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 8–9 at the College’s headquarters in Chicago, IL. Following is a summary of key activities discussed. The information provided was up-to-date at the time of the meeting.
From January 1, 2017, through December 31, 2018, the ACSPA and its political action committee, ACSPA-SurgeonsPAC, reported more than $1 million in receipts from more than 1,800 ACS members and staff. SurgeonsPAC disbursed $850,000 to more than 150 congressional candidates, leadership PACs, and political campaign committees. Commensurate with congressional party ratios, 55 percent of the amount went to Republicans and 45 percent to Democrats.
In addition to reviewing reports from the ACS division Directors, the Regents reviewed and approved the policy statement titled Guidelines for the Ethical Use of Social Media by Surgeons, which is published in this issue of the Bulletin.
The B/R also accepted resignations from 12 Fellows and changed the status from Active or Senior to Retired for 80 Fellows. The B/R approved the reinstatement of 146 Fellows.
Division of Education
The B/R approved the Division of Education’s proposal for the establishment of a new ACS Continuing Medical Education Credit System. The tiered approach supports the development and maintenance of expertise and mastery and promotes excellence in surgery through advanced education and training. It encourages surgeons to pursue these exemplary levels of achievement to improve patient care. The new system would recognize individuals who have demonstrated these high levels of achievement by issuing certification. The system will be based on new standards that would catalyze development of new and innovative education programs that use cutting-edge methods and state-of-the-art technology for teaching, learning, and assessment of cognitive, technical, and nontechnical skills.
Academy of Master Surgeon Educators
Established in 2017, the Academy recognizes and assembles a cadre of Master Surgeon Educators of national and international renown to work with the Division of Education to advance the science and practice of surgical education and training. More than 180 individuals applied for Membership and Associate Membership in the inaugural class, and 106 were selected for induction in 2018. For details, see the April 2019 Bulletin.
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement, including ACS research and accreditation programs.
Quality and Safety Conference
The 2019 ACS Quality and Safety Conference (QSC) will take place July 19–22 in Washington, DC, and will focus on putting the patient first. Sessions will highlight techniques to improve quality and safety, leadership, advocacy, and communication, with tracks devoted to important clinical topics, such as enhanced recovery, Strong for Surgery, emergency general surgery, transplant, geriatric, and trauma (see related story for details). The 2020 QSC is scheduled for July 24–27 in Minneapolis, MN.
In 2017, the ACS published Optimal Resources for Surgical Quality and Safety (the Red Book). The development of adjunctive and integrated resources/standards based on this manual are near completion and ultimately will be used to launch a Surgical Quality Verification Program. The principal areas of focus for the standards are rooted in the foundational elements of the manual and include the domains and phases of surgical care, the surgical quality officer, program and committee infrastructure, peer and case review, disease-based management, and components of data capture and surveillance. Pilot visits began last year and will continue in 2019. The goal is to refine and revise the set of standards based on findings from the pilot phase. Since its release, nearly 10,000 manuals have been distributed.
A total of 884 hospitals participate in the National Surgical Quality Improvement Program (ACS NSQIP®), with 716 participating in the adult option. The pediatric option represents 15 percent of overall participation, and another 19 hospitals are in various stages of the onboarding process. At present, 125 hospitals outside of the U.S. participate in ACS NSQIP—approximately 15 percent of all participating hospitals. Interest from international sites continues to build, particularly in Asia, Australia, Europe, and the Middle East.
A total of 907 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), 810 of which are fully accredited. This year, MBSAQIP will launch a patient-reported outcomes (PROs) project at small group centers. National implementation is expected by July 2019. PROs will provide the first results from comparative effectiveness analyses of the three most common metabolic and bariatric procedures (gastric sleeve, gastric bypass, and gastric band) based on patient-centered, patient-reported, one-year outcomes from data collected nationally through MBSAQIP. The project will help provide patients and providers with up-to-date, robust metrics to further help inform patients regarding their surgical procedure options.
The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring access to high-quality care for pediatric surgical patients. At present, the program has 129 active children’s surgery centers. Approximately 45 of these centers are in the various stages of verification, a 16 percent increase from 2018; 13 of the active sites are fully verified as Level I children’s surgery centers.
Plans are under way to create a CSV consultation program to allow centers to select their areas of focus based on their own assessment of their center against the CSV standards. As part of this program, sites will be able to select their areas of focus to provide more flexibility and customized guidance. The identified areas of focus include performance improvement and patient safety, data infrastructure, program support/staffing, non-pediatric providers, alternative pathways, anesthesia requirements, research requirements, and ambulatory centers. The process will be piloted at several sites before a public rollout later this year.
The Coalition for Quality in Geriatric Surgery (CQGS) Project, funded by the John A. Hartford Foundation, aims to systematically improve surgical care for patients older than age 65 by establishing a verification program. Based on feedback from the CQGS beta pilot, the team is revising the standards and compliance measures and solidifying the verification process for final publication later this year. The beta pilot confirmed that the standards are meaningful and have a significant positive effect on care delivered to older adult patients. The CQGS Project will launch at the 2019 ACS Quality and Safety Conference.
