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 virtually February 4–6, 2021. The following is a summary of key activities discussed. The information provided was current as of the dates of the meeting.
During the 2019–2020 election cycle (January 1, 2019, through December 31, 2020), the ACSPA Political Action Committee (ACSPA-SurgeonsPAC) raised more than $800,600 from more than 1,400 College members and staff and disbursed $680,000 to more than 140 congressional candidates, political campaigns, multicandidate, and other PACs. To remain balanced and bipartisan, 49 percent went to Democrats and 51 percent to Republicans, including support for all Fellows of the ACS in Congress, several physician candidates and incumbents, key majority and minority leadership, and members serving on U.S. House and Senate committees of jurisdiction that handle health care policies and procedures.
The B/R reviewed reports from the ACS division directors and approved the formation of the Paraguay Chapter and a matching grant funding program focused on innovative and impactful programs dealing with diversity, equity, inclusion, and anti-racism issues.
The B/R also accepted resignations from nine Fellows and changed the status from Active or Senior to Retired for 94 Fellows.
Division of Education
The Division of Education reported on the following key activities.
Accreditation of CME Programs
Following a Self-Assessment Study conducted by the Division of Education to evaluate the ACS-accredited Continuing Medical Education (CME) Programs, the Accreditation Council for Continuing Medical Education (ACCME) reaccredited the ACS with commendation in December 2020 for another six years, through 2026. This national recognition of the ACS underscores the rigor of the accreditation model developed and implemented by the Division of Education and the high standards of all ACS CME Credit-bearing programs, as well as the programs of other prestigious surgical organizations jointly accredited by the ACS through the Joint Providership Program.
Committee on Ethics
The Committee on Ethics, housed in the Division of Education, offered several activities during the 2020 virtual Clinical Congress, including the John J. Conley Ethics and Philosophy Lecture given by Robert D. Truog, MD, MA, on Microethics: The Ethics of Everyday Practice. The 2020 Ethics Colloquium focused on Contemporary Challenges to Surgical Informed Consent, and additional Panel Sessions included Big Data, Who Owns It?; Ethical Considerations for Surgeons Participating in Clinical Research; and Informed Consent Ruling: Contrary to Ethical Standards or Upholding the Primacy of the Surgeon Patient Interaction? Plans are under way for the 2021 and 2022 Clinical Congresses.
Applications are being accepted for the 2021–2022 Fellowship in Surgical Ethics, which prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics.
MyCME is undergoing a transformative redesign in both functionality and appearance to permit the platform to serve as an individualized education portfolio, incorporating all relevant data for individual state licensure requirements and specialty board certification, including the transition from Maintenance of Certification to Continuous Certification. Members and nonmember subscribers will have access to a personalized display of individual Specialty Board and State Medical Board Requirements, as well as a progress diagram illustrating the number of CME Credits earned versus the number of CME Credits remaining in any given content area, based on the requirements. Users also will be able to transfer CME Credit data to participating State Medical Boards through a collaboration with CME Broker, a third-party vendor tracking individual CME requirements and compliance for several states, including Florida, Louisiana, Mississippi, New Mexico, Ohio, and Tennessee. Enhancements through Phase 1 of this project were expected to be available to members in February 2021 and to nonmembers for a fee in spring 2021.
Division of Integrated Communications
The Division of Integrated Communications is on track to effectively meet its strategic priorities for this year: creating an overarching College narrative and unified branding that resonates across diverse audiences; revamping digital communications; implementing a data-driven approach to inform all communication initiatives; and optimizing collaborative relationships and deliverables among Integrated Communications and all divisions.
The division continues to focus on developing and implementing a transformative digital strategy for the College, one that provides a seamless user experience tailored to a diverse set of audiences with very different needs and that ensures a consistent ACS brand experience across all channels. At the center of this digital strategy is a new ACS website.
This digital transformation also includes revisiting the College’s visual identity and examining how to evolve the ACS brand and core design elements. A comprehensive assessment of ACS social media presence and performance is under way in order to build a forward-looking strategy that will modernize the College’s approach to become a best-in-class member organization on social media, take advantage of a growing and engaged audience, and demonstrate the impact that social media marketing can have on goals of College programs.
Rapid communications to Fellows continues via the Bulletin Brief newsletter, social media, and the communities. Readership for the Bulletin Brief and Advocacy Brief e-newsletters is strong, with significant attention and time spent on content, such as crucial new literature, clinical updates, and legislative and regulatory information.
Monthly publication of the Bulletin resumed with the January 2021 issue. Approximately 5,000 ACS members and staff continue to receive the print edition, and an average of more than 65,000 individuals visit the Bulletin website each month of publication.
