The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met February 2–3 at the College’s headquarters in Chicago, IL. The following is a summary of key activities discussed. The information provided was current as of the date of the meeting.
From January 1 to December 31, 2017, the ACSPA and its political action committee, ACSPA-SurgeonsPAC, collected $505,000 in donation receipts from more than 1,200 individual ACS members and staff. SurgeonsPAC also disbursed $377,990 to more than 170 congressional candidates, leadership PACs, and political campaign committees. In line with congressional party ratios, 57 percent of the amount given was to Republicans and 43 percent to Democrats.
In addition to reviewing reports from the ACS division directors, the Regents reviewed and approved the following policy statements, both of which were published in the April issue of the Bulletin:
- Statement on Credentialing and Privileging and Volume Performance Issues
- Statement on Medical Student Use of the Electronic Health Record
In addition, the Board of Regents accepted resignations from 11 Fellows and changed the status from Active or Senior to Retired for 99 Fellows. The Regents also approved the reinstatement of 177 Fellows.
Division of Education
Clinical Congress 2017
A total of 8,228 surgical professionals attended Clinical Congress 2017, October 22–26 in San Diego, CA. This total included the highest numbers of Initiates and residents in attendance since 2008.
The Transition to Practice (TTP) Program in General Surgery was established five years ago, primarily in response to concerns about readiness for independent general surgery practice among graduating surgery residents. To better reflect its mission and goals, TTP will be renamed the Program for Mastery in General Surgery. The basic tenets of the program will remain the same, and additional educational and networking opportunities will be introduced. The rebranded and revised program will formally launch in spring 2018.
Academy of Master Surgeon Educators
The Academy of Master Surgeon Educators™, which recognizes and assembles a cadre of Master Surgeon Educators of national and international renown, will select the inaugural cohort of members in spring 2018 for induction into the Academy in summer 2018. Members of the Academy will be selected through a rigorous peer-review process and are expected to engage in activities in conjunction with the Division of Education to advance the science and practice of avant-garde surgical education and training. Goals include defining megatrends in surgical education training, steering advances in the field, fostering innovation and collaboration, supporting faculty development and recognition, and underscoring the critical importance of surgical education and training in the changing milieu of health care.
Committee on Ethics
The Committee on Ethics, which is housed in the Division of Education, released Ethical Issues in Surgical Care at Clinical Congress 2017. More than 30 authors contributed to 21 chapters that are organized by the predominant arenas in which ethical issues in surgical care arise, including the surgeon-patient relationship, the surgeon and the surgical profession, and the surgeon and society. Chapters feature case scenarios to ground discussions in the realities of clinical practice.
The Fellowship in Surgical Ethics, sponsored by the Division of Education and the MacLean Center for Clinical Medical Ethics, University of Chicago, IL, prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics. Two fellows will complete the program in June 2018.
Safe and Effective Pain Control Initiative
The Division of Education’s Patient Education Committee launched the Safe and Effective Pain Control Initiative in 2017 with grant funding support from the ACS Foundation. The goals of the program include preventing chronic opioid use following surgery; reducing opioid distribution into the local communities, which may lead to misuse and nonmedical use through improved disposal and pursuit of opioid-sparing options; and implementing a patient-centered approach to safe opioid prescribing through education of the patient, caregiver, and surgical professional. The Opioid Workgroup, which includes members from all surgical specialties and several other external organizations, such as the Centers for Disease Control and Prevention and the Association of Hospital Pharmacists, has worked on several activities, including the following:
- A College Statement on the Opioid Abuse Epidemic, which was published in the August 2017 Bulletin
- Clinical Congress Panel Sessions
- Development of six professional e-learning programs
- Dedicated web page
- Creation of an office sign and patient handout on Safe and Effective Pain Control available to all ACS members
- Easy access to state Continuing Medical Education (CME) pain management and opioid prescribing requirements
Division of Integrated Communications
In 2017, the Division of Integrated Communications put an increased emphasis on data analysis to ensure that the College is communicating effectively and fine-tuning its communications strategies as needed. A far-reaching examination has included analyzing data on the transition to the online Bulletin, to the effectiveness of various online marketing campaigns, to data on which types of Twitter posts generate the most “likes” and “retweets.” The Comprehensive Communications Committee continues to provide leadership and guidance to refine the College’s messaging to ensure it resonates with key audiences.
As of January 1, 2018, the Bulletin has been a mostly online publication for a full year. The Bulletin team surveyed all Domestic Members in December 2017 to determine whether the transition has been successful. At the time of the B/R meeting, staff was analyzing the results from the survey and preparing to make recommendations for moving forward.
