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 6–8, 2020, 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.
In 2019, the ACS Political Action Committee, ACSPA-SurgeonsPAC, supported more than 120 candidates, political campaign committees, and other PACs. Nearly $400,000 was raised for key congressional champions. Commensurate with congressional party ratios, 50 percent of the amount given went to Republican and 50 percent to Democratic campaigns.
In addition to reviewing reports from the ACS division directors, the B/R approved the following policy statement:
Statement on Suicide Prevention
The B/R also accepted resignations from 12 Fellows and changed the status from Active or Senior to Retired for 74 Fellows.
The Regents also approved the formation of the Ontario Chapter in Canada.
Division of Education
The Committee on Ethics, housed in the Division of Education, held several programs at Clinical Congress 2019 in San Francisco, CA, including the John J. Conley Ethics and Philosophy Lecture, What We Talk About When We Talk About Surgery, by Gretchen M. Schwarze, MD, FACS. Additional events included the 2019 Ethics Colloquium, The Ethics of Extraordinary Care; a Panel Session, Should Surgeons Care for their Family Members?; a Meet-the-Expert session, Dealing with Death and Dying: How to Conduct Goals of Care Discussions, Provide Quality Care to Dying Patients, and Cope After a Difficult Death; and a Postgraduate Course, Ethical Issues in Geriatric Surgical Care. Plans are under way to develop programs for Clinical Congress 2020.
Division of Integrated Communications
In 2019, the Division of Integrated Communications developed and supported initiatives to enhance the College’s external reputation, increase engagement among members, boost awareness of and interest in industry-leading programs, and drive awareness of cutting-edge science. The position of Director of the Division of Integrated Communications was filled when Cori McKeever Ashford officially joined the College in December 2019.
STOP THE BLEED®
In October 2019, bleedingcontrol.org became StoptheBleed.org as the next step in raising the public profile of this internationally renowned public safety program. StoptheBleed.org is the College’s first entirely public-facing website. The content reflects a new approach to informing, educating, and empowering the general public to learn more about the STOP THE BLEED program. Since its launch and through January 20, StoptheBleed.org page views were up 46 percent and sessions were up 55 percent compared to bleedingcontrol.org. New social media handles were launched alongside the new STOP THE BLEED website to help spread information about the program. Twitter (@StopTheBleedACS) and Facebook accounts provide STOP THE BLEED-related updates and showcase the efforts of school and community groups that are training the public in their areas.
Clinical Congress 2019
Eleven studies from the Clinical Congress Educational Forum were promoted through press releases. These studies, selected for the impact and newsworthiness of their findings, addressed topics including the recurrence of traumatic injuries in children, the impact of surgeon shift length on patient outcomes, the ability of artificial intelligence to triage postoperative patients, and use of the ACS National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator to predict quality-of-life outcomes for geriatric surgical patients. Scientific presentations and activities during Clinical Congress 2019 captured 286 media mentions, with an overall potential reach of 466.8 million.
The College’s Geriatric Surgery Verification (GSV) Program—introduced at the July 2019 ACS Quality and Safety Conference in Washington, DC—captured national media attention this past summer with several news articles on the need for the program and how it will improve outcomes for older surgical patients. Stories were published online and in print by the New York Times, Associated Press, Kaiser Health News, AARP.com, Reuter’s Health, Becker’s Healthcare, and Fierce Healthcare.
In 2019, the College partnered with Harvard Business School (HBS) to create ACS THRIVE (Transforming Health care Resources to Increase Value and Efficiency), an ambitious new program to measure and improve the value of surgical care. Leveraging the College’s expertise in quality measurement and HBS’ expertise in activity-based cost accounting, the program will help hospitals accurately measure their costs, tie those costs more closely to robust outcome measures, and take steps to improve the value of care. Presentations were created for use on Capitol Hill and at a preconference session with industry thought leaders for the 2019 Quality and Safety Conference. Nearly 100 Capitol Hill staff members attended the briefing, and multiple media interviews were facilitated.
