Looking forward – July 2017

David B. Hoyt

David B. Hoyt, MD, FACS

The American College of Surgeons (ACS) was founded more than 100 years ago with the goal of improving surgical quality of care through education and the establishment of standards for hospitals and resident training. Despite the College’s efforts, however, concerns about quality and patient safety in surgery remain. In response, the College has sought to proactively address these issues and to provide all members of the surgical patient care team with the resources they need to improve outcomes.

Later this month, July 21–24, the ACS will host the inaugural Quality and Safety Conference—formerly the ACS National Surgical Quality Improvement Program (ACS NSQIP®) Annual Conference—in New York, NY. At this conference, we plan to release the first edition of Optimal Resources for Surgical Quality and Safety, a new, comprehensive resource for surgeons and other health care professionals who seek to improve patient care in their institutions.

Quality and Safety Conference

The rapid growth in ACS Quality Programs in recent years has allowed us to expand the scope of topics discussed at the annual meeting from ACS NSQIP to include content on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Children’s Surgery Verification™ (CSV) Quality Improvement ProgramACS NSQIP Pediatric, and the Surgeon Specific Registry (SSR).

The theme of this year’s Quality and Safety Conference is Achieving Quality: Present and Future, and the program will offer discipline and theme-based tracks focused on the specific needs of various learner groups. The conference will offer opportunities for attendees to share knowledge pertaining to local, national, and international quality improvement initiatives in surgery and to learn how to analyze and make practical use of clinical registry data. Sessions are designed to assist hospital quality improvement professionals in analyzing, managing, and interpreting data. To enhance the learning experience of this diverse group of attendees, the program will feature breakout sessions targeted to specific attendees.

A highlight of this year’s Quality and Safety Conference will be keynote speaker Blake Haxton, a member of the 2016 U.S. Paralympic rowing team. Mr. Haxton will share the unique insights he gained while successfully recovering from necrotizing fasciitis. Other sessions that should be of considerable interest include the following:

  • How to Become an ACS Quality Improvement Facilitator
  • Hot Topics in Surgical Quality and Safety
  • Patient-Reported Outcomes
  • What Residents Should Know about Policy, Quality Improvement, and Research
  • Emotional Intelligence in Quality and Safety
  • ACS Quality Programs and Registry Updates

Optimal Resources for Surgical Quality and Safety

Optimal Resources for Surgical Quality and SafetyIn addition, we will roll out the first edition of the ACS quality manual, Optimal Resources for Surgical Quality and Safety. This manual, five years in the making, is intended to be a trusted resource for surgical leaders seeking to improve patient care in their institutions, departments, and practices. It introduces key concepts in quality, safety, and reliability and explores the essential elements that all hospitals should have in place to provide patient-centered care. A brief overview of the topics covered in the manual follows.

  • The domains and phases of surgical care. The manual delineates the five phases of surgical care—preoperative evaluation and preparation, immediate preoperative readiness, intraoperative, postoperative, and postdischarge—describing where each phase of care is delivered, the activities performed, and the surgeon’s responsibilities as the leader of a high-performance team.
  • The Surgical Quality Officer. The manual advises that departments of surgery appoint a Surgical Quality Officer. The responsibilities of this individual are outlined, and the ideal characteristics, background, and training that this individual should possess are defined.
  • Peer and case review. The range of peer and case review formats, from broad case review in morbidity and mortality conferences to the granular discovery process used to review the cases of a surgeon who has had successive negative outcomes, are discussed.
  • The Surgical Quality and Safety Committee. The manual calls for all hospitals and departments of surgery to appoint a committee that is responsible for ensuring compliance with quality and safety standards and protocols and thereby setting the local infrastructure for quality improvement.
  • Privileging and credentialing. The manual describes the privileging and credential processes that hospitals may use to ensure that their surgical staff are properly trained and competent.
  • Patient-centered culture. The manual looks at the techniques and processes that can be used to create and foster an environment where doing what is best for the patient takes precedence over all else and where providers are held accountable for the care they deliver but are treated fairly and encouraged to learn from mistakes.
  • High-reliability organizations (HROs). The manual describes the characteristics of HROs and the change management and performance improvement techniques that lead to improved quality and safety.
  • The unique qualities of the surgical disciplines. The manual provides a brief overview of the resources, training requirements, and regulatory mandates that are specific to 20 surgical disciplines.
  • Regulatory requirements. The rules and regulations that affect all of surgery are reviewed, including evolving Medicare payment policies, federal and state agency mandates, and standards issued by our own accrediting bodies, such as the American Board of Surgery and the specialty boards, The Joint Commission, the ACS Committee on Trauma, the Commission on Cancer, and so on.
  • Data analytics. Because data provide the basis necessary to assess quality, two chapters focus on data collection and analysis. One chapter describes the range of databases and sophisticated risk-adjustment techniques that are available to help surgeons make evidence-based decisions. The second chapter explains how institutions can put the data to work to produce better outcomes.
  • Quality collaboratives. To help rationalize the investment in databases and to improve quality across regions, a number of quality improvement collaboratives have been established throughout the country. These partnerships allow institutions or individuals to benchmark their performance against each other and to share their success stories.
  • Clinical practice guidelines. Clinical practice guidelines based on the best available evidence are being promulgated with some rapidity. These guidelines offer a standard of care, but should be adjusted to meet the specific needs of each patient and the environment in which the care is delivered.
  • Education and training. Most clinicians are only as good as their education and training. Given the proliferation of new technology and techniques, all of us must commit to lifelong learning and continuing professional development. The manual summarizes the resources that are available to help surgeons at all stages of their career assess and improve their skills and knowledge.

The last section of this manual focuses more on the “soft skills” that influence our ability to provide optimal patient care. Specifically, it includes a discussion of the surgeon’s individual responsibility to the patient, colleagues, and the next generation of surgeons. The process of surgeon improvement, problems with disruptive behavior and how to address it, and the importance of mentoring and coaching also are covered.

An ongoing journey

Some surgeons may feel overwhelmed by the increasing expectation that they not only provide excellent care but that they prove they do it as well. The College is committed to helping to ease these burdens through its Quality Programs, and individuals who attend the Quality and Safety Conference and who make use of resources like Optimal Resources for Surgical Quality and Safety will find the road to better outcomes a little less bumpy.

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