Looking forward – August 2016

David B. Hoyt

David B. Hoyt, MD, FACS

The evidence is clear: coordinated, multidisciplinary team-based treatment models are most likely to result in surgical care that is high-quality, safe, reliable, patient-centered, and cost-effective.

As I noted in the November 2015 issue of the Bulletin,* the American College of Surgeons (ACS) has been engaged in various efforts to collaborate with other health care organizations to improve the quality and safety of team-based perioperative care. This month, I provide an update on those initiatives, including finalization of a Statement on Physician-Led Team-Based Surgical Care, the development of guidelines for geriatric care, the release of the Children’s Surgery Verification Standards, and increasing involvement in the Strong for Surgery initiative.

Statement on team-based surgical care

After approximately two years of collaboration, the ACS and the American Society of Anesthesiologists (ASA) have finalized a joint Statement on Physician-Led Team-Based Surgical Care, which is published in full on page 50 of this issue of the Bulletin. Several members of the ACS Board of Regents and their counterparts at the ASA were involved in crafting the statement. We also sought input from multiple surgical organizations and the Society of Hospital Medicine.

This statement acknowledges that coordinated, multidisciplinary care is more likely to result in positive patient outcomes, reduced costs, and greater patient satisfaction. Key members of the surgical patient care team include not only the patient and the operating surgeon, but anesthesiologists, hospitalists, specialty physicians, nurses, technicians, and other health care professionals.

To ensure that all of these providers are communicating and working together in a truly coordinated way that will ensure patients transition safely through the multiple phases and domains of surgical care, several models of team-based care are in development. The statement asserts that although these models will need to be adaptable to a range of practice and institutional environments, all should apply the following principles:

  • Active patient involvement in the decision-making process with opportunities provided for patient education, alignment of expectations, and the provision of informed consent
  • Optimization of the patient before surgery to reduce risks and enhance patient safety
  • Adherence to high-reliability and safety standards
  • Evidence-based care to reduce variability and perioperative complications
  • Effective coordination of care among all providers involved in the patient’s perioperative care
  • Recognition of the operative surgeon’s primary responsibility for confirming the presence of a surgical condition and the need for a surgical procedure, as well as directing or partnering with other team members to deliver optimal perioperative care

Special attention to vulnerable populations

The College has been involved in several collaborative initiatives to reinforce the principles outlined in the Statement on Physician-Led Team-Based Surgical Care, some of which are aimed at protecting our most vulnerable patient populations—the elderly and children.

For example, in January, the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and the American Geriatrics Society’s (AGS) Geriatrics for Specialists Initiative (GSI), with support from The John A. Hartford Foundation, released a new national perioperative guideline for the delivery of quality care for surgical patients who are 65 and older. The ACS Geriatric Surgery Task Force developed the guideline with an expert multidisciplinary panel, which evaluated current evidence and best practices in the medical literature to arrive at a set of recommendations targeting surgeons, anesthesiologists, and allied health care professionals who provide care to older adults. The guideline is organized into three distinct phases of surgical care—immediate preoperative management, intraoperative management, and postoperative management—addressing issues that commonly arise at each stage in this patient population, which tends to experience more postoperative complications and longer recovery periods.

Also in January, the Children’s Surgery Verification Quality Improvement Program released its latest standards document, Optimal Resources for Children’s Surgical Care. The standards set forth in this document are the nation’s first and only multispecialty standards for children’s surgical care and were developed in collaboration with the Task Force for Children’s Surgical Care. The new document includes recommendations on alternative training pathways for anesthesiology, emergency medicine, and radiology and outlines the safety elements that children’s hospitals should have in place to achieve verification.

Strong for Surgery

In addition, the College’s Division of Research and Optimal Patient Care will be taking responsibility for introducing an ACS Strong for Surgery campaign at the national level in the coming months. Strong for Surgery originated in Washington State and centers on evidence-based checklists that surgeons and other health care professionals may use preoperatively to improve clinical outcomes and keep surgeons ahead of the quality assurance curve. At present, the Strong for Surgery initiative focuses on preoperative optimization related to cigarette smoking cessation, nutrition, medication management, and glucose homeostasis.

A Panel Session on this initiative will be presented at Clinical Congress 2016 on Tuesday, October 18, at the Walter E. Washington Convention Center, Washington, DC. Moderating the session will be David R. Flum, MD, MPH, FACS, professor of surgery and director of the Surgical Outcomes Research Center, department of surgery, University of Washington Medical Center, Seattle, who has played a leadership role in Strong for Surgery since its inception. The co-moderator will be Thomas K. Varghese, Jr., MD, MS, FACS, associate professor of surgery, University of Utah Health Care, Salt Lake City.

Working together in our patients’ interests

The ACS always has been and always will be committed to ensuring that surgical patients receive care that meets the highest standards and produces optimal outcomes. In recent decades, we have learned that this care is most effectively provided by physician-led, high-performance teams. The efforts have been carried out in the spirit of collaboration with other organizations that share our commitment to making certain that patients transition safely through each phase of perioperative care, so that they can enjoy the postoperative quality of life they so richly deserve.

*Hoyt DB. Looking forward. Bull Am Coll Surg. 2015;100(11):8-9. Available at: bulletin.facs.org/2015/11/looking-forward-november-2015/. Accessed July 15, 2016.

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