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, CT

Urinary tract infection (UTI), which can develop from urethral catheterization, can lead to longer hospital stay and further complications such as bacteremia. Centers for Medicare and Medicaid Services (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, CT, 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, MN

Cuyuna Regional Medical Center, a 140-bed rural hospital in Crosby, MN, 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).

Tennessee Surgical Quality Collaborative—The Collaborative Model

Ten hospitals in the Tennessee Surgical Quality Collaborative (TSQC) have reduced surgical complications by 19.7 percent since 2009, resulting in at least 533 lives saved and $75.2 million in reduced costs. Compared with complication rates in 2009, participating hospitals in 2012 achieved 19.7 percent fewer postoperative occurrences (p<0.001), and the postoperative mortality rate dropped 31.5 percent (p<0.001). Hospitals prevented an estimated 3.75 deaths per 1,000 surgical procedures and avoided $75.2 million in excess costs. The collaborative saw improvements in 13 of the 17 types of complications, and nine improved significantly (p<.05). The areas of most improvement included all types of surgical site infections, pneumonia and urinary tract infections, which all dropped by approximately one-third.

Danbury Hospital, Danbury, CT

At Danbury Hospital, a 370-bed academic hospital in Danbury, CT, 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.