The division continues to provide a contemporary, user-friendly website experience for members and all facs.org visitors. In 2017, several new outward-facing features were made to the College’s website, including the ability to search and filter Clinical Congress sessions by Webcast availability, Credit to Address Regulatory Mandates, and Credit to Address ACS Accreditation/Verification Requirements; and the addition of a “Donate” button to the top of all pages and ACS NewsScope to support the ACS Foundation. Usability improvements were made to the site content search tool to prepopulate suggested search terms in the search field. Web traffic increased in 2017 from the previous year. The College’s website logged 9,644,134 page views; returning visitors represented 43.5 percent of the website traffic, and the remaining 56.5 percent were new visitors.
Bleedingcontrol.org recently completed its first full year online. In 2017, the site captured 401,147 page views. Returning visitors represented 39.7 percent of the site’s traffic; 60.3 percent were new visitors. In the last year, the public profile was substantially raised with the national Stop the Bleed® campaign, expanding awareness among the public and press. Extensive media coverage of bleeding control training and related issues occurred in the aftermath of shooting tragedies and continued throughout most of 2017.
Stop the Bleed is increasingly becoming part of the nation’s emergency preparedness consciousness, and the College’s role in the campaign has been prominently mentioned. In 2017, almost 500 news stories mentioned or were fully focused on bleeding control techniques, with either the College, the Committee on Trauma (COT), or the Hartford Consensus mentioned. These articles provided an estimated total reach of 603.12 million media impressions.
The College continued to improve its social media presence in 2017, with the most significant growth happening on Twitter. In just one year, the number of people who followed @AmCollSurgeons on Twitter increased by more than 22 percent. The Clinical Congress 2017 hashtag received nearly 110.5 million impressions (number of times users potentially saw #ACSCC17 on Twitter). New hashtags, such as #BulletinACS and #ACSredbook, were introduced to increase reach and usefulness. Launched in 2016, the @bleedingcontrol Twitter account now has 3,000 followers.
A five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” was developed to draw attention to gaps in the system and proposed solutions. To date, the stories have received 5,500 page views on facs.org, as well as significant shares on the College’s social media sites.
A total of 2,233 unique discussion contributors posted 18,922 messages across all communities in 2017, a year in which members viewed 764,122 community web pages. Overall, 3,030 more discussion posts were logged in 2017 than in 2016.
Division of Research and Optimal Patient Care
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement (CQI) and ACS research and accreditation programs.
Quality and Safety Conference
Following a successful 2017 conference, the 2018 Quality and Safety Conference will take place July 21–21 in Orlando, FL. The 2018 conference will include two additional ACS Quality Program tracks: Cancer and Trauma. With the theme of Partnering for Improvement, the program will focus on collaborative approaches to better understanding how the fundamentals of quality and safety apply across all programs.
Optimal Resources for Surgical Quality and Safety
The College officially released Optimal Resources for Surgical Quality and Safety in July 2017. The manual is intended to be a trusted resource for surgical leaders seeking to improve patient care in their institutions, departments, and practices. Exploratory work is under way to develop adjunct and integrated resources/standards within the manual to ultimately launch a Surgical Quality Verification Program. The aim is to present a set of standards for discussion and review by a larger group to pilot with a targeted group of hospitals in 2018.
A total of 796 hospitals participate in the College’s National Surgical Quality Improvement Program® (ACS NSQIP®)—685 in the adult option and 111 through the pediatric option. An additional 28 hospitals are in various stages of the onboarding process. At present, 87 hospitals outside of the U.S. participate in ACS NSQIP—approximately 11 percent of all ACS NSQIP participating hospitals. Interest from international sites continues to build, particularly in Australia, Chile, Mexico, and Portugal.
Interest in collaboratives continues to grow. To date, more than 68 percent of all NSQIP hospitals participate in at least one of the 56 established collaboratives. In late 2017, the NSQIP Collaborative Leader Quarterly Call Series was launched to aid in engagement and provide a forum for discussion and sharing of quality improvement efforts.
A total of 866 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), and 63 surgeon surveyors performed 245 site visits during 2017. MBSAQIP’s efforts continue to focus on data registry design, training enhancement and support for the Metabolic and Bariatric Surgery Directors, long-term patient follow-up tactics, and opioid-sparing surgery.
Children’s Surgery Verification Program
In January 2017, the ACS Children’s Surgery Verification Quality Improvement Program officially released its verification program with the goal of ensuring that pediatric surgical patients have access to quality care. Seven sites have been verified and 20 sites are involved in the verification process. Efforts will continue to focus on the framework to develop and bridge the resources of verification and the registry.