In 2020, the Journal of the American College of Surgeons (JACS) processed a record number of submissions, receiving nearly 2,200 manuscripts, a 25 percent increase from 2019. At present, 57 percent of JACS readership is online-only.
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 2021 ACS Quality and Safety Conference will convene virtually July 12–16. The program is being developed, with key quality improvement concepts, hot topics, and content organized by tracks relevant to ACS Quality Programs. The keynote speaker, Eduardo Garcia, will share his story of becoming a patient after being shocked by a 2,400-volt power line while elk hunting in Montana’s backcountry. Mr. Garcia endured months of intensive care, the amputation of half of his left arm, removal of several ribs, and a cancer diagnosis. His perseverance and determination will inspire audience members to further improve the quality of care they provide for their patients.
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 continued into 2020 as the verification elements of the program were further refined. The goal is to revise the standards based on findings from the pilot phase and launch the program either through onsite or virtual site visits in the first quarter of 2021. More than 10,000 manuals have been distributed since its release.
A total of 830 hospitals participate in the College’s National Surgical Quality Improvement Program (ACS NSQIP®)—683 in the adult option. The pediatric option represents 18 percent of overall participation. At present, 142 hospitals outside of the U.S. participate in ACS NSQIP—approximately 17 percent of all participating facilities.
A total of 968 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). From October 2014 through August 2020, 1,600 site visits were completed using the MBSAQIP standards. Because of COVID-19 restrictions, a total of 61 surgeon surveyors are expected to perform approximately 250 site visits in 2021, which is far fewer than in previous years.
Children’s Surgery Verification Program
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. A total of 147 centers participate in CSV. Approximately 30 of these centers are in the various stages of verification. Twenty-eight of the active sites are fully verified as Level I children’s surgery centers. All 147 centers participate in ACS NSQIP Pediatric.
Geriatric Surgery Verification Program
The Geriatric Surgery Verification (GSV) Quality Improvement Program launched in 2019 to ensure that older surgical patients have access to high-quality care. The program defines the resources required to achieve optimal patient outcomes in older adults undergoing inpatient surgery and offers institutional verification to sites that meet the standards. At present, 23 hospitals have applied to one of the three levels of participation: Level 1 Verification—Comprehensive Excellence; Level 2 Verification—Focused Excellence; and Commitment Level. Hospitals seeking Level 1 or Level 2 Verification must demonstrate all 30 GSV Program standards are in place through a comprehensive site visit. These visits confirm hospitals comply with the required structure, processes, and standards of care as outlined by the program. The GSV Program successfully conducted its initial virtual site visit and is scheduling several more for 2021.
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. Hospitals participating in ISCR receive a ready-to-use pathway, access to education materials on implementing the pathway, access to experts in performance improvement and education who help with troubleshooting, and inclusion in a community of professionals rolling out the same pathway. Approximately 60 percent of enrolled hospitals also participate in ACS NSQIP. More than 350 hospitals have participated in the program. The fourth cohort, focused on emergency general surgery and with a concentration on appendectomy, cholecystectomy, and laparotomy operations, was delayed until September 2020 because of the COVID-19 pandemic.
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. Since its release in 2017, S4S has more than 700 participating sites. The goal is to move the patient-facing version to an online platform for patients to complete before meeting with their surgeon.
The Surgeon Specific Registry (SSRTM) 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’ Quality Payment Program Merit-based Incentive Payment System, as well as the American Board of Surgery’s Continuous Certification Program requirements. The SSR has an active user base of approximately 6,600 surgeons, and more than 11.8 million case records have been entered into the SSR system since its release in 2017.
The Cancer Department has grown from six to seven programs with the launch of the Cancer Surgery Standards Program (CSSP) in 2020. The CSSP evolved as an outgrowth of the Cancer Research Program (CRP) when the Operative Standards for Cancer Surgery transitioned from printed books to live Commission on Cancer (CoC) standards. The CSSP is focused on designing, building, piloting, and disseminating products that support the new CoC surgery standards, including electronic health record (EHR)-based synoptic operative reports (SORs) and web-based protocols. It is expected that EHR-based SORs and the web-based protocols will be delivered in 2021 for melanoma, colon, and breast cancer. Content development is under way for five additional SORs.
The CRP continues to work on developing new operative standards and has completed the draft of the third volume of the standards manual. The CRP completed one National Cancer Institute Community Oncology Research Program Cancer Care Delivery Research trial and continues to support three other trials and submit new grants.
