to address similar issues and coding discrepancies. They also began to pass along unsolicited patient feedback, which had not been systematically captured before, through regular channels to improve quality.

Florida Surgical Care Initiative: The Collaborative Model

To combat inaccurate perceptions of Florida’s cost and quality of Florida as a higher cost, lower quality state, the American College of Surgeons partnered with the Florida Hospital Association to introduce a focused version of ACS NSQIP, using four measures targeted to a state with an older, higher-risk patient population. More than 67 hospitals have joined FSCI, making it the largest statewide surgical quality initiative in the nation. The program has gained prominent endorsements, including the National Patient Safety Foundation and Institute for Healthcare Improvement, and also secured $843,000 in grant support from Florida Blue.