Executive Director’s Update: Leading Quality Improvement in Trauma and Cancer for 100 Years

Patricia L. Turner, MD, MBA, FACS
The American College of Surgeons (ACS) was founded on the principle of “do what’s right for the patient.” That commitment to quality surgical care is reflected in the many initiatives that the College has introduced, particularly those emanating from the Commission on Cancer (CoC) and the Committee on Trauma (COT)—both of which are celebrating centennials this year.

The January issue of the Bulletin commemorated the evolution and contributions of the CoC, and this month’s cover story begins the COT’s celebration.

Over the past 100 years, the CoC and the COT have demonstrated unwavering dedication to providing safe, high-quality, and cost-effective patient care. Their efforts are tethered to a four-part framework—standards, infrastructure, rigorous data, and external verification—which, when implemented together, drive a continuous cycle of quality improvement (QI).

As surgeons and members of the ACS, we all can be proud of the extraordinary history and ongoing contributions of the CoC and COT, as well as the roles we all play to enhance patient safety, ensure equitable care, and advance surgical innovation.

As surgeons and members of the ACS, we all can be proud of the extraordinary history and ongoing contributions of the CoC and COT, as well as the roles we all play to enhance patient safety, ensure equitable care, and advance surgical innovation.

We are all an essential part of the healthcare team, and these groups, in place since nearly the beginning of our organization, continue to drive the transformations in care that have saved countless lives.

Committee on Trauma

After determining the need for an organized approach to care for injured patients, the ACS Board of Regents established the Committee on Fractures in 1922, which later evolved into the current COT.

In the early days, this prescient committee focused on standards for industrial, automobile, and traffic safety. In the modern day, the focus has extended to include finding practical solutions for challenges associated with firearm injury and violence.

The list of accomplished COT leaders, who redefine the term “visionary,” are too numerous to mention here, but I do want to highlight a few current ones:

  • Ronald M. Stewart, MD, FACS, outgoing Medical Director for the ACS Trauma Programs and Past-Chair of the COT, who led the College’s efforts to achieve consensus on firearm injury prevention strategies
  • Eileen M. Bulger, MD, FACS, outgoing COT Chair and incoming Medical Director of Trauma Programs, who renewed the COT’s focus on research activities, supporting the development of a research infrastructure within the Trauma Quality Improvement Program; she also established the Mentoring for Excellence in Trauma Surgery Program and the Future Trauma Leaders Program
  • Jeffrey D. Kerby, MD, PhD, FACS, the incoming COT Chair, who has worked to expand opportunities within the Mentoring for Excellence in Trauma Surgery Program and has brought rigor and depth to the selection process for the membership categories and awards programs such as the annual Scudder Oration

I look forward to attending the COT’s 100th anniversary meeting in Seattle, WA. The theme is “Looking to the Future through the Lens of Legacy,” which acknowledges the role the next generation of trauma surgeons will play in furthering the COT’s mission to develop programs and set standards that eliminate preventable death and disability across the continuum of care.

A commemorative book, also titled Looking to the Future through the Lens of Legacy, will be available soon, along with its concomitant interactive timeline. These publications provide a visual and contextual look back at the COT’s milestone achievements since 1922—and a look forward to trauma surgery’s next 100 years.

Commission on Cancer

Concurrent with our celebrations of the COT, we also are commemorating 100 years of high-quality cancer care.

In 1922, the ACS Board of Regents launched the Committee on the Treatment of Malignant Diseases (COTMD) to develop and implement cancer standards that would translate contemporary knowledge into practice and ensure optimal cancer care and outcomes.

The first six published standards required cancer clinics to define an organizational structure around cancer care:

  • Conferences and consultations with relevant professionals
  • Referral of all appropriate cancer patients to the clinics
  • Treatment of cancer patients by cancer clinic staff
  • Standardization of cancer treatment equipment
  • Record keeping (e.g., medical record documentation)
  • Periodic patient follow-up for up to 5 years

Over time, the COTMD became the Committee on Cancer (1939–1965) and now the Commission on Cancer (CoC) (1965–present), which has 38 standards that cover all aspects of cancer care.

Another significant milestone in CoC history includes establishment of the National Cancer Database (NCDB), which houses information on more than 40 million cancer cases. Accredited cancer programs are expected to follow evidence-based guidelines, conduct institutional-level QI initiatives, and monitor estimated performance rates for the NCDB quality measures and mitigate underperformance.

Patient-care standards, such as the CoC’s operative standards, are evidence-based to ensure that compliance leads to improved outcomes. During the COVID-19 pandemic, the CoC took a bold step and launched its first national plan-do-study-act (PDSA) return to cancer screening QI project and clinical study. The PDSA cycle is a systematic process for gaining valuable learning and knowledge for the continual improvement of a product, process, or service. In this instance, the methodology was used to ensure the safety of patients who missed screening during the pandemic.

Credit for the success and sustainability of the CoC belongs to many individuals, including the CoC program and committee leaders, committee members, accredited programs, cancer liaison physicians, registrars and administrators, state chairs, member organizations, and the ACS staff.

Forty-one individuals have led the CoC and the ACS Cancer Programs; they are spotlighted on the 100-year anniversary website.

In the next 100 years, the CoC will face new opportunities and challenges. For the near term, the CoC is positioned to launch more consistent and impactful QI efforts, especially now that the Rapid Cancer Reporting System is operational, making real-time data submission and reporting feasible.

The CoC also is poised to close the gap in standardizing medical documentation through point-of-care tools, which will allow for customized attention to the special needs of at-risk populations and address disparities in care. Heidi Nelson, MD, FACS, Medical Director, ACS Cancer Programs, and Timothy Mullett, MD, FACS, Chair, CoC, will lead the charge into the next century of improving care for cancer patients.

Setting the Standards

For the last century, the COT and the CoC have set the standards for improving patient care and have been the model for the development of other ACS other Quality Programs, including the ACS Quality Verification Program, as well as programs in pediatric, geriatric, breast, colon and rectal, and metabolic and bariatric surgery.

Lessons learned from the COT’s and CoC’s history and evolution enable us to more effectively “heal all with skill and trust.” Let us reflect on these accomplishments and celebrate the journey ahead.


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