ACS website (facs.org)
In a continuing effort to provide a comprehensive resource for those who visit facs.org, multiple content updates and overall improvements were made to the website last year. In 2019, the College’s website logged 11,264,958 page views from nearly 2.1 million visitors in 3.4 million sessions. Overall website traffic was up from 2018, with 11.6 percent more users, 9 percent more sessions, and 5.5 percent more page views. In 2019, returning visitors represented 17 percent of website traffic, and the remaining 83 percent were new visitors. Planning is under way for an updated facs.org in 2020.
In 2019, ACS launched a new artificial intelligence (AI)-driven version of ACS NewsScope to all members of the College—My ACS NewsScope—which was distributed twice a week and used AI to deliver customized content to each recipient. The AI database collected articles from nearly 80 sources of both clinical and nonclinical information on topics that are relevant to surgeons. Each issue included a “News Brief” on an important ACS program and occasional updates from the ACS Division of Advocacy and Health Policy. In response to the demand for more clinical information, abstracts from the top 50 journals in surgery were added. The traditional ACS NewsScope (now ACS Bulletin Brief) continues to be disseminated to more than 55,000 recipients.
A strategic plan was developed in 2019 to help freshen the print and online editions of the Bulletin. The Bulletin implemented content and design changes in both versions, including adding highlights and pull quotes to online feature stories, redoing the headers and table of contents in the print edition, and making other tweaks that improved readers’ experiences. A new navigational structure has been implemented in the online version to match the print version.
Clinical Congress Daily Highlights
Clinical Congress Daily Highlights supplements the on-site newspaper, Clinical Congress News, and is distributed to all Fellows, including those unable to attend. The 2019 edition included coverage of 40 sessions and more than 27 video interviews with investigators. Stories included Late-Breaking Clinical Trials, liquid biopsy, robotic surgery, machine learning, personalized medicine, resident duty hours, appendicitis, bariatric surgery outcomes, diverticulitis, and others. The newsletter was distributed twice daily over three days, and stories were shared on social media using the #ACSCC19 and #ACSHighlights hashtags. Plans for 2020 included extending the reach of selected stories through a targeted post campaign on LinkedIn.
In 2019, the Journal of the American College of Surgeons (JACS) successfully achieved a subscription benchmark of converting 40 percent of College members to an electronic-only format. The January 2020 issue featured 17 selected papers presented at the Clinical Congress 2019 Scientific Forum—an increase from 13 papers published in the 2018 inaugural issue. In the first three quarters of 2019, JACS full-text articles were downloaded approximately 375,000 times across journalacs.org and the Science Direct and Clinical Key platforms. In the same period, journalacs.org received nearly 799,000 page views.
Upward trajectories continue for engagement with the ACS Facebook, Twitter, and LinkedIn sites. By January 13, 2020, 34,639 people had “Liked” the ACS Facebook page, and 36,308 were following ACS. The College has 55,295 Twitter followers, representing a nearly 5 percent growth since October 2019. The College now has 25,801 LinkedIn followers, an 8 percent increase since October 2019.
Division of Research and Optimal Patient Care
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement (CQI), including ACS research and the accreditation programs.
Quality and Safety Conference
The 2020 ACS Quality and Safety Conference (QSC) will focus on the theme, Achieving Surgical Quality: HOW? and will provide attendees with practical and actionable steps to improve surgical quality and safety at their institutions. Sessions will highlight “the how” of achieving surgical quality, applying evidence-based best practices to improve quality, and how principles of value-based surgery can be better understood and ultimately achieved.
Optimal Resources for Surgical Quality and Safety
The development of adjunctive and integrated resources/standards based on Optimal Resources for Surgical Quality and Safety is near completion. These standards will be used to launch a Surgical Quality Verification Program. Pilot visits began with a group of targeted hospitals in 2018 and have continued into 2020 as the verification elements of the program are further refined. The goal is to refine and revise the standards based on the findings from the site visits and to launch the program in 2020.
