Florida initiative uses ACS NSQIP® processes to measure and improve care

At its 2012 annual meeting on May 18 in Sarasota, the Florida Chapter of the American College of Surgeons released preliminary data from the Florida Surgical Care Initiative (FSCI), a collaboration of the Florida Hospital Association, Blue Cross Blue Shield of Florida, and the American College of Surgeons (ACS). Applying the ACS National Surgical Quality Improvement Program (ACS NSQIP) processes, data from 26,824 operations reported by the first 50 of 65 participating hospitals were compared with a national sample of 313,529 procedures. Analysis of Florida participating hospitals’ rates of postoperative occurrences categorized by such critical issues as wound and bladder infections, pneumonia, blood use, and postoperative organ system failure demonstrated a level of performance equal to that reported by all hospitals participating in the program nationwide.

J.J. Tepas III, MD, FACS, state FSCI surgical coordinator, welcomed these findings as the starting point for continuous quality improvement in Florida. “The hospitals are performing comparably to the ACS NSQIP hospitals and, importantly, have identified areas where they are doing well and where there are opportunities for improvement. Ideally, every Florida hospital will join this program so that we can begin to work as a single entity to guarantee all surgical patients the best quality humanly possible,” Dr. Tepas said. “Better quality means less cost and much better value for everyone.”

Frank Evans, BSN, JD, surgical clinical nurse reviewer, South Miami Hospital, added that his institution depends on the ACS NSQIP to manage quality and save millions of dollars through the development of strategies aimed at avoiding complications.
“Before beginning to address our surgical problems, we had to first identify what they were. ACS NSQIP was the tool we were able to use to immediately allow us to identify those problems,” said Mr. Evans.

John P. Rioux, MD, FACS, a member of the ACS Board of Governors in surgical practice at three community hospitals in Port Charlotte, noted the importance of assessing surgical outcomes in smaller community hospitals so that all Floridians can receive state-of-the-art care, regardless of their proximity to an academic medical center. The College recently revised ACS NSQIP to expand its availability to smaller hospitals.

Dr. Tepas emphasized that all participating hospitals are continuing to improve their outcomes. High performers get even better, and those that want to improve find ways to achieve that goal through this program. Because the data reported back to hospitals are risk-adjusted, hospitals can assess their performance using real-time clinical information rather than pooled administrative or claims data.

The Florida initiative will bring another dimension to the process of quality improvement. Now that an appropriate baseline of state performance for comparison with the leading national hospitals has been established, specific regions within the state can aggregate de-identified data to determine areas where superior performance may be used to develop best practices.

“We have only just begun, but we have begun well, and are clearly on a path that will enable us to guarantee all Floridians the highest quality of surgical care every time and all the time,” Dr. Tepas said.

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