The Coalition for Quality in Geriatric Surgery Project
The Coalition for Quality in Geriatric Surgery Project, funded by the John A. Hartford Foundation, aims to systematically improve surgical care of patients older than 65 years of age by establishing a verification program in older adult surgery. In recent months, the team achieved the following: revised the beta standards, created a program compliance assessment, and launched the beta pilot. The four-year project will conclude in July 2019.
The Agency for Healthcare Research and Quality Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the College and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, is under way. At present, 206 hospitals are participating in the first cohort to implement the colorectal pathway and establish systems for collecting data in the ISCR platform on compliance with the pathway processes and outcomes. The second cohort, scheduled for March 2018, allows hospitals to focus on orthopaedics (joint replacement and hip fracture).
Strong for Surgery
Strong for Surgery, a joint program between the ACS and the University of Washington, Seattle, is a quality initiative aimed at identifying and evaluating evidence-based practices to optimize the health of patients before surgery. The program empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. The checklists target four areas known to be high determinants of surgical outcomes: nutrition, glycemic control, medication management, and smoking cessation. An online toolkit launched in July 2017 to aid two active pilot sites and access was provided to 178 other sites.
The new Surgeon Specific Registry (SSR) platform has an active user base of more than 5,000 surgeons. Since its launch in April 2017, more than 600,000 records have been entered in the new system. The case data migration from the legacy system was completed in late 2017.
The SSR offers several regulatory compliance opportunities for surgeons, including the Merit‐based Incentive Payment System (MIPS) by the Centers for Medicare & Medicaid Services (CMS); Maintenance of Certification (MOC) Part 4 by the American Board of Surgery (ABS); and submission of cases to the ABS during the MOC exam application. The College worked closely with CMS to achieve recognition and approval of the SSR as a MIPS-Qualified Registry and MIPS-Qualified Clinical Data Registry, and more than 500 SSR participants registered for MIPS 2017 participation. Continued enhancements are under way to improve the system’s functionality.
The Commission on Cancer (CoC) has more than 1,500 accredited programs, and 42 new cancer programs applied for accreditation in 2017. The CoC Accreditation Committee is undertaking a review of existing standards, which will lead to publication of a new manual in 2019 to align with the College-wide standardization of accreditation/verification programs.
The National Accreditation Program for Breast Centers (NAPBC) has accredited nearly 600 U.S. centers and received 62 new applications for accreditation in 2017. The NAPBC released a revised standards manual in January 2018 and were to begin using these standards in April 2018 following surveyor training.
The National Accreditation Program for Rectal Cancer is launching in 2018 with surveyor training; the first surveys were scheduled for March and April.
The Committee on Trauma’s (COT) Trauma Quality Improvement Program (TQIP®) has 754 participating hospitals. The TQIP Quality Measures Performance Workgroup developed several new performance measures, which CMS has approved and are set for implementation in 2018.
Attended by 1,800 participants, the 2017 TQIP Annual Scientific Meeting and Training took place November 11–13 at the Hilton Chicago, IL. The program comprised 26 educational sessions, 29 oral abstract presentations, and 102 posters. The 2018 TQIP Annual Scientific Meeting will take place November 16–18 in Anaheim, CA.
The COT released the “TQIP Best Practices Guidelines on Palliative Care” in November 2017, and the “TQIP Best Practices Guidelines on Imaging for Trauma Patients” is expected to be released at the November 2018 TQIP meeting.
This year marks 40 years of the Advanced Trauma Life Support® (ATLS®) Program. Several events and awards are planned throughout the year to recognize this achievement.
The Bleeding Control program has experienced rapid and unprecedented growth since its inception in January 2017. The Stop the Bleed program has a presence in all 50 states, with instructor requests from more than 50 countries. As of December 31, 2017, the program had been provided to more than 100,000 individuals via 17,000 registered classes. Integral to the growth of the program has been advocacy work by the COT. Several states have been able to develop and enhance their efforts based on lobbying and educational efforts to formulate legislation and increase funding for the Bleeding Control program.
The ACS Foundation had a strong year in its mission to obtain financial support for the College’s philanthropic and educational efforts. Thanks to the generous support of Fellows and friends of the College, contributions for fiscal year 2017 increased by 35 percent from fiscal year 2016. With the support of two major donors, successful matching gift opportunities were offered at Clinical Congress 2017 and the 2017 Annual Fund fall appeal, raising $100,000 and $200,000 respectively. The Foundation also offered several new initiatives to broaden its outreach to Fellows, including working with each division of the College to offer more defined giving opportunities to donors, as well as using 19 strategic projects to assist in fundraising goals and streamlining operations.