A total of 853 hospitals participate in ACS NSQIP—712 in the adult option. The pediatric option represents 17 percent of overall participation. Another 26 hospitals are in various stages of the onboarding process. At present, 130 hospitals outside of the U.S. participate in ACS NSQIP—approximately 15 percent of all participating hospitals.
A total of 936 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), and 60 surgeon surveyors are expected to complete 275 site visits in 2020. Between October 2014 and January 2020, 1,573 site visits were completed.
In 2019, MBSAQIP launched its third national collaborative project, Bariatric Surgery Targeting Opioid Prescriptions (BSTOP), focused on opioid reduction in bariatric surgery. The project’s primary objective is to reduce provider prescription of opioids and patient use during the perioperative period in more than 300 participating hospitals. In January 2020, the second phase of the project started, with hospitals collecting data after implementation of an evidence-based protocol designed to track use of multi-modal pain strategies. Data will be collected until the project concludes in 2021. Preliminary hospital engagement with BSTOP has been positive.
The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring that pediatric surgical patients have access to quality care. In all, 141 centers participate in CSV. All 141 centers also participate in ACS NSQIP Pediatric, an increase of 12 sites since January 2019. Approximately 45 of these centers are in the various stages of verification. A total of 21 active sites are fully verified as Level I children’s surgery centers. Approximately 15 site visits are projected for 2020.
GSV Quality Improvement Program
The GSV Quality Improvement Program launched in 2019 and is composed of 30 required and two optional patient-centered standards designed to systematically improve surgical care and outcomes for the aging adult population. The program defines the resources required to achieve optimal patient outcomes for older adults receiving surgical care at verified health care facilities. Hospitals began enrollment at Clinical Congress 2019. An education curriculum is being developed for sites to help them prepare for the verification process.
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, continues to attract hospitals interested in implementing enhanced recovery practices. Approximately 60 percent of enrolled hospitals also participate in ACS NSQIP. The final cohort launched earlier this year with a concentration on emergency general surgery—specifically, appendectomy, cholecystectomy, and laparotomy. Hospitals participating in ISCR receive a ready-to-use pathway, access to educational materials on how to implement the pathway, access to experts in performance improvement and education who will help them troubleshoot problems as they implement new practices, and inclusion in a community of surgeons and clinicians rolling out the same pathway.
Strong for Surgery
Strong for Surgery (S4S), a joint program of 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. Released in 2017, S4S has more than 700 participating sites. Newly added topics include chronic disease management, mental health, and substance abuse.
The Surgeon Specific Registry (SSR) allows surgeons to track their cases, measure outcomes, and comply with changing regulatory requirements. The SSR can be used to meet the requirements of Centers for Medicare & Medicaid Services (CMS) Quality Payment Program Merit-based Incentive Payment System (MIPS), as well as the American Board of Surgery Continuous Certification Program requirements. The SSR has an active user base of approximately 5,600 surgeons, and more than 2 million case records have been entered into the SSR system since its release in 2017.
The Commission on Cancer (CoC) accredits more than 1,500 U.S. hospitals. In 2019, the CoC scheduled and surveyed 405 facilities and issued accreditation decisions and performance reports. The new 2020 CoC standards have been released and will be implemented this year.
The National Accreditation Program for Breast Cancer (NAPBC) is a multidisciplinary accrediting body that sets standards, conducts surveys, and accredits 674 U.S. and three international centers. In 2019, NAPBC scheduled and surveyed 185 breast care centers and issued accreditation decisions and performance reports.
Launched in 2017, the National Accreditation Program for Rectal Cancer (NAPRC) sets evidence-based standards and conducts surveys. NAPRC has 15 newly accredited centers, with 42 in the pipeline. Sites must be CoC-accredited to join NAPRC to ensure harmony between both programs.