The Agency for Healthcare Research and Quality Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the ACS and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, is under way. The program continues to attract hospitals throughout the nation that partner with the ISCR national program team to implement enhanced recovery practices. Participating hospitals receive a ready-to-use pathway and access to educational materials on how to implement the pathway and to experts in performance improvement to help troubleshoot implementation concerns. Participants also recently gained access to the ISCR Simuleader, an interactive tool that allows participants to learn implementation and change management practices that affect the success of the pathway.
Strong for Surgery
Strong for Surgery (S4S), a joint program between the ACS and the University of Washington, Seattle, identifies and evaluates 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 S4S checklists are used to screen patients for potential risk factors that can lead to surgical complications and to provide appropriate interventions to ensure better surgical outcomes. As of January, the program grew from 178 sites to 413 sites after release of the tool kit.
The Surgeon Specific Registry (SSR) continues to evolve with more features as an online software application and database that allows surgeons to track their cases and outcomes from their computer or mobile device. Since its launch, more than 1.4 million cases have been entered into the SSR by a user base of 5,500 surgeons.
The Commission on Cancer (CoC) has accredited 1,483 individual and network programs, and 37 new cancer programs applied for accreditation in 2018. The CoC standards are undergoing a major revision focused on strengthening their overall impact on the delivery of quality cancer care. The revisions will eliminate redundancies; retire the commendation criteria and Outstanding Achievement Award; and, most importantly, introduce standards derived from Operative Standards for Cancer Surgery (OSCS), Volume I. The standard revisions will be ready for field testing and constituent feedback in 2019.
The National Accreditation Program for Breast Centers (NAPBC®) has accredited 669 centers and satellites and received 25 new applications in 2018. A comprehensive review and revision of the NAPBC standards will occur in 2019.
The National Accreditation Program for Rectal Cancer (NAPRC) launched in 2017 and has five accredited centers. Participating NAPRC programs must first receive CoC accreditation.
Cancer Programs will participate in the 2019 ACS QSC with a half-day, preconference workshop on the National Cancer Database (NCDB) and four cancer tracks that include 13 individual sessions highlighting the American Joint Committee on Cancer (AJCC), Clinical Research Program, CoC, NAPBC, NAPRC, and NCDB. In addition, the annual meetings of the AJCC, CoC, and NAPBC will take place in conjunction with QSC to allow for greater participation.
The 2019 Cancer Cluster Program Workshops took place April 7–9 in Chicago. These workshops provided attendees with three consecutive days of programs to educate, engage, and enhance understanding of the NAPBC, CoC accreditation, and the NAPRC. These workshops are targeted at programs preparing for either accreditation or reaccreditation.
The NCDB—jointly sponsored by the College and the American Cancer Society—is a clinical oncology database sourced from hospital registry data that are collected in more than 1,500 CoC-accredited facilities. NCDB data are used to analyze and track patients with malignant neoplastic diseases, their treatments, and outcomes. Data represent more than 70 percent of newly diagnosed cancer cases nationwide and more than 39 million historical records.
In 2019, the NCDB will launch a new data file uploader and submission reports and the Rapid Cancer Reporting System (RCRS). This new infrastructure will simplify data submission, decrease time between diagnosis and the NCDB’s receipt of an initial record of disease, and integrate a quality improvement platform for CoC-accredited cancer programs to assess their performance with quality measures. Reporting capabilities also will be added for NAPBC- and NAPRC-accredited centers.
In 2018 the ACS Committee on Trauma (COT) Executive Committee initiated a strategic planning process to create a five-year plan to serve as a blueprint to guide the committee’s priorities and activities. Project management principles were used to define, accept, operationalize, implement, and evaluate each program element. This process has produced the following updated vision and mission statements:
- Vision statement: To eliminate preventable deaths and disabilities across the globe by preventing injury and improving the outcomes of trauma patients.
- Mission statement: To develop and implement programs that support injury prevention and ensure optimal patient outcomes across the continuum of care. These programs incorporate advocacy, education, trauma center and trauma system resources, best practice creation, outcome assessment, and continuous quality improvement.
As of January 8, 812 hospitals were participating in the ACS Trauma Quality Improvement Program (TQIP®), including 142 programs participating in Pediatric TQIP, with 14 percent of Adult TQIP programs also participating in Pediatric TQIP.
Stop the Bleed® training is being provided in more than 77 countries. As of December 31, 2018, bleedingcontrol.org had more than 35,000 registered classes, 39,000 instructors, and 547,000 individuals trained worldwide.
Data from the ACS Membership Survey on Firearm Injuries is being analyzed and will be used to drive ACS efforts to reduce firearm injury. More than 11,000 ACS Fellows responded to the survey. The College also hosted a Medical Summit on Firearm Injury Prevention, February 10–11 in Chicago. The meeting, attended by representatives from more than 45 organizations, promoted further engagement in establishing a consensus-based, nonpartisan, public health approach to firearm injury.
In 2018, more than 40,000 students were trained in the following COT courses: Advanced Surgical Skills Exposure for Trauma, Advanced Trauma Life Support®, Advanced Trauma Operative Management, Disaster Management and Emergency Preparedness Course, Rural Trauma Team Development Course, and Basic Endovascular Skills for Trauma.