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

BMJ Qual Saf. 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223. Epub 2014 Apr 19.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Benchmarking / methods*
  • General Surgery / standards
  • Humans
  • Outcome Assessment, Health Care / methods*
  • Patient Safety
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / prevention & control
  • Quality Improvement
  • Quality Indicators, Health Care*
  • Societies, Medical
  • United States / epidemiology