The National Cancer Database (NCDB) has curated more than 39 million cancer records since inception and is the largest database of its kind in the U.S. The NCDB, through its 1,533 CoC-accredited sites, continues to collect roughly 1.5 million cancer cases annually, which represents 72 percent of all newly diagnosed cancer cases in the U.S. In 2019, the NCDB initiated the new Rapid Cancer Reporting System data processing infrastructure and rolled out the Participant User File program.
The American Joint Committee on Cancer (AJCC) is a multidisciplinary team of professionals who are responsible for developing and publishing staging standards. The AJCC recently published the eighth edition AJCC Cancer Staging Manual, complete with 80 chapters and 100 staging systems, which has sold more than 41,000 copies. In 2020, the AJCC is expected to complete Phase 1 of the structured authoring (EasyDITA) implementation.
The ACS Clinical Research Program (CRP) is strategically aligned with the Alliance National Cancer Institute (NCI)-sponsored clinical trials cooperative group and is supported by the Patient-Centered Outcomes Research Institute and NCI to conduct health sciences research and clinical trials. In 2019, the CRP integrated six operative standards into CoC accreditation standards and sponsored the Designing and Running a Prospective Surgical Clinical Trial Didactic Course at Clinical Congress 2019.
Launched at Clinical Congress 2019, the FTL 100 Fundraising Campaign was established to generate financial support for 100 Future Trauma Leaders (FTL) to coincide with the 100th anniversary of the Committee on Trauma (COT) in 2022. FTL’s mission is to foster the advancement of future leaders in trauma. The FTL aims to recruit, mentor, provide program support, and reimburse travel to various trauma meetings for eight participants annually. The COT is seeking funding from previous donors and targeted individuals, independent corporations, not-for-profit organizations, and individual trauma leader groups, with a target goal of $1 million to support the program and make it self-sustaining.
The 2019 TQIP Annual Scientific Meeting and Training took place November 16–18 in Dallas, TX, and focused on error management and high-functioning teams. The inaugural Advancing Leadership in Trauma Center Management Course was held at TQIP and received positive feedback. TQIP also is piloting a new peer coaching program. This initiative will link high-performing centers, evaluated via TQIP benchmark report results, with centers requesting assistance, and will help to provide a framework to facilitate a peer coaching relationship. TQIP will celebrate its 10th anniversary in Phoenix, AZ, on December 6–8, 2020.
The STOP THE BLEED program’s primary focus is to provide training in the techniques of basic bleeding control and to impress upon the public of the importance of learning the skills in becoming immediate responders in the event of a bleeding emergency. A redesigned public-facing website debuted in 2019 to better focus on the general populace. The STOP THE BLEED instructor portal launched January 2020 to provide more automation for potential instructors. The STOP THE BLEED State Champions convened for the first time at Clinical Congress 2019 to discuss roles and responsibilities for states to foster growth, provide necessary resources, and grow public interest and training for STOP THE BLEED.
The COT continues to review and revise standards in the Resources for Optimal Care of the Injured Patient and expects to complete all standards revisions in 2020. Next steps will include transitioning the new standards into a new format, updating the pre-review questionnaire, and developing and rolling out training for reviewers and trauma centers.
The COT also is in the process of implementing its inaugural Firearm Injury Prevention Clinical Scholar in Residence Fellowship later this year.
The ACS Foundation remains focused on securing and growing financial support for the College’s charitable, educational, and patient-focused initiatives. The development team and the Foundation Board of Directors are working to increase individual and corporate support. Through December 31, 2019, philanthropic support totaled $578,801.
The Foundation’s portfolio of new projects and programs continues to expand. Philanthropic gifts from Fellows continue to support Operation Giving Back, international scholarship travel awards, fellowship research awards, STOP THE BLEED training materials, and the Support A Student program. Corporate grants provided support for the following:
- 13 Skills Courses at Clinical Congress
- The third annual Residents Surgical Skills Competition featuring eight teams from across the country
- Educational materials to educate patients and medical staff on proper pain management, wound care, and ostomy maintenance.