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

Frequently Asked Questions about ACS NSQIP Pediatric

What is the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Pediatric?
ACS NSQIP Pediatric is a nationally validated, risk-adjusted, outcomes-based approach to measure and improve the quality of surgical care for pediatric patients. It employs a prospective, peer-controlled, validated database to quantify 30-day, risk-adjusted surgical outcomes, which provide a valid comparison of outcomes among all hospitals in the program. Currently, nearly 60 hospitals use the ACS NSQIP Pediatric tools, analyses, reports, and support to make informed decisions about improving the quality of their care.

How can hospitals benefit from implementing ACS NSQIP Pediatric?
Participating hospitals benefit from access to powerful tools and a proven process to assess and improve their surgical quality; by sharing what they have learned with other participants; and by building on the lessons learned. They also have a significant opportunity to reduce costs and improve profit margins by reducing complications.

How is ACS NSQIP Pediatric different from other quality improvement programs?
The data collected in ACS NSQIP Pediatric relies on clinical data from highly trained and certified abstractors. Most quality improvement efforts are based on claims data from billing files. Among many shortcomings, claims data does not enable researchers to adjust for patient risk factors or to determine if a patient experienced a related complication after leaving the hospital—when half of all such complications typically occur.  In contrast, ACS NSQIP Pediatric uses risk-adjusted data gathered from medical charts by clinically trained personnel and includes an assessment of the patient’s condition 30 days after a surgical procedure. This information enables each hospital to make a valid comparison of its outcomes with those of other hospitals and, as a result, determine where it needs to make improvements.

How long before we start to see meaningful data for our site?
Because ACS NSQIP Pediatric captures data prospectively, it takes most sites approximately 6–12 months to capture enough data to begin to be able to make meaningful comparisons to other sites and to receive statistically significant OR ratios calculated by the ACS NSQIP Statistical team. However, any case data saved by hospital in the ACS NSQIP Pediatric registry is available for download and non-risk-adjusted comparisons with all participating sites from the time the hospital begins participation in the program. Factors such as how many surgical clinical reviewers (SCRs) the site has and the presence or absence of data automation will also affect the volume of cases submitted and subsequent speed from which a site will have enough data to draw any conclusions.

Our hospital is interested in enrolling in the ACS NSQIP Pediatric. What steps should we take to make sure our hospital is ready to participate?
It is very helpful to make sure that your hospital's administration is enthusiastic about participating in the program prior to applying for participation. Identifying a surgeon champion who will be the lead in obtaining administration approval and implementing the program is a key step in gaining administration support. In addition, determining the sources of funding for the program (hiring of a full-time SCR and paying the program fee) in advance will aid in making the enrollment process run smoothly.

Our hospital is already enrolled in the ACS NSQIP. Can we add on the pediatric module and begin collecting data? 
The ACS NSQIP Pediatric has been designed as a program that is separate from the adult version. The pediatric program requires that a SCR be hired specifically for ACS NSQIP Pediatric so that enough data can be captured to result in meaningful information for the hospital. If you are enrolled in ACS NSQIP, you will need a separate contract with ACS and will hire a pediatric SCR in order to participate in the pediatric program.

Will data on outpatient operations be collected? 
Yes, outpatient surgical procedures that are performed at an ACS NSQIP Pediatric-enrolled hospital will be included in the sample. Surgery centers that perform only outpatient operations will not be eligible to enroll in the program.

Does the program take into account that pediatric surgical procedures have very low morbidity and mortality rates?
ACS NSQIP Pediatric and the program committees have taken this fact into consideration and have therefore selected certain operations that will be restricted in the sampling plan to avoid overwhelming the sample with low morbidity and low mortality procedures. For example, the inclusion of procedures such as appendectomy, laparoscopic cholecystectomy, and gastrostomy are restricted to a certain volume.