The American Joint Committee on Cancer (AJCC) continues to update the staging standards and has now adopted annual digital publishing with the first version nine protocol (cervix chapter) published in 2020. Diagnostic staging tables and protocol formatting have been adopted as responses to user preferences for quick point-of-care access to vital staging information. In support of digital interoperability, the AJCC has submitted the TNM (tumor, node, metastasis) standards to the U.S. Core Data for Interoperability, an effort of the U.S. Office of National Coordinator for Health Information Technology.
The National Cancer Database (NCDB) curates 1.5 million cancer cases and supports 1,000 research projects annually. In September 2020, the program released the Rapid Cancer Reporting System, which supports real-time data abstraction and reporting. NCDB and the Quality Integration Committee of CoC presented a new curriculum on QI at the 2020 Quality and Safety Conference, developed evidence-based approaches to quality measures, and conducted Standards for Oncology Registry Entry (STORE) manual reduction activities to reduce the data abstraction burden.
The Committee on Trauma (COT) has successfully completed a Phase I pilot of virtual verification site visits and began a Phase II pilot in December 2020 to add virtual reviewer training. Findings support the feasibility of moving forward with virtual visits on a larger scale. During the Phase II pilot, the COT plans to reschedule 86 visits that were postponed in 2020. It is anticipated that all site visits will be completed by June, but if necessary, the verification periods of verified hospitals will be extended until their virtual site visit can be scheduled.
The National Collaborative for Gun Violence Research has awarded a $711,218 two-year grant to the COT for a multicenter, prospective study to improve understanding of the individual and community-level risk factors for nonlethal firearm injuries in the U.S. More than 190 Trauma Quality Improvement Program (TQIP) centers have registered to participate in the study. The centers will collect and submit additional data elements in the categories of demographics, patient risk factors, circumstances of injury, and early functional outcomes. The collected patient data will then be linked by ZIP code to community- and neighborhood-level indices to explore the association of injury and social determinants of health.
The National Highway Transportation Safety Administration awarded a two-year cooperative agreement to the College to revise the 2011 Field Triage Guidelines. A multidisciplinary expert panel will use prehospital end-user feedback on the present guidelines, along with a comprehensive literature review being conducted by an Agency for Healthcare Research and Quality Center of Excellence to guide the revision by a multidisciplinary expert panel. A stakeholder feedback tool has been disseminated to a broad audience through several partner organizations, and the COT has already received 3,200 responses.
The COT continues to revise Resources for Optimal Care of the Injured Patient. All standards have been updated, reviewed, and approved. The standards have been transitioned into the nine ACS Standards Categories, and the new trauma standards manual is expected to be released by spring 2021.
Launched at Clinical Congress 2019, the Future Trauma Leaders fundraising campaign (FTL100) was established to generate financial support for an initiative to coincide with the 100th anniversary of the 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. Because of the COVID-19 pandemic, the momentum of the campaign has slowed, and COT leaders and staff are exploring ways to reenergize FTL100.
TQIP celebrated its 10th anniversary in 2020 at a virtual event December 7–10, 2020. The meeting attracted more than 5,800 attendees and featured informative sessions for all trauma team members, including medical directors, nurse program managers, trauma registrars, and performance improvement coordinators. A keynote address by Mike Barger, MD, co-founder of JetBlue Airways, focused on leadership in times of crisis, and firefighter and paramedic Dan Sundahl spoke on resiliency and posttraumatic growth. All educational content will remain accessible via the virtual meeting platform through December 10, 2021.
STOP THE BLEED® (STB) faced programmatic challenges because of COVID-19 and expanded its resources to include a video-based educational component. The program is now piloting courses that provide one-on-one training with equipment to meet the skills portion requirement for STB and completing the empowerment and education components of training. The program has approved the first nonmedical professionals to be associate instructors, called Injury Prevention Coordinators. This approval resulted from multiple requests from trauma centers wanting to engage the community and provide an increase of STB instruction resources. At present, 93,279 classes and 1,628,498 attendees are captured in the portal. The number of registered instructors has increased to 85,170.
The ACS Foundation remains focused on securing and growing financial support for the College’s charitable, educational, and patient-focused initiatives. The Foundation Board Directors and development team are seeking to increase individual and corporate support. Through December 31, 2020, philanthropic support totaled $635,728.
Philanthropic gifts from Fellows support the newly established Barbara Bass Global Relief Fund, international scholarship travel awards, and fellowship research awards, as well as provide funding for the FTL100 Campaign.
Corporate grants secured by the ACS Foundation continue to provide support for the following:
- Skills Courses at Clinical Congress
- The annual Residents Surgical Skills Competition featuring eight teams from across the country
- Educational materials, both print and electronic, to educate patients and medical staff on proper pain management, wound care, and ostomy maintenance