The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program

Abstract

Postoperative adverse events occur all too commonly and contribute greatly to our large and increasing healthcare costs. Surgeons, as well as hospitals, need to know their own outcomes in order to recognise areas that need improvement before they can work towards reducing complications. In the USA, the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) collects clinical data that provide benchmarks for providers and hospitals. This review summarises the history of ACS NSQIP and its components, and describes the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety. The potential harms and limitations of the program are discussed.

Keywords: Health Services Research; Quality Improvement; Quality Measurement; Report Cards; Surgery.

Figure 1

Key aspects of the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). *Surgeons selected the content, make decisions about changes in the way data are collected and analysed, and they provide oversight.

Figure 2

Example reporting events by odds ratio using hierarchal modelling with shrinkage adjustment. Hospital specific bar plots. Each box shows the distribution of odds ratios for hospitals in the model; the top and bottom of each box give the smallest and largest values, and horizontal lines give the deciles. The point and vertical line within each box give the individual hospital's odds ratio and 99% CI. General and vascular surgery (GV) outcomes models are reported. DVT, deep venous thrombosis; PE, pulmonary embolism; ROR, return to operating room; SSI, surgical site infection; UTI, urinary tract infection. Adapted from Cohen, JACS, 2013.

Figure 3

Geographical distribution of American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) participating sites. Number of sites by state, region and country included in the January 2013 NSQIP semi-annual report. Reprinted by permission of ACS NSQIP.