Most hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) improve surgical outcomes over time, and improvement continues with each year that hospitals participate in the program, according to a study recently published online in Annals of Surgery.*
The study by the American College of Surgeons (ACS) research team found that among hospitals currently participating in the program for at least three years, 69 percent reduced their mortality rate, 79 percent reduced their complications rate, and 71 percent reduced their surgical site infection (SSI) rate. It was estimated that, on average, these hospitals reduced their death rate by 0.8 percent per year, their complications rate by 3.1 percent per year, and their SSI rate by 2.6 percent per year, based on comparisons with rates from the previous year.
The study is based on ACS NSQIP data collected between 2006 and 2013. Complications included in morbidity were superficial, deep, or organ space SSI; failure to wean; pneumonia; renal complications; urinary tract infection; cardiac complications; and vein thrombosis/pulmonary embolism.
Annual reductions allow hospitals committed to participation in the program to see significant improvements accumulate over time, according to the study authors. For example, by year five of participation, an average-size hospital is likely to prevent at least seven deaths, 150 complications, and 66 SSIs per 10,000 surgical procedures. A large hospital with 800 to 1,000 beds could prevent twice as many instances of patient harm, study authors noted. The estimates likely underrate the actual benefits of the program, as some complications were excluded from the study because they could not be counted consistently over time and because multiple complications in the same patient were omitted.
“These results show that hospitals committed to measuring and acting on their clinical data, implementing steps to improve, and establishing a culture for continuous quality improvement can achieve significant reductions in patient harm,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS NSQIP and ACS Division of Research and Optimal Patient Care.
“Studies have consistently shown that reliance on clinical data is necessary for hospitals to get an accurate picture of their outcomes and to identify areas for improvement. Because of inaccuracies, it is often inappropriate to use administrative data to make quality improvement assessments,” Dr. Ko added. “We now have enough evidence to know that the best approach to quality improvement requires clinical outcomes data. Then, once hospitals have an accurate measure of their quality, they must act on that data to improve.”
At press time, the study was scheduled to be published later this year in the print edition of Annals of Surgery.
*Cohen ME, Liu Y, Ko CY, Hall BL. Improved surgical outcomes for ACS NSQIP hospitals over time: Evaluation of hospital cohorts with up to 8 years of participation. Ann. Surg. 2015; Feb. 26 (e-pub ahead of print).